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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His early curiosity around dentistry is not uncommon. His path and experience is quite unique.

From the moment, he was referred to the orthodontist at eleven years old and realized that he could wear cool ties every day, he was intrigued. When he watched (suffered) as his huge “buck teeth” became a more reasonable part of his face with the help (torture) of a bionator, the dreaded head-gear, and huge uneven brackets on every tooth, he knew this was his future. It wasn’t necessarily creating nice smiles that struck him. He intuitively knew that he could have a positive impact people’s happiness, self-esteem and confidence (But at his young age those were not the words he would have used. He wasn’t much of an accomplished reader at that time, nor did he possess a broad vocabulary).

He worked in the lab of that same hometown (Reno, Nevada) orthodontist in high school and eventually managed the lab (fabricating a wide range of orthodontic appliances every day) while completing his undergraduate studies (and starting a family a bit early just to keep things interesting) until he was accepted to dental school in Oregon. His experience of the team in that practice and the intentional energy given to it laid the foundation for his future, to say the least. Once in dental school in Portland, (Oregon Health & Sciences University), he connected with the Department of Orthodontics, working on several research projects and was even published! But no, he is not an orthodontist. Crazy, right?

He went back to his home town to practice dentistry, which is really where his career began to evolve in a unique way. He was an impatient associate in a practice he would purchase after a one-year associateship. He was then a young practice owner and disrespectful boss of the dentist who had owned the practice for 34 years. Yes, he has learned much the hard way, but learned he has. He focused on his team and quickly learned a new word for his vocabulary: Humility.

As fate would have it, he and his family would move back to Portland, creating an opportunity for Kevin to quickly find and associate to help the transition, find a buyer for his practice, work as an associate in Portland, while looking for a new practice to purchase, all simultaneously! Yes, early in his career, he would experience almost every aspect of the dental business, a gift wrapped in unique box. The new practice in Portland had its challenges, as all practices do. This time it was a turn-key experience in a practice that needed considerable updating. Shortly after paying for (ok, financing) the improvements, it became obvious that the practice needed a better location. So, Kevin had an opportunity to experience a new building with new build-outs, new equipment, and patients that were uncertain if the drive to the new location was worth it, another gift and a weird looking package.

While dealing with the crazy business side of dentistry, he was focusing on becoming a better leader, facilitator, and dentist. His many hours learning from Frank Spear, The Pankey Institute, Tucker Gold Study Club (Tom Walker), TMD Study Club (Sam Higdon), Behavioral and Occlusion Study Club (Margie Mannering and David Latz) and so many others allowed him the opportunity to create a practice with exceptional dentistry, yet always focused on his team. As some in the dental community took note of his ability to truly integrate what he was learning into his practice, he was asked to start sharing his experience in the dental school, study clubs, and several other organizations. And he loved it!

Following his passion for education and facilitation, he sold his practice to pursue academia, completing a Master’s Degree in Healthcare Administration (Identical coursework and pathway as the MBA Healthcare degree as a cohort), direct several clinical courses at the dental school, and direct the Faculty Dental Practice. In 2014, he was asked to join as full-time faculty at Spear Education, where he served several key roles until 2018, including Director of Spear Online, co-course-director of Facially Generated Treatment Planning Workshop, Occlusion Workshop, Dental Sleep Medicine Workshop, Exceptional Dental Team Workshop, Comprehensive Dentistry in the Digital World, Seminar, multiple Spear Online educational courses, Director of Visiting Faculty and practiced in the Faculty Practice.

Kevin has practiced, learned and taught at every level. His very unique experiences and education provide him with the tools, empathy and skills to help dentists and dental teams reach appropriate goals and dreams, helping make every day in the practice a day of camaraderie, love, compassion, and empathy for each other and the patient.

https://ksquaredfacilitation.com/

Howard: It is just a huge honor for me today to be podcast interviewing Kevin Kwiecien, DDS MS right here in Ahwatukee. Where do you live in town?

Kevin: Scottsdale.

Howard: Scottsdale?

Kevin: Yeah.

Howard: He lives in the rich and famous section. I'm down here in the poor, born in the barn Phoenix, Arizona. Whenever I tell someone I live in Phoenix. They go, "Oh, you mean Scottsdale." I'm like, "No." And they go, “You mean Paradise Valley?" "No." "Where do you actually live?" "Actually, I live in Phoenix." But Dr. Kwiecien graduated from Oregon Health Science University School of Dentistry. Now is that the ducks or the...?

