Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

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Dr. Kelly Bradley was born and raised in the Valle Vista / Kingman, Arizona area. Her goal as a young child was to go to college and return home to help the community with all their oral health needs.  Grand Canyon University in Phoenix, Arizona was her undergraduate stepping stone where she obtained a B.S. Degree in Biology and a minor in Chemistry with Pre-Med Emphasis and graduated with Cum Laude Honors.

The journey to obtaining her Doctorate of Medicinal Dentistry (D.M.D.) took her to Portland, Oregon. Dr. Bradley graduated from Oregon Health & Science University in 2008, then returned home. Dr. Bradley opened her own practice in 2010, and has been serving the community since.  Dr. Bradley is married and has 2 sons, ages 8 and 11. She enjoys traveling with her family to race dirt bikes, attend a magnitude of dental CE, and seeing the country. 

http://www.familydentistrybydesign.com/

Howard: It is just a huge honor to be sitting in my house on a Saturday morning with Dr. Kelly Bradley and her husband Chip who drove three and a half hours today all the way from Kingman, Arizona. I really, really appreciate that. Kelly has been a role model, an idol of mine for a long time. She was born and raised in the Valley Vista, Kingman, Arizona area. Her goal as a young child was to go to college and return to help the community with all their oral health needs. Grand Canyon University in Phoenix, Arizona was her undergraduate stepping stone where she obtained a BS degree in Biology and a minor in Chemistry with pre-med emphasis and graduated with Cum Laud honors. The journey to obtaining her Doctorate of Medicine Dentistry, DMD, took her to Portland, Oregon. Dr. Bradley graduated from Oregon Health and Science University in 2008 then returned home. Dr. Bradley opened her own practice in 2010 and she has been serving the community since. She is married to Chip and has two sons, ages eight and eleven. She enjoys traveling with her family to race dirt bikes, attend a magnitude of dental CE and seeing the country. My gosh, she started as a dental assistant in a dental office where her mom worked at age thirteen and worked there until she was seventeen. So you've been a dentist for ten years, but you've been working chair-side for twenty-three. How cool is that? 

Kelly: Some days it's cool, some days it hurts.

Howard: One of the reasons I wanted to get you on this show so bad was so many, I don't think as a man I can talk about woman issues, but so many women in dental school think, “You know what? I don't know if I want to own my own business because I want to be a mom and maybe if I just go work for a big DSO, Monday through Friday, eight to five. Five o’clock I can check out and I can go be Mrs Mom.” What would you say to that? What do you think because you're heavily involved in your children? I've followed you on Facebook for a decade and what do you think's better to be a supermom? Being an employee somewhere else eight to five and not have to worry about the business or owning your own place?

Kelly: For me, owning my own place is definitely better because at times we'll take a week off or I might fly out on a Wednesday, come back Sunday or take off a Tuesday. I don't have anybody controlling how many days I can take off, what hours I work. If I'm not there enough then you have other associates that you can hire or specialists that you can hire to keep the ship running while you're out doing what you enjoy. I also can push super hard during three or four days a week and get more done than I could maybe if I was in an associateship position because I can really utilize my staff more effectively that way for me. I don't know, I prefer owning my own business at this point in my life. 

Howard: To me, all social animals are controlling because it's linked to your survival. You want to control your environment, you don't want to be eaten by hyenas and left behind and it just seems like if you want to control a bunch of people, like the military, you should want a bunch of kids eighteen to twenty-one. You're not going to control people our age, but it seems like by the time you go to eight years of college and be a dentist, a physician and a lawyer, it's like controlling cats and I just don't see anybody ... I mean all animals don't like to be controlled or under someone's thumb, but the highly educated I think are the least psychological profile to want to live under somebody's thumb and be controlled. 

Kelly: Well, as far as…

Howard: I think that's the word you used, you said controlled.

Kelly: Yeah, as far as efficiency…

Howard: You started it.

Kelly: I know that I can control myself or I can make myself more efficient than if somebody else is directing me or telling me what to do, but that's my personality. I'm a driven ... I see one goal and I want to get to the next. Whereas, if you're in an associateship position, which I did for two years I had more goals than my employer had at the time and he was just kind of sailing smoothly and I wanted to rock the boat. So I can rock the boat owning my own place, whereas you can't necessarily when you're in an associateship position. 

Howard: You take more CE than anybody I personally know. 

Kelly: I love taking CE. 

Howard: I mean how many hours do you think you take a year? 

Kelly: There's been years I've taken three hundred hours. This year I've cut back a lot because my boys are active in their racing venues, but …

Howard: It's hard for me to go to a bar and drink three hundred hours a year.

Kelly: Yeah, no you can do it.

Howard: I'm just kidding.

Kelly: Especially after an Endo lecture or something, but I enjoy traveling, which helps me meet other dentists that are kind of rock the boat type personalities. They're not just …

Howard: Absolutely…

Kelly: Smooth sailing, 

Howard: When I look back at all the institutes I went to, Pankey, Dawson, Kois, Spear, Misch, Ross, all the great ones. They were all great, but thirty years of looking back at that, the best one about all those institutes was the people you met.

Kelly: Exactly.

Howard: When people say you know I've just taken my FAGD, I'm like, well that's just because you want to be a [FAGD? 00:05:41], but when I would go to those AGD courses in Arizona for decades getting my FAGD, MAGD it was always the same dentists there and you might be at an Endo course and he's over here talking about implants and bone grafting and over here they're ... I mean your mind was just so stimulated. That's why I did this podcast because they're commuting an hour to work each way and the more food and energy and thoughts get in their brain. We've thrown a thousand podcasts out there. I'm sure at least one of them was good. One of them made an influence on their life. But when I see you posting and things seems your number one love besides Chip, is implants. 

Kelly: Definitely. 

Howard: Definitely. How did you fall in love with implants? 

Kelly: Kind of by accident, honestly. There's not really many specialists in Kingman. Everybody's general dentists. 

Howard: Okay so Kingman's fifty thousand people. How many dentists?

Kelly: Twenty-two right now.

Howard: Twenty-two dentists and how many specialists?

Kelly: There's one orthodontist.

Howard: One orthodontist in a town of fifty thousand.

Kelly: Yeah, well sorry, his son is there now too, so it's a father and son. 

Howard: So are they just crushing it? 

Kelly: Yeah.

Howard: And every orthodontic graduate will want to go to downtown LA, downtown Phoenix. "Oh, I’m going to go to Scottsdale."

Kelly: I've had to add up to hire dentists. It took me five years to get two specialists to come in so I hired a Periodontist and an Endodontist.

Howard: So is that Periodontist from your town?

Kelly: No.

Howard: He comes in from another town?

Kelly: Yes.

Howard: So what town's he live in?

Kelly: Havasu.

Howard: And that's about what, an hour?

Kelly: An hour, yeah a little over an hour.

Howard: An hour. I love Havasu. I love Parker too.

Kelly: And the same with the Endodontist, it's a husband and wife, but it took me five years.

Howard: The husband and wife, Endodontist?

Kelly: Yeah. Well, one's a Perio one's an Endo.

Howard: Yeah, I've invited them to come on the show. Tell them you made the drive, tell them they got to make the drive. But so they live in Parker, Havasu?

Kelly: Havasu.

Howard: So that's what a lot of these big implant franchises have done they'll go into a big town of Phoenix and all the local oral surgeon and the periodontist say no way. So they'll go to a town an hour and a half away like Tucson and say, "Hey, any of you Periodontists or oral surgeons, need some more work then come here?" So you got two specialists coming to see you, but back to Kingman, fifty thousand people, twenty-two dentists. One Orthodontist, what else? 

Kelly: They're father and son so there's two, I apologize.

Howard: One office. 

Kelly: And then there's one oral surgeon. So basically what I was seeing was all of my patients were complaining about having to travel outside of Kingman to get their work done, their specialty work. But I'm …

Howard: For what specialties?

Kelly: Mostly implants and they would come back and I would look at this and I would say this is not specialty work. I have to have angled abutments all the time. It was costing me $700 and the lab fee to one crown. It was a nightmare to restore the stuff. So I said, why don't I just start placing my own implants? Best decision I ever made.

Howard: And how many years ago was that because you've been in practice ten years?

Kelly: Well, I mean I started placing implants ten years ago.  

Howard: Right when you started?

Kelly: Yeah. 

Howard: Just right out the gate?

Kelly: Umm.

Howard: Okay, podcasters are young. They're not like me who's got, four grandchildren. All the dentists that I professionally drink with if I put a gun to their head and say download a podcast, I'd have to shoot all my friends. So it's a millennial thing and I would tell you send me an email at howard@dentaltown.com and tell me your age, where you live, what you like about the show, what you want to see. 25% are all in dental school and all the rest are under thirty and I get one old guy a week that says, "You know, dude, I'm as old as you." Like one a week.

Kelly: No, people don't like change and that's why you don't have the older generation. 

Howard: But what the kids are telling me is that in the United States all the implant training is tied to manufacturers. So they kind of almost feel like they have to pick an implant system before they start training. 

Kelly: This is true. So I started implants with Imtech 3M, which they're not even around anymore which makes me sad.

Howard: And that was the mini implant. 

Kelly: Mini implant, so that's where I starting.

Howard: And no one can tell me why that shut down. 

Kelly: It's a secret. 

Howard: It is a secret isn't it?

Kelly: I think that there was a merger. It's interesting that Park Dental almost every component is exactly the same as 3M Imtech's. The threads are a little bit different. The torque values are different, but... 

Howard: Was Park Dental the original Imtech? 

Kelly: I do not believe so, no. Park Dental's a New York company. 

Howard: It's a New York company. Can you send me the link to Park Dental? 

Kelly: But all the components are universal between the two.

Howard: So does it seem to you obviously this is just conjectural, but do you think 3M sold Imtech to Park Dental?

Kelly: Some type of merger I'm assuming, yes. 

Howard: Yeah.

Kelly: But yeah, nobody really says.

Howard: Remember this is dentistry uncensored.

Kelly: Yeah, nobody really says. 

Howard: Yeah, well it's bizarre. Okay, so you started with mini implants.

Kelly: Started with the mini implants. It was the most financially savvy decision I've made probably in dentistry, is all I had to do was buy an implant cassette and ten implants. I think it was a $2,000 investment. It was a weekend course, which then from there you had access to all their websites. All their cases that were posted online. So I scoured that website. I watched everybody's cases. You saw failures, you saw successes, everything. From there that really took off for me because most people in Kingman are low economic, lots of dentures, lots of lower dentures floating around and you can become a hero in two/three weeks placing mini implants and locking a denture down. So that's where my implants started. And then from there, I got more interested in patients that were only missing one tooth or a couple of teeth they wanted individually where they can floss between their teeth. Then I got into conventionals. 

Howard: So really the only thing different between a mini and a conventional is diameter?

Kelly: The size, yep.

Howard: I mean a mini is considered…

Kelly: Anything less than three millimeters.

Howard: Three millimeters or less? Is it two point nine or less or is a three-point O a mini?

Kelly: I think it's two point nine or less.

Howard: See I got her, I got her. That's the only thing I know more about implants than Kelly was that. So you started with mini, so it's Park Dental Research?

Chip: Yeah.

Howard: So would you recommend that people do minis, go to Park Dental Research? The reason I ask is because on Dentaltown dentists they can be a piece of work.

Kelly: Oh, yeah. Everybody's against minis, which…

Howard: So under dental implants, we had to switch mini implants and conventional's and we also had this on cad cam separate the Sirona CEREC from E4D because the Sirona people are…

Kelly: Name brand.

Howard: You know anybody posts, "Well, you shouldn't have used E-force." It's like "Shut the hell up. You're an idiot." And most everybody posting anti E4D stuff is on the payroll of Sirona. They lecture for them. They're speakers at their Sirona meetings. 

Kelly: And they probably drive Chevy's, not Ford's.

Howard: I wish when they lectured they had to be like Nasdaq and have all the badges of all the people paying all their bills. But so it's so damn emotional. Because the one thing that makes sense for me on mini is I would imagine an implant on you would be a different size than on Charles Barkley. 

Kelly: Absolutely. So my patients... 

Howard: I mean aren't apes and monkeys variance in size? 

Kelly: Right. My patients, most of them haven't had teeth for twenty/thirty years. They've been wearing a denture. Now how are you going to take that bone that hasn't been stimulated for twenty/thirty years and get a three to five, six-millimeter implant diameter in there? You're not. There's not enough bone. 

Howard: So that's the Park Dental.

Kelly: Yes. 

Howard: So would you recommend they start with that because now some implant systems have small diameters?

Kelly: They do, I believe. 

Howard: Do do you still use Park Dental mini implants?

Kelly: Umm.

Howard: So you still recommend them? 

Kelly: Well, absolutely. From a cost standpoint, you can get an implant with the housing for I believe it's $79, under $100, versus you go with the conventional sized implant. I mean you're going to be at least one forty, one fifty and I mean I'm being very generous with the conventional's because most of them, I like Camlog, that's my preferred implant system.

Howard: What is your preferred implant system?

Kelly: Camlog.

Howard: Camelot? 

Kelly: Camlog.

Howard: Camlog. C A M L O G.

Kelly: Correct. 

Howard: One word? 

Kelly: Correct. Yeah, so chip handles the 3D printing aspect so our guides are 3D printed. Why I like Camlog because you don't have to have keys. So I can get to eighteen and thirty-one and limited vertical dimension and I can fit. I mean you can get eleven millimeter [inaudible 00:15:20] 

Howard: Okay, but a lot of my homies doesn't know what you meant by that. What do you mean doesn’t have keys?

Kelly: Okay, so a key is like a device that you put into your guide or you use to place the implant. It's a separate little tool that you have to fit the drill through. Whereas, Camlog each drill is unique to that diameter and length of implant that you chose. 

Howard: So are you going to go to Camlog's …

Kelly: Symposium?

Howard: Symposium. 

Kelly: In the Netherlands.

Howard: Conveniently located.

Kelly: In two weeks or something? I would love to, but I'm already busy 

Howard: It's in Rotterdam. 

Kelly: Yep.

Howard: What country is Rotterdam in?

Kelly: I wish I could be there. It's Netherlands, right, part of the Netherlands.

Howard: Is Rotterdam in the Netherlands, Ryan? Ryan, you should know that. You went to college for four years.

Ryan: Rotterdam is a city in the Netherlands. It's a major city in the Dutch province of South Holland.

Howard: And they pronounce it the Nederlands. And you know what it means? Lowlands. And you know how everybody in America thinks America's the greatest country on earth. 

Kelly: That's sad.

Howard: And everybody who says that has never left Kansas or Nebraska or Texas. When you go to what I consider the greatest civilization on earth is Scandinavia, Denmark, Sweden, Norway. If you think Oklahoma and Kansas are better than Denmark, Sweden, or you just never been there, but back to the Louisiana dikes that broke and flooded. When you go to Louisiana in the country that landed on the moon it's a dirt bike and then when you go to the Nederlands they've been growing their country by building these seamount wall dikes. And they'll build the walls out, drain the water, fill it up with dirt and their cities been growing that way. Their dike system looks like it was made by Star Wars. And then you come to Louisiana you thought "Really that hill, that dirt hill broke. Well, how did the dirty hill break? And my God, the Netherlands, the Nederlands they're just crazy sophisticated. 

Kelly: Well, that's one thing I recommend to people that are just getting out of school or still in dental school is don't look for classes necessarily in our country because our country limits what we can do. So if you go out of the country you can have a dental license, a business license, everything within like two/three days. Your hands aren't tied by all the red tape and you can do procedures that you could only dream of doing here. So I went to the Dominican Republic and this course I chose because they were not tied to a specific implant brand. So most of the implant training that you go to, you're correct, it's tied to a specific implant system. Implant seminars, Dr. Garg is the main mentor I have there, they don't tie themselves to a specific implant brand. So you could learn multiple different systems going through one seminar series and you work in the Dominican Republic where you walk into the clinic and there's a hundred/two hundred people lined up at the door that will let you do whatever you want.

Howard: Okay, you know we got that approved for Arizona right?

Kelly: Oh really.

Howard: Didn't you hear about that?

Kelly: No.

Howard: Well, first of all, I got to interrupt one thing, so I went to the Camlog and interesting when I hit the Twitter link it goes to Henry Schein Dental Surgical Institution.

Kelly: They've just been bought, yep.

Howard: And it says, "We're pleased to announce that Bio Horizons will become the exclusive distributor of Camlog Brad and Price, United States, and Canada affect June 27. And that Henry Schein Dental has Bio Horizons …

Kelly: So Henry Schein has recently purchased all those companies.

Howard: Recently purchased or exclusive distribution?

Kelly: As far as distributing believe, yeah.

Howard: Okay, they're exclusive distributors.

Kelly: I believe, yes.

Howard: Okay, interesting.

Kelly: Yes, that's been …

Howard: And Bio Horizon that's a really interesting company. So Camlog's out of the Nederlands because a Bio Horizon's I went there one time they're northern Alabama. That's where they made all the booster rockets for the space shuttle. Well, they got four seasons, but it's miles, it's really beautiful. I think Arkansas and Alabama and the Carolina's are the least talked about prettiest places in America. My God, Charlotte, North Carolina, the forest you get all the four seasons, but you don't get brutal seasons. Arkansas, my sister lives in Faith, Arkansas. Oh, my God, that's just ... and Alabama, but anyway and then all of a sudden you're in this area where it's one of the most high-tech havens and America. But, so you were talking about, go back to what you just said last. I interrupted you on the Bio Horizon's thing.

Chip: He said they're in Arizona just to prove the…

Howard: Oh yeah, Arizona. So basically, women dentists …

Ryan: Germany.

Howard: It's Germany. What city?

Ryan: [inaudible 00:20:33]

Howard: Okay. I'm mad at Germany because last time I went there and found out that the hamburger was not invented in Hamburg.

Ryan: Moonshine, near Stuttgart.

Howard: And the hot dog was not invented in Frankfurt. I don't believe the Germans. I think they're lying. I'm still going to tell my grandchildren it was me. Oh and I'm seeing two original museums. I went to the museum where cologne was invented in Cologne, Germany and I went to the museum in Paris where perfume was invented. And both places I told them, I said, and in America, I've lectured six times in the city that had a museum or ice cream was invented. So talking about fake news, we need to talk about fake museums. How could six different cities have a museum for the invention of ice cream?

Kelly: Because it's a business and people still go there.

Howard: So anyway there's homeless shelters and so there's a homeless shelter in Arizona just for vets. So women dentists said, "Well, I don't feel safe going into Mexico and Dominican Republican and I want a hands-on deal." So they have to go their hands in their state because they're only licensed their state. So Chris Walczak, who born and raised in globe, been a dentist in a homeless shelter for thirty years, went down to the board and said, "Do you have a problem with licensed dentists in America coming to the homeless shelter and placing free implants on vets?" How could you say no to that?

Kelly: Right.

Howard: So he got the deal. So now you could have a hands-on course or Arun Garg You should tell Arun you should do it so that any licensed dentists in good standing in the United States can come to Arizona. So once that was done and we talked about it on the podcast …

Kelly: So you don't have to have an Arizona license?

Howard: Umm and once we started talking about some other dentists I forgot where it was, but it was somewhere in New Jersey he did the same thing in his deal. And I'm trying to get, he shouldn't have to go to another country to work on the poor in America. Tennessee was the first state where the dentist went to the DO and said, "Okay we cleaned grandma's teeth and when she comes back in six months one of the top five reasons she didn't come back is because she died of the flu and we're not allowed to give a flu shot, but you can go to Walgreens and a pharmacy tech with nine months of training give a flu shot, but a dentist can't.

Kelly: Right.

Howard: So Tennessee was the first state that said, "Yeah, you're right, that's crazy." And I want to get that and also the HPV. This flu season was brutal about eight thousand to thirty-eight thousand die of the flu each year. And the last time it was closer to thirty-eight thousand was 2009 and the CDC's saying it could be close to that one again. And so it's pretty sad that you died of the flu in Arizona and the last time you went to the dentist you got your teeth cleaned, they check you for gingivitis instead of checking Grandpa if he got a flu shot and then oral cancer pretty much is oropharyngeal HPV and we're not allowed to give the HPV shot and I guess you got to give the vaccine Gaudia, is that what it's called? Gardasil. I guess you've got to get it into them before they've been exposed to it, I guess or something like that. You've got to get them under ten or twelve. 