Kevin: Neither unaffiliated.

Howard: Oh, it's unaffiliated.

Kevin: It's just a Health Science University.

Howard: What is the rivalry there? The ducks versus the…

Kevin: The ducks and the beavers.

Howard: The ducks and the beavers. That is an intense rivalry.

Kevin: Yeah, my son is a duck, so…

Howard: Your son's a duck. And he graduated in 1995 and holds a Master's Degree in Healthcare Administration. He has more than twenty years of private practice experience with most of those years overlapping in academia.  He was with Spear Education from 2014 to 2017. He served as assistant professor restorative dentistry Oregon Health Science University School of Dentistry, where his roles included Director of the University's Faculty Dental Practice as well as Course Director of Pre-Clinical fixed prosthodontics and Co-Course Director of Advanced Restorative Concepts. Dr. Kwiecien’s dedication to high level, continuing education began with Dr. Frank Spear in 2001. Shortly thereafter he completed a curriculum at the LD Pankey Institute. He has a decade of national and international lecturing in workshops. He is the owner of ksquaredfacilitation.com, so it's ksquaredfacilitation.com and facilitating long-term health for the practice team and patient. Thanks so much for coming on the show, man.

Kevin: Thanks for having me. My pleasure.

Howard: I've been wanting you on the show for a long time.

Kevin: Thanks.

Howard: You have an amazing resume and you've done it all. We're right here in Arizona and a couple of weeks ago I lectured at one of the dental schools, [inaudible 00:02:08] A.T. Still, I always lecture there once in a while, and Midwestern Dental School in Glendale and a lot of those kids come out and they look at guys like us and they say, “well, Kevin, Howard, you graduated in the golden years. We're coming out of school $350,000 in student loans and you're talking about this high-end dentistry,” and what would you tell kids walking out of school today? Is everything you've accomplished still doable?

Kevin: Oh, absolutely and then some, I think. It's doable because the market still bears it. I don't think I graduated in the Golden Age and in 1995 we were all over $100,000 in debt. Some of us almost $200,000 in debt and then bought a practice and then bought a house and did everything that the young dentists today do. And some of us were smarter than others and didn't go a million dollars in debt, but it certainly is doable. I really think deeply it's a matter of knowing who you are and honoring that and being a little more thoughtful, but yes, it's very doable. Very doable.

Howard: So what are you actually doing at ksquaredcommunications.com? 

Kevin: Facilitation, it's a little bit of everything. As you well know, dentists come out of dental school not with a full understanding of anything, if we can go so far as to say that. Not a full understanding of…

Howard: I call it Dental Kindergarten. 

Kevin: Yeah, right exactly. I mean everything from the business aspect to the communications, to the leadership, to the marketing, but also they don't understand how to do the dentistry. They don't understand occlusion, they don't understand the patient, they don't understand how to connect with the patient. They also don't understand how to honor themselves and honor the patient at the same time. So it's all of that actually and in today's day and age it is more of what I would call integrative health. We have to look at helping the patient be healthy. It's bigger than just dentistry. It's been that way for a while, but yet it's moving in that direction more and more. It's something I've been passionate about for years. It's looking at sleep, it's looking at nutrition, it's looking at wellness. It's helping the patient move towards health and I help dentists and practices do that using the gifts and tools that I have, they help patients move towards health using the gifts and tools that they have so it's really not so complicated.

Howard: A lot of people say that it's so competitive out there and I always tell them that my dental office up the street just right when you drove in here, 48th and Elliott. We just celebrated our thirtieth year anniversary, September 11th, and in thirty years I've never met a dentist in all my travels around the world that doesn't take new patients. So when you look at any American who's born and raised and lived in the same town by sixty-five they've gone to half a dozen dentists. Dentists they want to solve all their problems with new patients. They don't want to solve their problems by closing the back door. So you can go across the biggest legend in dentistry, in your hometown and you say I can never do that. Dude, if this hygienist works forty hours a week, fifty weeks a year, that's two thousand hours, she can only see a thousand people twice a year. So every time you throw twenty-five new patients on her schedule, twenty-five are out the back door and they'll come across the street to you. So no one has mastered keeping the patient.

Kevin: No.

Howard: I mean do you know anybody who does any new patients?

Kevin: No.

Howard: Yeah.

Kevin: Never have.