Kelly: Before they're inoculated with the virus because the virus lives in the [gingland? 00:23:45] and once you have it, you have it. 

Howard: Yeah, so we're really not doctors if you can't give a flu shot and a HPV shot. 

Kelly: Well, it's the same with Botox and dermal fillers. So in Arizona, you can't administer Botox or dermal fillers unless you have a dental license. So the hygienists can anesthetize you and paralyze your jaw with anesthesia, which is rare, but they can't use Botox or dermal fillers.

Howard: So if you ever know somebody from out of state you should go to these veteran's [inaudible 00:24:13]  and you should get that because I think it's pretty sad that American dentists have to pay thousands of dollars to go to other countries and not feel safe. I don't feel safe in Mexico. I quit going to Mexico. I used to go with my best dental friend from [inaudible 00:24:24] me and Craig [Cykman? 00:24:24] go down there and we'd go to Cabo and we'd go deep sea fishing. And the last time we went deep sea fishing, walking back from the boat to the [DO? 00:24:39], the police pull up behind us so we just figured they were look... so we just stepped to the side. They were looking for us and then they frisked me. Took my wallet, took all my cash out, threw my wallet on the ground and jumped in a police car and drove off. And then I went back I told them the manager of the resort, he started crying. He said they're ruining our business because I have so many regulars like you who just aren't coming back because of the damn police. And it's just crazy. So if that's two grandpa fisherman males, imagine a young woman who wanted to go to that course alone. 

Kelly: Well you have bodyguards the whole time, but you don't know if the bodyguard's safe. 

Howard: Yeah, when I was in Tanzania I wanted to go to the garment district that's the coolest thing and the hotel said no, you're absolutely not going to the garment district. That's so damn dangerous. And I was with four dentists there, said, "We got to see it. This is the coolest town." They go, "No way." So I said I'm a little more street smart so I just started walking down the street and I walked into this restaurant and there was just this huge man. He was the biggest man in the restaurant and he was probably about thirty. He just looked like the most badass son of a bitch in the world. And I went up to him I pulled out a Benjamin I said, "If I give you this, would I be safe? Could you walk me through the garment district?" And he said, "Absolutely." And so I just walked through with this guy. I looked like I mean I think that my head came up to his belly button. But people look at me then they look at him and they just very on their way. So I took a whole tour of the garment district with this three hundred pound man that could probably throw me up onto the roof. So you recommend Irwin Garg?

Kelly: Yeah, I had a very good experience. I was sitting …

Howard: Is he your top choice?

Kelly: I really liked my Camlog course as well. Implant Direct also has some good courses, but I'm not a huge Implant Direct fan. 

Howard: And why is that? 

Kelly: I just don't like the components as well. The tissue doesn't seem to heal as well. I liked a machined collar up at top if they don't have good hygiene. 

Howard: Who's the founder of Implant Direct? Gerry Niznick. 

Kelly: Yes.

Howard: We had him on the show. Oh, my God, he started what, three implant companies? 

Kelly: Something like that, yeah. 

Howard: Yeah, unbelievable.

Kelly: But it's just whatever you like in your hands. It doesn't matter. An implant is going to do what an implant's going to do. It's just what you prefer. It's like, do you like Ford or Chevy? Are they both going to get you from point A to point B? Yes.

Howard: A Chevy will?

Chip: [inaudible 00:27:16]

Howard: Really. Has she been drinking?

Chip: Yeah.

Kelly: The same with implants. It's just whatever you like, but you have to watch the economics because you can eat yourself alive and you're just spinning your will if you don't watch the economics of how much some of the implants cost. 

Howard: So is Camlog a lower price implant?

Kelly: No Camlog is a high priced implant. 

Chip: Well, you feel like your failure rates …

Kelly: My failure rate's way less. I've done pretty good studies and …

Howard: And what do you think causes failures? When something fails is it a surprise? Is it like, "Wow, I can't believe my implant on the yoga instructor eating tofu failed, versus, oh yeah, he's a freaking chain-smoking alcoholic." Is it like that?  

Kelly: 98% of them there's chew all around the threads the whole time.

Howard: Chew?

Kelly:  eah, like tobacco. They snort five packs a day. 

Howard: Really if it's implants, really? This is news. You're the first on dentistry uncensored 

Kelly: Or congenitally missing teeth that kind of surprised me. There's not good blood supply to that bone. I mean a tooth didn't form there for a reason. How come? There's no [su sack? 00:28:18]. Well, there's no blood supply either, so …

Howard: So congenitally missing teeth?

Kelly: Yeah, that …

Howard: And the smoking. The problem when you say chewing tobacco and smokers, do you think alcoholism hurts it?

Kelly: Absolutely. 

Howard: I don't know if I'm jaded, but around here, the yoga instructor never loses a tooth. The personal trainer lady doesn't have any gingivitis.

Kelly: Correct, so that's why …

Howard: Everybody that needs me the most has issues with tobacco and alcohol. 

Kelly: Right, so why are you placing an implant? Because they didn't take care of themselves, because they didn't take care of their teeth. So you're putting a titanium man-made object into a body that they already killed their own body essentially. You know what I mean? Now you …

29.10 Howard: Because I think the two Gods of lightning and thunder fighting would actually be the late Carl Misch and his brother Craig. Two of the most genius implantologists that I know of, I mean amazing. Carl would put them in smoking, drinking alcoholics because he said they need a doctor too. Craig's said I won't do it. 

Kelly: I put them in anybody, anybody that I have enough bone to put it. That's why I like mini's because I've gotten a lot of implant patients from people that have been told there's no hope for them. You can't have implants, we can't do it. You don't have enough bone and …

Chip: She'll do it every time. 

Kelly: I love to do it.

Chip: She don't turn it away.

Kelly: And knock on wood, I've not had one, yeah, I have not had one mini implant fail and those patients they go from the floating, horrible lower denture to a beautiful locked-in denture.  

Howard: Well and one of the reasons mini implants hardly fails is because if you did a histology examination, cross section the histologists say, “well it failed. It didn't integrate.” But this bone is so wood …

Kelly: Solid.

Howard: That it completely failed mini implant down here in this and this wood bone can …

Kelly: It's still there.

Howard: Still work for a long time, but when you start getting into posterior mandible, it goes from Oakwood to Bolsa and then the upper [friends? 00:30:29] were like Styrofoam.

Kelly: But you have to …

Howard: And then the sinuses pretty much …

Kelly: Well [we're 00:30:33] 98% of my mini implants in the lower anterior mandible.

Howard: Right. Well even if they fail, grandma still loves him.

Kelly: Yep, I've seen very, very few fail. Very, very few and most of them were placed maybe thirteen, not placed by me, they were placed thirteen, twenty years ago and they broke. 

Howard: So you recommend that they get the Park Dental mini implant. 

Kelly: Yeah, but like I said do whatever you want. What works in your hands and what you enjoy.

Howard: Yeah, but it's confusing. At the last ADA meeting, I think there was a hundred and fifty different implant vendors. Italy alone has two hundred different implant companies. And whenever you see a cluster like that, what is a tennis racket made out of what's that called that material? Fiberglass. For some reason, Taiwan got into fiberglass and almost everything in fiberglass is made in Taiwan. So Italy had a very robust titanium industry so it was very, very easy for any dentist, periodontist, or oral surgeon to go to some vendor and say make me one. So they have two hundred different companies, so one of the problems these girls have is they say, "Come on man you've been doing it ten years. I just got out of dental kindergarten. I don't want to go evaluate a hundred and fifty different systems. What do you use?"

Kelly: Well, and I would say pick what you like and stick with it. Don't even change like connection types because now you have so many parts and pieces. I know what it all means, but when you have staff turnover, so Camlog has cone log so now I need a Camlog abutment. They give me a cone log abutment. They don't fit, the connection doesn't go. So pick one system and stick with it. There's lots of places that are like, well we place five different types of implants and [inaudible 00:32:29]. You go to restore, that's a nightmare.

Howard: And what is your average implant case. Is it a single tooth replacement? Is it two implants and an overdenture? Is it an All on 4?  

Kelly: Most of our cases we're doing multiple implants in one patient. 

Howard: Multiple singles for single missing teeth. 

Chip: Yeah, a lot of singles lately, yes.

Kelly: Yeah.

Howard: If a lady comes in and has canine to canine, no first bi to first bi and she wants them in the back. Would you do two implants and a three and a bridge or would you do three implants and three singles? 

Kelly: It's so dependent on their cash-flow, on how much they want to invest. If it was my choice I'd do all single units so that they can floss and clean around them. But also there's usually an issue with bone or spacing almost always. So there's a nerve in the way or we don't have enough bone to put three singles or you don't have enough bone in between each implant. So often times ...  

Howard: So are you evaluating this on a CBCT? 

Kelly: Yes.

Howard: Because I thought you were Wonder Woman who had X-ray vision.

Kelly: Well, I …

Chip: It used to be that way.

Kelly: It used to be that way.  I'm not Wonder Woman anymore. Now I have a company, but …

Howard: So what cone beam did you go with?

Kelly: The instrumentarium OP300.

Howard: And how much that cost? Can you send me instrumentarium?

Kelly: About a hundred thousand.

Chip: A little over, yeah like a hundred and seven, a hundred and ten. 

Kelly: It's like a hundred and seven thousand, yeah.

Howard: What was the numbers on it? Instrumentarium...?

Kelly: OP300.

Chip: OP300 Maxio.

Howard: O ...?

Kelly: OP …

Howard: OP ...?

Kelly: 300.

Howard: 300 ...?

Kelly: Maxio.

Howard: Maxio.

Kelly: That just gives you the largest field of view.

Howard: OP or OB1 Kenobi?

Kelly: Just OP.

Howard: C3PO?  

Kelly: OPP, you know me.

Howard: OP. What's the song that you say?

Kelly: Is it OPP, you know me. 

Howard: What is that song? 

Kelly: I have no idea.

Howard: Oh my God, I actually have that on my playlist. What is that song, Ryan OPP? Naughty by Nature. OPP.

Kelly: Yeah, it's a good tune, yeah. 

Howard: That is an awesome workout tune, but anyway so they set you back a hundred?

Kelly: It's one O seven.

Chip: Yeah.

Howard: One O seven and buyer's remorse, glad you bought it?

Kelly: Glad we bought it yeah, for sure. We use it for more than just implants. Lots of sinus infections, implants, failed implants. Or excuse me, not failed implants, Endo, should we do Endo, should we just pull it. Grafted …

Howard: Ryan, shoot me an email to me and Jason Howes. Put in just J, he's been on the show. I think he's email search is JH, but we need to get that rhinologist on the phone. There's more and more rhinologists every day across the country where someone always goes through their whole life thinking they have allergies and then they finally get to a rhinologist and they scope up there and there's a chronic failing molar Endo into the sinus and there's white fungus and he's shown pictures of this stuff. 

Kelly: All the time.

Howard: It's just crazy. And really intelligent protocols should be on every chart they say, do you have sinus problems? And then if they say yes, the next question is, do you have any upper root canals on your second bicuspid, first or second molar? And the nerve of the tooth is gone and she doesn't know it and for twenty years it's just leaking crap into the sinus and what's funny is when you go to a sinus lift, the dentist, it's kind of a religion. So we go to the Church of Odontology so enamel and dentin are sacred and screw the sinus. We'll do a sinus lift pack it with cow bone, paper clips, BNP, who gives a shit. It's just a sinus. Then you go to the rhinologists and they're like the sinus is sacred and I had one kind of almost chew me out at the gym saying, "What's wrong with you guys? What's wrong with you? What is this sinus lift bullshit." And then they're telling me what they're seeing and I said, well looks like we have a communication problem and we need to get you on the show and you guys need to build us some online CE course and show us what's going on because it's pretty sad to think that Mr. Jones was eating, what's that common antihistamine that they all use?

Kelly: Claritin.

Howard: Claritin and she's been on Claritin for twenty years thinking that everything's blooming and she has chronic failing so …

Kelly: Well, in that respect though, so I'll take a CT. We'll send it with the patient and say, "Hey, you don't have a tooth problem. You have a sinus problem." They'll go to their ENT and guess what the ENT says?

Howard: What?

Kelly: This is from a dentist they don't know what they're talking about.  All the time I get that. So …

Howard: And do they have a 3D X-ray of it?

Kelly: Well, not yet, but now they go send him for another one that costs a patient instead of my couple hundred dollars CT, now it's a couple thousand dollars. They get a different one and then they're like, "Oh yeah, you do have a sinus problem. How did your dentists know that?" Well, I sent you a disc of it, but they won't even look at it because it came from a dentist. 

Howard: I'm so proud of my dentists, the vets, and the chiropractors compared to the physicians. I mean in every measurement. You go to every physician's website, they don't even have an email contact. They don't even any of the kind of. It looks like a six-year-old made the website. You go to a physician's office they all still have the glass walls, they slide it over and some dysfunctional woman hands you a chart without making eye contact. They're not on social media, they're not available. They're just …

Kelly: They're one step above the rest of us so they don't have to direct.

Howard: In their own mind.

Kelly: Yes.

Howard: It's amazing how they think they're all that and a bag of chips when the Centers for Disease Control says two hundred thousand Americans die in their system every year. I believe 9/11 was what, thirty-two hundred?

Kelly: Yeah, about that. 

Howard: About thirty-two hundred, but the MD's killed about two hundred thousand people a year and what it is, it's this culture where news doesn't want to talk about it because it's all St Francis Hospital. They're just given this pass because everybody just thinks they're trying real hard and you go to Intel and you want to go see where the chips are made for this phone. You take off all your clothes, you take a shower, you go to the next room you put on this [duo? 00:38:52]. The air is filtered to less than one part per billion and none of their chips fail. Then you go across the street to [Chanra? 00:39:01] Hospital and the surgeon and the nurses all show up in Nike tennis shoes walk-through bird shit, water, leaves, dirt the lawn and then go up there and for some religious reason, wash their hands for like fifteen minutes like some of priest with incense and frankincense and myrrh and then flays open grandma in a room just filled with infection and then two hundred thousand Americans die of iatrogenic infections and they don't even look in the mirror and realize.

Kelly: Mercer. 

Howard: That they're ... the number one killer in America is heart disease, number two is cancer, and number three is MD's. And they think they're our saviors and they're our killers and then grandma passes out in the [safeway? 00:39:43] and the ambulance shows up and they're on thirty-six hundred different software systems. The ambulance doesn't know that Jimmy Garcia is an insulin dependent diabetic. You don't know what meds they're on. The MD's …

Kelly: They take the car accident to one hospital, the car goes to a whole other city we just had that yesterday, yeah it's absolutely insane.

Howard: The MD's they're almost as pathetic as Congress in the media. 

Kelly: It's scary.

Howard: They're like a three-way tie for dumb and dumber. Or what is the three stooges? Moe, Curly and ... 

Kelly: We don't trust our kids or ourselves to go to most doctors. We just do it our self.

Howard: Yeah.

Kelly: I mean it's kind of like building a house or anything. You have to do it yourself.

Howard: Well what's funny is, it's a historical debt. When you go back through the literature the early hospitals were called sanitariums and all the intelligent people wouldn't go there because you would go in there and they'd amputate a gangrene foot then turn around and deliver your baby and then you die of gangrene and all the smart people were like we just have our babies at home. We don't have this problem. And you go back every hundred years back the smartest people never went to the witch doctor. They never went to sanitariums. And now when a dentist goes to the physician he says, "Hey, you got high blood pressure and I want you to take this pill and you have high cholesterol I want you to take this pill." Dentists are ,[nah? 00:41:05] I'm not buying into your pillow system. I finally need to get off my ass, change my diet, join a gym, start jogging every morning. I'm not going to get into your polypharmacy. By the time you're on five prescription pills, you're just basically falling apart. Yeah, so implants, what are you restoring with? Are you cad camming single units. You take them …

Kelly: No, I'm not a big ... as you know I barely turn on the computer, I'm not a big software junkie per say. Traditional take a PVS impression and send it to the lab. 

Howard: PVS, poly, vinyl siloxane. What you using?

Kelly: Umm. I think it's Take One.

Howard: Take One? Who makes that?

Kelly: Probably 3M.

Howard: Now see I use 3M poly, ether.

Kelly: No you don't.

Howard: Impregum.

Kelly: For reals?

Howard: Oh yeah.

Kelly: Oh yeah, yeah, I know what you're saying, yeah.

Howard: And you know it's funny …

Kelly: That's just in the big machines.

Howard: It's funny 3M dental was here, which was so cool. He sold last year one point one billion, but they want me to replace my $17 impregum impression that's never failed for thirty …

Kelly: With your $150, 000 CEREC.

Howard: With a $17,000, what is 3M's oral scanner? What it is?

Kelly: I know what you're saying.

Ryan: True Definition.

Howard: True Definition and then go from being able to send it to any lab on earth to just a few labs and then the contract to [inaudible 00:42:34] for the software, maintenance is two hundred a month. She only needs $200 of impregum. What would $200 …

Kelly: It's a lot of freaking impregum.

Howard: So $200 divided by $17 is twelve impressions so you're not scanning your impressions either?

Kelly: Uhmm.

Howard: And these dentists they always whine they come out of school $350,000 in student loans. First thing they do is buy a hundred $150,000 CEREC machine instead of a $17 impregum impression. And then they buy a $100,000 laser so I want to ask you about that. Millennium, [le nap? 00:43:16] the research is pretty consistent on the American Academy of Periodontology website that at five years, 20% of the implants have peri implantitis And at nine years it's between forty and 60% depending on which study you …

Kelly: Absolutely. Who do you put implants into what patients? Perio patients ...

Howard: Irish because Irish you're drinking whiskey, smoking and drinking and the Russians vodka, smoking, and drinking.

Kelly: 60% of the time from Perio so absolutely I agree with that. 

Howard: So what is your protocol to treat perio-[implant? 00:43:53] Are you using a laser?

Kelly: Yeah, we have some lasers.

Howard: Which laser?

Kelly: Iolase.

Ryan: Ryan, could you send me iolase.

Kelly: Which is made by Biolase and I want to say that iolase's are under five grand, soft tissue laser. 

Howard: Is it [inaudible 00:44:14]

Kelly: And the other one is Epic.

Howard: Is it an [inaudible 00:44:16] laser?

Kelly: I think so yeah.

Howard: Okay, and the other one is what?

Kelly: Epic, which is also made by Biolase, which is probably right about five grand as well, but I use those to uncover after the implant was placed as well if it didn't have a …

Howard: But you laze around peri-implantitis. 

Kelly: Umm.

Howard: Well, the people who use [le nap? 00:44:33] by a hundred and thirty, the lasers between seventy thousand and a hundred and thirty-five thousand depending on how much training you get with it. 

Kelly: It's crazy to me. I think you can get the same results. 

Howard: So you think a lasers a laser, a laser, laser.

Kelly: Well, a wavelength and continuous pulse or yeah it's the same. You program it how you want it. 

Howard: On the Iolase or the Epic?

Kelly: The epic you can have personal settings. 

Howard: Does Biolase …

Kelly: But they come pre-programmed.

Howard: Does Biolase say that the Iolase and the Epic is used for peri-implantitis? Do they make that claim? 

Kelly: I would imagine they do, yeah.

Howard: So instrumentarium okay, that's your CBCT and that's by Cavo, which is owned by Danaher, which is now the largest dental company in the world if you're at Chicago [inaudible 00:45:27] here they are. I just retweeted there, my homies follow me on Twitter because they're driving right now. 

Kelly: Which they need to work on their reliability of that instrumentarium. We've had some issues with ... 

Howard: With the CBCT?

Kelly: Yeah.

Chip: Yeah.

Kelly: But it's mostly …

Howard: What kind of issues have you had?

Kelly: Like computer components essentially.

Chip: Yeah.

Howard: Okay so they're saying the Iolase is the first personal laser that packs power and portability into a tiny deal. Use Biolase patented line of non-irritated, non-initiated, non [inaudible 00:45:59], faster clinical results. They're selling a personal laser versatility, clinically convenient, power that lasts, affordable. Wavelink nine hundred and forty nanometers, pulse modes, but I don't see any claims for ... but is it your go to protocol for peri-implantitis? 