Howard: Yeah, they don't exist.

Kevin: At least not that I know of for sure, but no. People die, people move, families change. They are dictated by their health insurance, their dental insurance, no matter if they love you or not so, of course, the practice is always changing so you always have to be taking new patients.

Howard: And these big cities when we were little, only the rich people flew in an airplane but now Southwest Airlines is the number one carrier, twenty-eighth of the market and everything I read on Phoenix in LA 10% of the town flips every year.

Kevin: Yeah, oh for sure.

Howard: 10% of the town chasing jobs, going back home to Oregon, whatever, whatever.  So it seems to me that patients always think they want the cheapest, but my God when it starts involving their mouth. You know it's like the iPhone. The iPhone is significantly nicer than android and it seems to be when you look at maps where they ... I love what this ... read it on porn column map porn on Reddit. It's map porn where they take data and make maps. In every city, the richest areas are all iPhone and the poorest areas are all Androids.

Kevin: Androids, okay, yeah.

Howard: And Android is the lower cost so it rules in Africa, Asia, South America, whatever, but they know they want to pay more money for an iPhone. They think when it comes to their mouth they want to pay down and get an android, but every person I've talked to in dentistry is upset about this filling done by someone. So it's a very sensitive service that we do and it's all surgery. I'm touching you. I'm working on you. I'm selling the invisible.

Kevin: Yeah, it's in your face.

Howard: I do think when they come out of the dental school they've probably only done what, five crowns, five root canals and twenty fillings. I mean…

Kevin: Yeah, it depends on the school, yeah.

Howard: Yeah, so they just got to do their basics for at least what, two, three, four years. What do you think they have to focus on fillings, crowns, and endo, basic endo before they're ready to learn the fancy stuff that you've been teaching for years?

Kevin: Yeah and I think that's a great question actually because I know from way back when I was in dental school and then of course when I was teaching at the dental school for the years, there are plenty of students who get to do somewhat you might call advanced dentistry. They do. I mean I got done with my requirements in dental school my junior year, basically, so most of my senior year I was able to do ... I loved endo, so I did a bunch of root canals, a bunch. I was like the endodontist, I was one of the few endodontists from my class basically, I got to do basically a full mouth rehab for a patient but under the guidance of somebody. So I like your question, but I would say there's not a lot of people that just do the bare minimum and you can get good ... you can have exposure to something more than that while you're in dental school so you know it exists. So how many years till they feel good about it? I think it depends on what you do immediately when you get out of school. Do you have a mentor? Is the person that you're working with or for moving you toward something like a Pankey or a Spear or a Kois or a Dawson so that you know it exists in the first place because then you're going to move there quicker because you know it exists? As opposed to if you don't know it exists, then yeah all you're going to do is fix the broken tooth and put it back into the place that caused it to break in the first place.

Howard: So you said Kois, Spear Pankey,...

Kevin: Pankey, Dawson.

Howard: Dawson, Nash Dickerson, and LVI, but these kids have a lot of student loan debt. When I was eighty still, a couple of Sundays ago one kid had $400,000 and he's not graduating until May.

Kevin: Sure, yeah.

Howard: Unbelievable, but I'm old school, I'm cheap. I like relationships. Gosh, they got periodontist, you'll set up in an old town and there might be two periodontists and one thinks in fear and scarcity and just wants you to refer everything to him and the other one thinks in hope, growth, abundance, says I'll mentor you. I'll teach you perio, I'll teach you implants and by the way young kids, of all the nine specialties I'm still convinced that periodontist are the best treatment planners. I mean it's not your role as surgeon and your orthodontist isn't looking for interproximal decay but in my experience the best treatment plan presented for periodontal. I mean to help a young kid learn how to go diagnose treatment.  You laugh, you disagree?

Kevin: No, I think that treatment planning has always been a huge part of my life and a systematic way to look at every patient and then including your periodontist and your orthodontist is what it's all about so I don't know who…

Howard: Including your what?

Kevin: Orthodontists and periodontists. I mean all the specialists, but I will speak for myself way back in the day in my Portland practice I met with my orthodontist and periodontist. We met the third Thursday of every month.

Howard: Nice.

Kevin: We had dinner. We had our articulators and our radiographs out and the server, wherever we were having dinner, was sort of grossed out, but they wouldn't even bring…

Howard: Was it apple piece?