Kelly: Yep, use the laser, yeah. Th Epic I prefer it's a little more powerful. The Epic has more pre-controlled where you can pick implant recovery or a Perio setting or frenectomies. It's really good for frenectomies. 

Howard: Okay, sorry to ask this personal question, but at least your husband's here. It's very controversial a lot of mothers have... you've had two children. May I ask if you nursed the children?

Kelly: Both of them.

Howard: Both of them. Now that when you have a baby in there, a trainer comes in and tries to give you an hour or a CE about nursing and a lot of those people are seeing these tongue-tied.

Kelly: Yeah, frenums too tight and they won't latch.

Howard: And they're saying you need to go lase that, but that's a controversy deal. Some people are saying, "Well, how come we've been nursing for two million years and grew from a couple thousand to seven and a half billion and all of a sudden everyone's ... " Do you think that's overkill? Do you see that's place? Have you ever …

Kelly: I think people are lazier now.

Howard: Have you ever lazed a child's tongue so he can nurse better?

Kelly: No, not for nursing more first speech pathology. When they get to that age where they're not enunciating their syllables, then it's like, oh yeah, they're tongue-tied. Their speech isn't good, but a lot of its laziness honestly.

Howard: So do you do more frenectomies or more tongue ties.

Kelly: Frenectomies.

Howard: Frenectomies? 

Kelly: Umm.

Howard: And why are you doing most of these frenectomies?

Kelly: Diastemas, between eight and nine or …

Howard: Diastemas or diastemas? Depends on what part of the country.

Kelly: Tomato or tomato.

Howard:    It's barbiturates here and then in New York it's barbiturates. 

Kelly: Barbiturates, yeah or a lower anterior recession like after ortho you're advancing the teeth to the facial, so then you got that frenum pulling. Then you got recession. Recession a lot on the lower.

Howard: So this peri-implantitis, what is your failure rate at implants at five years? What is it at nine years? 

Kelly: Geesh, at five years I don't have those statistics exactly, but …

Howard: What would you guess?

Kelly: 75%.

Howard: Failure rate?

Kelly: No success. 

Howard: So 25% implant failure rate?

Kelly: 25% and five years I would say, yeah. And I place them in people that most people would not place. I'm the opposite end of the spectrum where they're like …

Chip: No ways close to that.

Kelly: You don't think that? 

Chip: No.

Kelly: I don't know I'm totally making it up. 

Howard: So what do you think it is?

Chip: There's very few. I mean I don't know. It's not that.

Kelly: But after five years?

Chip: Yeah, after five years.

Kelly: Unfortunately after five years half of them are dead or we never see them again. 

Chip: No.

Kelly: That's the truth behind it. We don't have very many fillings.

Howard: You know I've seen it both ways. People, sometimes they do change. I had a patient where he never took care of himself, we did a bunch of dentistry and he turned a new leaf. And then one of my biggest failure rates, my biggest failure rate for the last thirty years I didn't even know what was causing it. I wasn't aware of meth mouth fifteen years ago. It's very isolated. Out here …

Kelly: Well we have soda mouth, same as meth mouth.

Howard: And is it Mountain Dew mouth or is it soda?

Kelly: Any soda or Gatorade, Powerade does the same thing, just takes longer, but it's all acidic. All the sugar-free drinks that are supposedly healthy are not healthy. Monster Energy, Rockstar. 

Howard: My friends in Bakersfield told me that for some reason meth took over Bakersfield ten years ago.

Kelly:  Umm, same as Kingman. Kingman's considered meth capital country I think.  

Howard: What are some signs? My dead giveaway is stimulants like caffeine, nicotine amphetamine, workout through your skin so they always have sores. Some things work out through your skin, some kidneys, some liver, some, but if you think they're scratching, I mean they just have a certain look, but with that look it's removable. The first case I ever did this poor kid come in and his dad paid for it all and I basically root canaled and crowned like almost all of his teeth. And it just looked gorgeous and we cleaned them and he's all so happy and everything.

Kelly: For about two years.

Howard: And he relapsed and the next time I saw him, it wasn't recurrent decay, it was just mush. I mean it was just mush. It was hard to extract the teeth and it was the biggest waste of money.

Kelly: Because you're [inaudible 00:51:13]

Howard: And you know who that patient was? That was Ryan. Oh no, that was another Ryan. So that's cool. So we've been talking about implants, what other things do you do and what things do you not do? Do you do molar Endo, do you do Invisalign? What are your do's and don'ts? 

Kelly: I don't enjoy Endo that's why I have an Endodontist  come in and do it for me.

Howard: And how many days a week?

Kelly: He's at one day a week.

Howard: So when someone comes in with a toothache you just give them antibiotics, pain meds until he's in or what?

Kelly: For the most part or sometimes I'll access open it. It depends on the severity. 

Howard: It just doesn't seem that you would love implants.

Kelly: And not like Endo.

Howard: And not Endo. It seems to me you're either blood and guts and love pulling teeth, placing implants and Endo ... 

Kelly: Most of the time the teeth are too far gone so we have meth mouth, we have soda mouth so the [carries? 00:52:05]] is so subgingival. I'm going to do crown lengthening, Endo buildup, crown post, what's that going to cost? Twenty-five hundred bucks. What's going to happen? Two years from now it's going to be rotted out and I'm going to have mush. Pull it, do an implant. They'll have it the rest of their life. 

Howard: Yeah, so you don't do Endo?

Kelly: I don't enjoy doing Endo, very rarely.

Howard: No Endo and the endodontist comes in once a week. Are you allowed to say you pay, is what percent or is …

Kelly: 50% of …

Howard: You split it fifty/fifty.

Kelly: Yep and there's no other Endodontist in the town, so all the other offices refer to him and ... 

Howard: In your office?

Kelly: Umm.

Howard: That's high self-esteem to send your patient to another general dentist that has an Endodontist. Now to do a lot of them stay with you afterwards? 

Kelly: No, I'd say we work really hard to keep them going back to their office. We're pretty much capped out with how much we can handle of our own so …

Howard: Kids go rural. What I don't understand about these kids, they go, "I don't want to go to Kingman." Your mom came from India. 

Kelly: I've been looking for an associate to come work in my office, a general dentist associate, and they all want to stay in the city. Everybody wants to stay in the city. I don't understand it at all. I'm like you can come here. 

Howard: And what I don't understand is I know so many people who go do four ten hour days, Monday through Thursday in Bakersfield and they're so wealthy that Thursday night they go to the airport and get in their Cessna double prop and fly into Orange County and have the million dollar condo on the ocean and party like a rock star for three days. 

Kelly: That's what we do.

Howard: But the dentist who have the office right looking out at the ocean on the weekends they're selling Amway and part-time jobs as a bartender because they practice in an area that has a dentist for every three hundred and fifty people. 

Kelly: Exactly, so we live and work hard in our town, but we love it. It's a beautiful area for us, great place to raise kids, but we travel a lot. So we go travel to the beautiful places when we can enjoy them and do nothing but enjoy them.

Howard: But you were born in Kingman. 

Kelly: Correct.

Howard: And this is what the deans in the [pew?] research center does a day. They think that if you double the number of dentists, it'll force them to go rural and the bottom line is, I've been telling him this for thirty years, that everybody in my graduating class and went back to a small town they were born in that small town. And if you fill up your class with who has the highest four-point O and DAT score and you've got all these kids from downtown LA and Phoenix and Manhattan they all stay there because it's all you know. It's like there's no such thing as good food. If you were born and raised in India, you think curry's good. If you were born and raised in United States, you need salt and pepper. If you're born in Mexico it's salsa. If you're born in Kansas it's ketchup. There's salsa, ketch-up what tastes better? There's no right or wrong. It's what did your momma stick in your mouth when you were a baby and that's your comfort food. And in a pew research and these dental school deans are really concerned about rural, they should quit accepting kids based on their stupid scores and Algebra and Calculus and Geometry, which I want a refund back from all those courses I took. When I think of how many thousands of hours I stayed in the library studying Algebra, Calculus, Trig, and Geometry when I could've been reading history books and all these other things that would have mattered and I wasted so many millions of hours on shit that doesn't matter. And if they would just say, well, if you want kids to go on the Indian reservation, what do you do? Accept Indians from the Navajo Indian Reservation. But he said, "Oh, but you need to have a four-point O."  And it's like, screw that. Nobody born in Scottsdale is going to go live the rest of their life into a city, let alone speak Navajo. You know pews always posting all these research sales from all these towns that don't have dentists. Why don't they just go to those high schools and say, "Who wants to be a dentist?"

Kelly: Well, isn't that where the pew foundation's pushing the whole dental therapist's act?

Howard: And what are your thoughts on that?

Kelly: I'm a little concerned only because I know when I went to college for eight years, I came out knowing most of what I learned was not from dental school. Most of what I learned was from working in the dental field, hands on. I'm concerned that people think they can go to school for five years they're going to come out and they're going to be able to do these supposedly simple procedures. Unfortunately, how many simple extractions did you start doing that you go, "Oh shit, that's not simple. Now I've got a hole on the sinus or now the whole facial plate broke off." What it looks like on the x-ray is not really what happens, right? I mean that happens …

Howard: The most fun in nerves is when you pull number two and the whole tooth [inaudible 00:57:03] comes out.

Kelly: Right, and that happens.

Howard: I don't know what can make your day better than that? It's like no big deal let me just go change my underwear and I'll be right back. 

Kelly: But everybody's going to say, "Oh, that doesn't happen." Baloney, the best of the best that happens to. Everything's taboo to say, "Oh that doesn't happen to me." Yes, it does. 

Howard: But I have a whole different twist on dental therapists and I don't want to talk about it because the hate mail from it is off the charts [inaudible 00:57:25], but this is dentistry uncensored.

Kelly: Well it can be good it can be bad.

Howard: So when hygienists wanted to have their own place to practice, for the better part of my thirty years, for twenty years it was only really in Colorado. I could only find seven people who did that. They were all in a town of one thousand, you can't afford to have land, building, equipment, computers for cleanings. So they go in their front room like this is my dining room and since we never used it from 2005 to 2018 and we're a bachelor pad, we've figured shit make it a podcast studio. They got rid of their dining room table and I don't know what a China closet is where you have dishes on display that you don't even cook.

Kelly: A waste of space.

Howard: You want to hide anything from an American just put in the oven and no one will find it. And they put a dental chair there and so they had no overhead that no employees. People come and do a cleaning and if she saw something she'd write a note and then you would drive into town and see Dr. Smith. Dr. Smith thought it was the greatest thing on earth. He's like, "Oh my God, I mean she's a hygienist. Every time she finds something it's a crown, it's a root canal." I mean she gets it right all the time and some of them didn't even have x-ray machines and they would send them up once a year to get a FMX and they all loved it. So on this dental therapist thing, well Bob Barkley, when he went around the country trying to build the hygiene department, like when I got out of school in 87, the first time I lectured in Australia, they didn't have hygiene schools. It's a new thing over the last thirty year. When Bob Barkley was doing it in the United States all the dentists like, "I don't get time for this bullshit. I'm so booked up doing immediate dentures and what do you want me to do? Hire some hygienist or what, get the shit out of here." And Barkley he's really credited for talking to these guys saying, "Hey do you want your kid to grow up and need an immediate denture." Why don't we start preventing immediate dentures, but the biz model was immediate dentures and so now when I go to these places that have dental therapists, what I see is the dentist love it  because now I got a hygienist, two hygienists, and then I got dental therapists doing all my restorative, which they're burned out of after. You've been practicing ten years, you still get excited about [nimo de-filling? 00:59:44]? 

Kelly: No, I hate doing restorative.

Howard: See you say you hate doing restorative.

Kelly: I would love for a dental therapist come do all my restorative.

Howard: I know and I knew a guy that has a dental therapist with an expanded duty function assistant. He doesn't numb, he doesn't drill, he doesn't fill. He doesn't even check it when it's done.

Kelly: No, my hygienist numb.

Howard: He's got a hygienist doing the cleanings, dental therapists doing the restorative. So what's he doing? Root canals, implants, he's doing everything a dental therapist can't. Now when you say that you're a traitor to the cause. You're an evil …

1.00 Kelly: No, it can definitely be used for a positive good. The problem is the overhead.

Howard: Well, let me say the other thing is there's one million MD's. They went down this physician's assistant, so it's a four-year registered nurse is four years like her hygienist. The MD's eight years like the dentist and the PA is six years. Well, I don't have one MD friend in Ahwatukee who doesn't love their PA? I don't have one.

Kelly: No, the only …

Howard: But you say that to dentists and you're not allowed to drink with them anymore.

Kelly: It's because they feel threatened, most dentists feel threatened by that, but why would you be threatened because they're not going have, most of them aren't going to have the interest in doing the cases that you do. You're interested in two different things. I'm not interested in imodi fillings,they are. Make sense? And the insurance company isn't going to want to pay the same to a dentist versus a dental therapist, right? Your pay scales going to be different.

Howard: Is it? I've never heard of that.

Kelly: I think. No, it's going to be the same. So then maybe the…

Howard: But I would say this, this should get me the most hate mail, the dental therapists do better fillings than the dentist and you know why? Because she schedules an hour to do one and if it's an amalgam, it's got anatomy, polish. What does a dentist do? If he's got an hour he tries to do the whole quadrant.

Kelly: Absolutely.

Howard: So you are a dentist, you don't have time for this bullshit restorative dentistry so you're in there doing the whole quadrant and the thing is when you're doing a quadrant with that many composites, there's not really any shortcuts. It's a time-consuming deal.

Kelly: It's a very time-consuming practice, yeah.

Howard: You can't do other stuff. You got to numb, rubber dum, prep, isolate.

Kelly: You can't go to your hygienist [inaudible 01:02:12]

Howard: One at a time. I can't do snappy contacts with four mod's next,  I can't do it ever. 

Kelly: No

Howard: So you got to do one at a time and it's basically you go in that operatory at two o’clock with four mod composite and arch and you're going to be working your ass off until three. But that dental therapists, hell she'd scheduled two hours for that. I don't want to do it. 

Kelly: How can you afford to get paid for one filling for two hours or an hour, one filling in one hour. 

Howard: Well, what do you get for an imodi composite?

Kelly: How is the operatory going to afford that?

Howard: Yeah, it's going to be one of those deals if you're on a PPO. I mean my book people time and money. I mean you got to know the cost of the [inaudible 01:02:59]. Southwest Airlines takes every single cost they have and puts in the common denominator of flying a seat through the air for an hour. So you have a no-show cancellation. Was there a cost flying that seat, plane for an hour? Yes, it wasn't pulled by the tooth fairy on a unicorn with sprinkle dust and so if you can get these dentists to sit there and take all their costs like we do at our [inaudible 01:03:24] every month and divided it by the number of chairs per hour, so you know what that chair costs you per hour and then you'll know what that fee is. That's the only way you schedule.

Kelly: Exactly, that's the only …

Howard: But they can't do that because they use Dentrix and Eaglesoft which isn't hooked up to accounting. So they have this schizophrenic accounting system where Dentrix and Eaglesoft does all the insurance and billing and all this stuff, but all your payables, receivables, rent, mortgage agreement, labor, computer interim, oh yeah, why would we need that data? Because if your receptionist scheduled Chip and Chip has this insurance and she schedules for a MOD and that computer knows what that opertory costs and could turn red and say, "Well you schedule an hour for that, you'll lose $27 and eighteen cents." So she moves down to forty-five minutes and it says, "Now you're doing it for free." She moves down to thirty minutes and now you're going to make thirty bucks. But see we don't have that and when people tell me, "Oh, I love Dentrix." 

Kelly: And that's exactly what we need.

Howard: That's like saying that you love Mountain Dew and cigarettes. I mean your number one problem is Dentrix and Eaglesoft and trust me, I have gone to Provo, Utah and talked to the founder there back in the day. I've flown to Effingham and talked to the people at, Eaglesoft. I've flown to Melville, New York and begged Stan Bergman, I mean I begged him like a child. I went to Minneapolis, St Paul to [inaudible 01:04:46]. I begged him and I finally got it. You know how I got it? I was in the headquarters of Patterson with my idol mentor. I love Pete [Patterson? 01:04:53]. He was one of the greatest guys ever, but he was sitting there in his office and I realized - there's no computer in this room and he had these, what was that American rainbow tablet? Remember those?

Kelly: Yeah.

Howard: When we were little and he had a very sharpened number two pencil and he's taking notes and like oh my God, he's taking notes with a number two sharpened pencil on an American rainbow tablet and I'm trying to get him ... and you know what I really can't stand the most about that issue. It was gushed on Bill Clinton. My biggest beef with Bill Clinton was not Chunky, the file clerk, it was the fact that he blocked Microsoft from buying Insight, which owns Quicken. So you would have had a standard instead of just having Word and Excel and Powerpoint, Bill Gates knew that small businesses their number one problem on a farm is they don't know their cost and he wanted to buy that and freaking Bill Clinton who never owned his own business. If he had been spending less time with Chunky, the file clerk and more time with small businesses, especially his dental office, I mean I have yet to walk into a dental office in my entire life and say, "Hey, you just did a [heightening? 01:06:05] check. You should have cleaning, examined, bitewings. Did you make $9 and twelve cents after taxes in [Ebidoc? 01:06:15]or did you lose three bucks?

Kelly: Exactly.

Howard: It's, "How should I know?" Well, cow shit, you don't know because of Bill Clinton and I still think Microsoft, which I think is one of the best long-term companies in the world because when you go back to the '94 to March 2000 internet bubble stock, the four ringleaders were Microsoft, Intel, Oracle, and Dell or Cisco and Dell and Oracle to some extent. And then that bubble popped so now we're into the new bubble, which we're in bubble territory and this baby's coming down. It's been a decade since 2008 but who are the players again? Facebook, Apple, Amazon, Netflix, Microsoft and you look at Facebook and Google it's 98%of the revenue comes from ads. Microsoft has seven diverse groups. They just bought LinkedIn. They're so diversified and God ding I wish they would go back and pick up Intuit. And I'm sure if I send them a letter, I'd get a PR email back like I do when you send one to the president. I used to write Obama just the greatest ideas in the world that he could do and didn't even get a reformed deal. But, yeah Microsoft needs to do that, yeah.

Kelly: I think that …

Howard: Because small business and I mean I only know two things. I only know raising four boys, dentistry and business, those are my three areas. And my God, dentists don't know their costs and they not only do not know their cost, but most of them are taking a dozen different insurance plans. So when you come and you go to Kingman and you go into a 7:11 at [inaudible 01:07:55] They say, "Yeah, this is a buck. We buy it for eighty cents and we sell it for a buck. We make twenty cents." Here's a dentist. I have no idea what I bought it for. I have no idea the cost and I sell it for twelve different prices. Then you say, "Well, look at your prices. This filling goes anywhere from a hundred to two hundred so do you think you have 50% overhead?" "Oh hell no." Okay well at two hundred to a hundred and you don't have 50% overhead. If you did have 50% overhead this one for a hundred you'd be doing free, but you don't have 50% overhead so don't you think maybe you might be losing a $20 bill every time you do that? And they say, "Yeah, probably." And I say,"So why don't you drop that?" "I don't know because my kid's teacher, she asks us to take this insurance and that who teaches my kid." So if you walked up to your teacher, would she just give you a $20 bill? I mean it's so ...

Kelly: Yeah, you can still have them as patients they're just out of network.

Howard: Yeah, it's so [inaudible 01:08:57]

Kelly: [inaudible 01:08:55]

Howard: So what about ortho. You do ortho?

Kelly: Yes.

Howard: What do you do? 

Kelly: All of it. 

Howard: All of it. Invisalign or clear liners? 

Kelly: Mostly not clear liners. Mostly band and brackets. 

Howard: You know what's amazing is every Orthodontist I think I've had the twenty-five greatest orthodontists as defined by the busiest guys on the lecture circuit with a very successful office. All of them say they're eighty/twenty. They're 80% fix. The only time they're doing a twenty is when the patient …

Kelly: The patient forces you into doing.

Howard: The patient grabs the towel and shaking the dog. They all prefer fIxed, but you prefer fixed.

Kelly: I prefer fixed just because you get the results that I want, but that's not necessarily what the patient cares about. 

Howard: And back to Kingman. What percent of the boys who are chewing tobacco are compliant with wearing their aligners? 

Kelly: Very few. 