Kevin: It was not apple piece, no, definitely not, but they would even bring cases of other dentists to say, you know what it's a dentist that maybe doesn't have the experience that I had. I'm not saying I'm better than them I just had more experience and they appreciated that. So basically I was helping other patients of other dentists get better treatment because we were all treatment planning the same, very systematically.

Howard: You're not going to believe, but back in the day like thirty years ago all the young dumb dentist opening about the time I did, there was a periodontist named Marc Shlossman. You know Marc?

Kevin: No.

Howard: He teaches perio at Eighty still.

Kevin: Okay, no umm.

Howard: And it was amazing because the smart ones they take the FMX study models. They do the diagnose treatment plan, but they would go by Mark's place and ask Mark if he'd look at it too. Every single time he added massive insight and value and I mean, gosh you could double your treatment plan, case presentation, everything young kid, just when you do your diagnosis and treatment plan is drive across the street and sit down with a periodontist. And like I say half of them live in fear and are crazy except for orthodontists then I'd say it's 90%. You go ask an orthodontist how Invisalign case and he starts going into Afib but in every town that I know of the most successful orthodontist in the town is one that has an Invisalign study club for anybody to bring their Invisalign cases…

Kevin: For sure, for sure.

Howard: And they all tell me they say the biggest one is in Australia. Who's that guy in Australia? The orthodontist that we had dinner with right by the ... but anyway he now has an orthodontic office in Sydney, north, south, east, west.

Ryan: Derek Mahoney.

Howard: Derek Mahoney. I think each one does five million a year and he started, he says when dentists were doing all the bleaching then [Crest? 00:13:17] got into it. Well, you're not going to change that. You're not going to go to City Hall and get the governor and the president to stop that so Invisalign came and hell, general dentists were doing it and the orthodontists said they couldn't do it. Hell, now Invisalign is bypassing the orthodontist with Smiles Direct Club saying we don't even need an orthodontist.

Kevin: Yeah, crazy.

Howard: But still most of the orthodontists they don't even think a general dentist can do it when Invisalign, the company that they built thinks we don't either of you, but he thought, well they're going to do this. What he told me is that half the dentists that get into Ortho after two or three years say, "I don't want to be married to a case for two years. I'd rather do a root canal and build up crown for two thousand than be married to you once a month for two years." And then he said and all the ones that did refer did all their Invisalign, didn't do all their complex cases and everything, and the more general dentists he taught, the bigger he got. He's just a monster and I saw that in Singapore. I've seen that in many American cities so find specialists that think in abundancy and get friends with them. Do you think if they walked out $300,000 in debt out of school, they should still do a Kois, Spear, Pankey, Dawson, Nash Dickerson?

Kevin: Do I think they should?

Howard: Or do you think they should find a free mentor across the street?

Kevin: You know that's a good question. I'm a firm believer in finding a Pankey or a Dawson or a Kois because I know it's life-changing. That experience is worth it.  It'll pay for itself. It's an investment, right?

Howard: I did, I did all of them. I did all six of them.

Kevin: You'll definitely get a return on your investment. However, there are certainly ways to move that along without spending that much money right away. I mean there are plenty of people who want to mentor people. When I was in Oregon I through the AGD did a study club and so basically I can say that it was basically a Spear, Pankey style treatment planning, and philosophy that I did through the AGD, the Oregon AGD. And so I promise you they did not pay as much to me as they were paying to Pankey and Dawson and Kois, but yet they were getting amazing experience and knowledge to take back to their office. So it's something like that, it is something. In this day and age that's one of the things that I do is working in practices with whether it be the new patient experience and being a leader in communicating. I can also look at cases with them and treatment plan with them and talk about helping a patient move towards health if you want to call it case presentation. I'm not a big fan of that word because it's not a presentation. It's just helping a patient decide what's most appropriate for them, but they don't have to go to Pankey or Kois or Dawson I can do that in an office as well because I'm doing the same thing. But there's pros and cons to both.

Howard: And another one I had to add is Misch. Misch, I did his nine 3D weekend course. But I look back, I loved all those guys, Carl Misch, my God I love that guy.

Kevin: Oh yeah.

Howard: Kois, I mean my God, Spear. I never met LD Pankey. I'm not that old.

Kevin: Me neither, but he definitely impacted my life.

Howard: But who was the guy, Becker...?

Kevin: Irwin Becker.

Howard: Irwin Becker.

Kevin: Yeah, Irwin.

Howard: Love that guy.

Kevin: Yeah, me too.

Howard: And I love it. We fought like cats and dogs. I mean we argued up and down, but it was great because…

Kevin: He's passionate.

Howard: Yeah, it was just passion and gentlemen can disagree and I love the fact that I was such bad student of his that he had to take me to dinner…

Kevin: Irwin did?

Howard: Several nights.

Kevin: Oh, I'm sure.

Howard: He said we're going to continue this discussion at dinner and I'm like this is cool. I get free dinner instead of arguing with the guy.

Kevin: So true.

Howard: Well the only thing, just to be clear, the only thing we argued about is I mean I have an MBA from ASU. There is more money in McDonald's than there is in Ruth Chris and some of these guys get so focused on the millionaire in North Scottsdale or Beverly Hills or Key Biscayne and they leave so much money on the table and, but as a dentist, I'm a firm believer that everyone needs a dentist. And I'm in Phoenix. I'm across the street from the Guadalupe Indian reservation where they still have dirt floors. 25% of my practice doesn't even speak English and I have learned some Spanish. I'm pretty sure that my name Howard Farran in Spanish is actually Gordo cracker because that seems to be the only two words I keep hearing over and over.

Kevin: It might have nothing to do with your name.

Howard: But there's dentists on Dentaltown like, "What do you do when someone's coming in and, you know they want pain pills?" Dude, you live in a society where 15% are alcoholics. Get the frick over it. I used to work at Walgreens and on Sunday mornings you know what we had to do with one of the employees in Kan City, they didn't sell liquor till noon. So someone had to be in the aisle where they sold Listerine because it's 28% alcohol and someone's standing there and all the alcoholics that come in, they drink the whole [inaudible 00:18:40] of Listerine and put the can back and if you weren't paying attention all your Listerine was empty. They all need a doctor and they don't need a judgmental doctor and they don't need a condescending doctor. By the way, condescending means talking down.

Kevin: Yeah, thanks, yeah.

Howard: So I loved them all, loved them all, but looking back at those who I loved the most is the people I met at those courses because what that young dentist does, a lot of them leave dental school and they live in an apartment with three guys who all they did is whine, bitch, and complain and moan and the sky's falling. And it's all unfair and everything is a problem but the man in the mirror. But when you go start finding the dentists that are taking a hundred, two hundred, three hundred hours of CE a year, there's no limit. It's all growth and if you hang with the right birds of a feather, you'll fly to the top in dentistry.

Kevin: Yeah, there's two things you just said that that struck me. One is about patients coming in. I'm actually giving a presentation next week at the American Equilibration Society in Chicago and it's about their connection to the systematic [napic? 00:19:52] system to overall health. But the beginning of that, at least that's what I'm presenting is to make an assumption, we know what happens when you make an assumption, right, except this is a very safe assumption that every patient wants to be healthy. If you ask anybody today if they got to wave a magic wand, excuse me if they got to wave a magic wand and say if you could have optimal health right now, would you? Show me one person that's going to say no? Of course, they want to be healthy. Everybody wants to be healthy.

Howard: Well, a lot of times married women have no desire to live. They're like if you could just shoot me right now.

Kevin: No, they would wave the magic wand. It would just be a different vision of what we have. Yeah, but they would and so that is a big deal though. To make an assumption that every patient wants to be healthy. Nobody wants to have chronic illness. Nobody wants to have some chronic pain or even acute pain, so that's a big deal. The…

Howard: That's my washing machine, thank you.

Kevin: I got that. Do you want me to keep talking to you?

Howard: Yeah, yeah.

Kevin: I'll wait for Alan. I love those washing machines. 

Howard: That means I overloaded the washing machine. Whenever I put too much in it, it spins out of control. Ryan, remind me not to put so much laundry in the washing machine.

Kevin: Yeah. The other thing that you reminded me of is you said attach yourself to good people is through Pankey back in the day for me, was a study club that wasn't an official Pankey study club, but it was a study club that people that I went through Pankey with we just decided we wanted to learn and grow together. And the mentors for that study club, David [Lattes? 00:21:39] and Margie Mannering I will completely honestly tell you today I learned more from those two about life and dentistry and good dentistry and occlusion and understanding who the patient is, I learned more from those two than I did from anybody else in my whole career, my whole life. So going back to the young dentist, I mean yes I started my education with Frank up in Seattle and then at Pankey there, but it was connecting with those two and learning from those two in a small group environment that absolutely changed my life and any young dentist can do that. You can attach to somebody and learn and that's my hope for every young dentist.