Howard: Yeah and you say that you're a racist, sexist pig, but when a boy has a [burnham? 01:09:49 up his nose, his hairs band up and he's wearing the same UFA shirt for three days. 

Kelly: It makes you look bad, yeah.

Howard: I want control. I want to glue all that on so I don't have to worry for Frankenstein to wear his clear aligners and he didn't even want him in the first place. Who's wanting them?

Kelly: Mom.

Howard: Mom, because she wants them to reproduce and have offspring and make a grandchild. It just comes down to that. 

Kelly: Exactly.

Howard: So what ortho system are you using? 

Kelly: Like what brackets.

Howard: Yeah, what system?

Kelly: I started with Six Month Smiles and they'll actually set the brackets for you and now I transitioned it more into just placing my own brackets using self-ligating brackets. I like those a lot.

Howard: But what company? What [inaudible 01:10:42]

Kelly: I'll think of it here in a minute. See I don't order this stuff somebody else does that for me. 

Howard: Right. You like the self-lighting [E? 01:10:42] brackets.

Kelly: Yeah, carriere ... what is it. I like the carriere motion appliance.

Howard: Carriere motion appliance. We had him on the show. Where's he from? Carriere …

Kelly: He's a hoot, isn't he.

Howard: I love that guy. Spain?

Ryan: Yeah, it is Spain.

Howard: Yeah. I think he sells those to Henry Schein, doesn't he? 

Ryan: Luis Carriere, yeah. 

Howard: Luis Carriere, what show was that was?

Ryan: That was four forty-eight.

Howard: Four forty-eight and that's from Henry Schein Orthodontics, which is really gotten huge in ortho.

Kelly: They own everything and implants too. They're huge in [inaudible 01:11:23] and implants.

Howard: So why do you like self-ligating?

Kelly: Well there's less resistance on the wire so the teeth can slide easier. So if you have elastic on the bracket, the elastic is holding the wire or the tooth to the wire so it doesn't slide as much. There's so much resistance. If you have a self-ligating bracket, the tooth can freely move on the wire. Shortens up your treatment time is huge. 

Howard: And are you using any orthodontic accelerators? They have those vibrating devices. They have …

Kelly: No, I don't use any of those, but yeah …

Howard: And then they have that other one the …

Kelly: You can drill a whole bunch of little holes in between the …

Howard: Yeah, the micro ...  what company was that?

Kelly: I don't know. 

Howard: But you're not buying that?

Kelly: No.

Howard: Yeah.

Kelly: Well, I mean how many people are going to be like, "Yeah, go ahead put a whole bunch of pinholes in my facial plate and my teeth [inaudible 01:12:16]

Howard: Yeah, but you like surgery, you like blood and guts so I figured you'd just do it.

Kelly: For fun?

Howard: Cos you just wanted a chance to cause more blood.

Kelly: I don't think you're going to get much case acceptance in that.

Howard: Gosh, what about dental insurance plans? Medicaid, Medicare, PPO's, Delta? 

Kelly: We take I don't know some of the bigger traditional …

Howard: Delta?

Kelly: Insurances, yeah, Delta and Blue Cross, Blue Shield and stuff like that, but as an associate, I worked with some of the other state-funded plans, I suppose, and that wasn't my cup of tea.

Howard: Ryan, didn't we do a podcast with somebody who's in the Congress from Kingman or who's that woman dentist?

Kelly: Gina, Regina Cobb.

Howard: Yeah, Regina Cobb. Cobb. What city is she from?

Kelly: Kingman. 

Howard: Kingman. So are you going to be the next congressman from Kingman?

Kelly: No thank you.

Howard: So that's a pretty unique [inaudible 01:13:08] a dentist and a congressman. Is that a …

Kelly: That was her goal. She likes politics. She was in with the Arizona dental board for a long time and then from there, she moved on to bigger and better things.

Howard: Did you see her podcast?

Kelly: Probably not.

Howard: Well, my God, I'm going to email it to you. It was six fifty-one, dentistry, family and politics with Regina Cobb. So she your drinking buddy? 

Kelly: Used to be. She's never in Kingman anymore. 

Howard: Because she's busy.

Kelly: She's busy.

Howard: And then a congressman is a dentist out of Flagstaff, Paul Gosar and went to Creighton with him. We were both in the same dormitory. I saw that guy a hundred times in and out of the elevators. I was on the ninth floor and he was on the eighth floor and then he went to Flagstaff and now he's one of only four dentists who's a congressman. Paul Gosar here and then there's one out of Idaho, Texas, and Georgia. And I've asked them all to come on this show and they're like, "Yeah". But you know what I bet they all show up.

Kelly: Well they should I mean ... 

Howard: But u know when they will, I'm predicting.

Kelly: When they need to get reelected.

Howard: When they need to get reelected and fundraise so you probably because the one thing they say, the congressman always say is that all politics is local and long-term memory is about six weeks. So what is this February and the election's November so everything you're talking about today, no one will remember a thing. So I bet you they're all going to or at least some of them, I think they're all going to show up probably October. 

Kelly: Yeah.

Howard: That's what I'm guessing. But, so the other thing, oh yeah, last question you write,  you talk about why is it taboo to talk numbers? No consistency, very poor business training schools, schools driving costs, education.

Kelly: It's the same thing ... 

Howard: We haven't had Chip talk, but it seems to me that you're the dentist and Chip's the business. Is that fair to say? 

Kelly: Yes. So I started as a startup. I invested a hundred, I borrowed $100,000 to start my practice from scratch.

Howard: So why did you borrow hundred thousand because you were inherently wealthy. You've inherited billions.

Kelly: I start in the negative zone a and we ran that equipment for a couple years and then we didn't really have much overhead. I mean our overhead was phenomenal. We probably made more money than we do now because we bought a CT and all new chairs and computers in every operatory and we spent all this money in technology. But as things got busier I don't enjoy running the business side of it as much. I enjoy being in the operatory, doing, producing my passion. That's how we produce money faster and he deals with the numbers and basically says you're spending too much time doing this. You could be more productive or efficient doing that. Plus we used to spend, when I first started printing guides, I was paying four hundred and fifty bucks an arch for a guide.

Howard: A surgical guide for an implant.

Kelly: A surgical guide, now it's like $60 or less. 

Chip: Well, yeah basically. Yeah.

Howard: What 3D printing did you buy to print the ...?

Kelly: So we actually outsourced the 3D printing portion, but the guides already built in the software, everything. You just basically send the print to a printer off-site. 

Howard: Is the printer in Kingman?

Kelly: No.

Chip: Chicago.

Kelly: Chicago. 

Howard: So are you thinking about buying a 3D printer? What do they charge you to print it?

Kelly: No really it's too cheap to print it.

Chip: It's forty-three bucks shipped to us. so …

Howard: Yeah and you're an engineer?

Chip: Yeah,  I'm a mechanical engineer.

Howard: Mechanical engineer. Is this a full-time job or are you got a  mechanical engineer ... because you used to work for a company in Kingman?

Chip: Yeah, I worked at a chemical lime plan which was a mine, but it was a …

Howard: Oh, the lime plant. Is that near [Saligman? 01:17:31]

Chip: Yeah, so that was over sixty miles from the house.

Howard: My son told me to tell you when you came here today, he wants to know if you can get him on at the mine.

Chip: Oh, I could help him for sure. 

Howard: Well Eric and Greg, no Greg desperately wants to get in that mine because he bought forty acres in [Saligman? 01:17:31] on the national park.

Chip: Oh really.

Howard: And he's paid off, that's why he moved back home to pay that off and so he's got forty acres, but he really has a million and forty acres because he's on the ... and it's just, oh my God, every time you go there there's elk, deer. But the only place to really work is that mine, but you think you can help him get on at the mine. 

Chip: Oh yeah, for sure.

Howard: But anyway, so now you're doing this full time?

Chip: Well, yeah, I don't have my full-time job and so I spend what I can at the office, but also with the kids and their dirt bike stuff we travel a lot, right, so it kinda just depends on the demand at the office you know. 

Howard: Now what advice would you give because a lot of people, it's like girls marry economically up so boys have to marry down. So when 30% of the girls in dental school marry a dentist in their class. Whereas, 30% of the guys who marry the waitress at the waffle house, who's never going to have a job and women don't marry dentists, they marry engineers, lawyers.  They always marry someone who has a professional job and men more than likely always marry someone who's not going to do that. But I always say that let's say the spouse made fifty thousand and the dentist was making fifty thousand and all. Let's say they each made a hundred thousand, one plus one equals three. When you're an employee somewhere, it's not like you own your own business and whenever I've seen a spouse making a hundred, the dentist making a hundred and they work the family business together now combined, they're making three hundred. So the fastest way your spouse can make 50% more money on the deal is because when you own your own business, you're in, you're totally motivated. You're dreaming about this shit in the middle of the night and even when you're on vacation, your brain's still going. And how many times when you're on vacation, you guys listening to podcasts and YouTube or going to CE courses.

Kelly: The kids know that.

Howard: What percent of the time?

Kelly: I'm always on them.

Howard: Yeah, so I always tell people and they'll say, "Well, you know, my husband he's an engineer." Well, I don't care he'll make more money owning his own business every single time. That's what built the planet's economy, small business.

Kelly: If you're a driven person.

Howard: Yeah.

Chip: But woman are.

Howard: Women dentists always marry driven men and driven men always marry what looks the nicest in a pair of Jordache jeans.

Kelly: Because they're thinking with a different brain it's not the same.

Howard: I know and they look so good in those Jordache jeans for about six weeks and then you're now you're married  I mean …

Kelly: That was one expensive pair of jeans you bought.

Howard: Oh my God, I just tell people if you're going to do that, just don't sign a contract. Can't you just shack up with her and live in sin and go to hell when you die. Do you really need to sign a contract and give her half of your money in ten years? So what advice would you give a young couple?

Chip: Oh my.

Howard: Because you work together, you live together and there's a lot at stake because you got two children, so you don't want to screw up the marriage when you got two children. So what advice have you learned? Was it the book Men are from Mars, Women are from Venus. I mean what advice would you give young married couples who are listening to this podcast on their commute to work? 

Kelly: Oh boy. I don't think you want my advice. 

Howard: No, we do. This is dentistry uncensored. Dentistry uncensored. If you don't make him blush, I'm going to have to repeat the question. 

Kelly: You have to rate your priorities correctly. If your marriage isn't the first thing, you're not going to make it. You cannot rate your business or your success or your bank account above, for me spiritually, marriage then comes work in my career. 

Howard: So just like that ... what's my favorite show, Porn, Pornstars ...?

Kelly: Pornstars?

Howard: What is that shop that they all ... Pawn Stars.

Ryan: Pawn Stars, yeah.

Howard: By your house. Have you ever seen that show?

Kelly: Vegas thing. [inaudible 01:21:41]

Howard: He always says, family first, business second and that's the rule. So you say family first, business second. 

Kelly: Absolutely. 

Howard:    Absolutely. Now you said spiritual. Are you guys religious? Is that a big part of your ...?

Kelly: I am. That's a very important part of me. 

Howard: What about Chip?

Chip: She's working on that.

Kelly: Chip's a work in progress. 

Howard: So are you like an orthodox religion or just spiritual? Do you believe a certain creed at a certain church? 

Kelly: Not necessarily. I think there's a bigger being than two rocks came together and everything just happened. I mean it's …

Howard: No, the story is better. Nothing condensed into something exploded bounced around and now you butterflies and rocky road ice cream and me. And the Bill Mare people think that just makes sense and then when you tell Bill Mare well maybe there's a smarter being than the human being. Well, that's just crazy and I'm from the [Capler? 01:22:46] how the shit would I know.

Kelly: That's what I was going to say it doesn't matter …

Howard: [inaudible 01:22:53] I'm looking behind me like …

Kelly: Does it matter if the chicken came first or the egg? Does it matter? No. You're happy that you had eggs in the morning, right and you're happy you got to kill a chicken and you had some chicken nuggets. That's what matters, right? I mean all I care is we live a healthy moral, happy life. You know what I mean? It doesn't even matter to me if you're married or you have ten women, whatever you need, but you have to feel like you treated one another one with respect. 

Howard: Now if you had ten women, totally you'd be in hell. I mean ten I mean at that point you're having lunch with Lucifer.

Kelly: No, if you feel as though you respected everybody as you want to be treated, you treat others the same.

Howard: Right. So my sister has been a nun for forty years, whatever, and she actually knows all the language. In fact, Vatican sends her documents to be translated. So she's been translating, that was her job when she became a [closure monk? 01:23:52] for translation. In fact, it was so much long time ago she called me one time and she said, "Can I ask you a huge favor. Someone told me it might help if I had a computer." I'm like, "Oh my God, you don't have a computer." So I bought her this Mackintosh way back in the day, but anyway she can read. She's read every single ... she told me the one time she had read like every single thing the Vatican had for its first five hundred years she'd read. but anyway she says when you read every major religion, what's creepy to her? There's not a city, person, place, thing, there's nothing in all the major religions. Hinduism, Buddhism, and Taoism, Confucianism, Christianity, Islam, except for one line, which they call the golden rule, treat other people like you want to be treated. But she said if you read it, it would go down as plagiarism. Your college professor would say you copied off him. You're like, "No, this is Islam.

Kelly: It's the golden rule.

Howard: And this guy's a Hindu." And the golden rule, which I thought was whoever has the most gold rules, but my sister tells me. But so that's the bottom line of religion is just treat other people like you want to be treated. 

Kelly: That's the bottom line of my ... exactly.

Howard: And that's another thing where people always have problems with treatment planning. I say well that's the easiest thing. What would you want to do on yourself? If I was smoking, drinking and on meth, I wouldn't want hero-dontics done on a tooth. And in fact what gives dentists clarity with money because money is the answer, what's the question? I say well just have a policy that you warranty everything for five years. Then when that tooth snaps off at gum line, you do a root canal and post buildup and a crown.

Kelly: Then you have to do an implant for free.

Howard: And two years later they come in and hand you this PFM with a dowel and you're like, "Oh now I've got to redo that for free." And furthermore, the average man till he's seventy-five. What's seventy-five divided by five? I should know that since I had Calculus Geometry, Trig, seventy-five divided by five, that means if it only lasted five years, they have to have it done fifteen times in their lifetime. I know they go to a dentist who could give me ten. Now I have to have it done seven times in my lifetime so if you're treatment planning, I mean, what would you think if you bought a car, a microwave, a refrigerator and in five years you had to throw it away? 

Kelly: You wouldn't want to do it. Well, that is what the American does. That's what we do.

Howard: So I think five years gives moral ethical clarity.

Kelly: That's why implants are so on the rise. They have a normal success rate. 

Howard: And final question I want to get back to. So when I got out of school thirty years ago, the implantologist were all known as butchers. I mean even in my school, the oral surgeon placed the implants, the other instructors called them the butcher in class. And when I moved out here are some of the greatest early pioneers in implantology, [inaudible 01:26:45], subperiosteal they're trying everything. First time a really big major case failed they took their license away and some of them went from living like rock stars to be an alcoholic in a trailer and it was very, very sad. And then the pendulum came out of the gate and then it was like periodontal disease, perio surgery, fix all that with titanium. And now I'm starting to see it coming back to perio. And a lot of the people with the peri-implantitis [inaudible 01:27:16] are sitting around thinking, "You know what if that was me. I'd still try to save that tooth. I would do crown lengthening and I would do that. Where do you sit on treating periodontal disease with forceps and titanium or sending them to a Periodontist for crown lengthening or periodontal treatment or ... 

1.27 Kelly: I'm not a huge fan of when the decay is subgingival or under the bone, I'm not a huge fan of crown lengthening. 

Howard: So for bacterial streptococcus mutant decay, not a big fan. But what about they don't have a decay problem and it's …

Kelly: And it's [inaudible 01:27:53] then we work a lot harder if it's just pure perio ... 

Howard: And you know my final word.

Kelly: We work extremely hard to save them.

Howard:  True or false. Do you think the people that you've seen just in your gut feeling, and I know guts are filled with fecal matter and shit and it's worth nothing, but do you think people that have a lot of perio don't really have a lot of decay and people with a lot of decay don't have a lot of perio or do you see a lot of perio and decay? 

Kelly: No, It's generally true. You're usually dealing with the perio patient or you're dealing with a cavity patient.

Howard: And you know what I think that's going to come down ... I think they're going to look back twenty/fifty years on that when you look in the mirror, you see one trillion cells, animal cells. They're huge they're like Shay stadium and they came from your mom and dad, but you have this tube from your mouth to your rectum and that too has ten trillion cells and they are life forms and they're very, very small viruses, fungi, microorganisms. But talking to dentists, watching Dentaltown, looking at research, it looks like that gut microbiome.

Kelly: Absolutely. It's whatever you're inoculated with from intro-utero or from birth, and then how you deal with that.

Howard: And you know what the number one transplant is on the planet today? It's not a lung, it's not a liver, it's not a kidney. It's a fecal matter transplant. They are doing more research and they're doing it with mice, they're taking obese mice, they're taking skinny mice's fecal matter and doing an enema in the fat mice and it's changing theirs. When you change your diet, when you eat this high sugar American diet with all this soda and everything, you have completely different gut microbiome than a vegan. And when you eat everything out of a processed box, there's no life forms in there. But the thing about vegans that are so healthy, you don't have to be a vegan, but the fact that when you eat a banana that's got bruises on it you're inoculating ... I mean some people take probiotics.

Kelly: Right you're inoculating. 

Howard: You know what's better than probiotics?  A rotten banana and if you can't eat it maybe if you just shove it up your rectum, same thing you get done because most of those life forms are in your in your colon. Not the first twenty feet, stomach and small intestine, all this stuff, but that's why I want to live the most. It seems every five years something I believed in in dentistry has changed. 

Kelly: Oh absolutely and then same with your life. My goals from five years ago are completely different from my goals now. So when I got out of dental school my goals were totally different. The problem was we blew through them in about I don't know,  two years or something. So then we had to make ... and I thought those were unrealistic goals and you blow through them then what's your next set of goals? Everything changes. 

Howard: That was my favorite song as I was growing up. What was that Cats in the Cradle? 

Kelly: And a silver spoon. 

Howard: And a silver spoon. [Inaudible 01:30:51] I'll be happy when I get out of high school and I'll be happy when I  get out of college and I'll be happy when I get married. 

Kelly: So always the next thing.

Howard: And so you always blow through your goals. That's why don't be goal toward that, happiness in life is a journey. And seriously you drove three and a half hours and she didn't want to be on the show. She's shy. Her husband's shy. He said, "No, I don't want to do that." And I said, "No, Kelly how many years have I known you? 

Kelly: Oh boy since 2003.

Howard: 2003 and were we in drug rehab or were we ... we both had an ankle bracelet on, didn't we?

Kelly: Super good AA meeting.

Howard: We both had ankle bracelets on in the same meeting. And, but I've been a big fan of yours and I wanted to get you on the show. You do so many things right. You guys have a great marriage, great family, great million dollar practice in the rural. You're my little unicorn. 

Kelly: Well, if you want to be successful everybody talks about their million dollar practice. Don't get divorced. I mean that's …

Howard: Million dollars.

Kelly: I'm talking more, yeah.

Howard: My divorce was three point eight million dollar, what you mean million dollar.

Kelly: Yeah, so everybody has this million dollar dentistry book. It always cracks me up. Why don't they write a book about don't get divorced and you won't have to worry about anything.

Howard: Yeah, but again I can't believe you made the drive, so it's three and a half hours to go back home?

Kelly: Yep.

Howard: My God, you drove seven hours to be on the show.

Chip: We woke up at 4:15 this morning.

Kelly: No, we're going to go look at tractors and appliances now.

Howard: What kind of tractor? You mean a …

Chip: Smaller, not like a lawn tractor, a real tractor, but not huge.

Kelly: Like a Kubota.

Howard: A Kubota. That's the name of it? I'm from Kansas, all I know John Deere. 

Kelly: Well, they have John Deer's too, but now the John Deere's apparently the motor's not really made by John Deere. It's outsourced to something else.

Howard: Oh yeah I think it's so insane when people say, "Oh, I bought American cars." "Okay, dude there's thirty thousand parts in that American car. You know what percent of them were not made in America?" "Oh, just 80% of them." 

Kelly: All of them, yeah. 

Howard: But thank you so much. 

Kelly: Appreciate it. 

Howard: Thank you so much.

Chip: Alright.