Howard: Now I'm going to prove that I am older than you.

Kevin: Yes.

Howard: I'm so damn old when I first saw John Kois and Frank Spear they were together.

Kevin: Yep. Yep. Yep, that's old.

Howard: I'm so old that when I first saw a Cliff [Ruddell? 00:22:37] [inaudible 00:22:38]...

Kevin: [inaudible 00:22:40] they were together.

Howard: They were together.

Kevin: There has been a lot of dental divorces.

Howard: Those were a lot and Dickerson I think he married and divorced. Who was he with?  Gosh, darn, Hornbrook, Rosenthal.

Kevin: Yeah, Rosenthal, yeah.

Howard: Nash.

Kevin: Yeah, there's been a lot of divorces.

Howard: Yeah and the reason I point that out is that why are you marrying another dentist? I mean you look at the biggest legends in dentistry. Cliff [Ruddell? 00:23:02], CB Canon two of the greatest, nicest guys on the universe, two of the greatest orthodontists that ever lived, they couldn't stay married. John Kois, Frank Spear, both world class they couldn't stay married. Dickerson and Hornberger and Rosenthal and Nash and others. I think one of the greatest pleasures in owning your own business is that you're a totalitarian dictator.

Kevin: You are, you are a totalitarian dictator.

Howard: And they divorce over things you don't see coming. You go, "Oh this is my best friend in dental school." Yeah, but you want to go into laser dentistry and cad cam and he wants to go into cosmetics or he wants to do a big Medicaid practice or he wants to start Denture World and again there's nothing wrong with Denture World because if a hundred dentists take an All on 4 course, ninety-nine will never do one All on 4 and they're all going to go home and do All on none five times a year for the rest their life. And there's ten times more money than All on None than All on 4. You just don't get it. You're always chasing this Clear Choice. Clear Choice biggest national DSO implants in an hour.  They do seventeen thousand cases a year in a country with three hundred and thirty million people and I can name you Denture Worlds and Denture Universes from Phoenix too, what's the armpit of ... what did Johnny Carson say was the armpit of California? Bakersfield

Kevin: I was going to go Fresno, but Bakersfield, yes.

Howard: Where these places do $5,000,000 a year and just doing dentures and but anyway, so but back to healthcare where you think they just want what the insurance will pay. My favorite economist, was Joseph [Shoompters? 00:24:51], creative destructionist, I learned the most at, but Milton Friedman remember his healthcare test the little blue pill?

Kevin: Yes.

Howard: Yeah, he said people would always say we spend too much money on healthcare and he'd say okay so as an economist we have to devise a clarity question because human’s words and actions never match up. That's why they quit doing focus groups because ten years ago, Phoenix was a big hotbed for all. You know they pay you a $100. You come in and they'd hand a product or on the table, but what you all said about the product and if you'd buy it and what you'd pay for it, never matched up to results so those are gone. But Milton came out with a little blue pill and he said, "Here's your options, Kevin. You either die tonight or you buy this little blue pill and you die one year for tonight. Those are your only options. You want to die tonight or what will you give me for your bill?"

Kevin: I'd give you a little bit for that blue pill, yeah.

Howard: Yeah, would you give me your house?

Kevin: Maybe.

Howard: Your car?

Kevin: Possibly.

Howard: Your iPhone.

Kevin: For sure.

Howard: Yeah, so the bottom line is the only people who say we spend too much money on healthcare are government officials who steal other people's money off the IRS and then buy healthcare for other people. But when you know it's you, I mean if you find any mom with a two-year-old baby and say your baby's dying of cancer, what would you give me to save your baby from cancer? She'll give you everything. So when you go to the people and the people say, "I'll give you my house, my car, my iPhone, my savings, my 410k if you don't let my baby die." Then how does the government get so detached to say we spent too much money on healthcare? So the bottom line is it's the same with teeth. I've asked this question to a thousand women in the last thirty years. I say, "How much money would I have to give you to pull your front tooth and you can never replace it and the rest of your life you'll have no front tooth. You'll look like someone from Oregon.

Kevin: Yeah, southern Oregon.

Howard: Southern Oregon.

Kevin: Eastern and southern Oregon.

Howard: Every damn woman, "Oh, my God no, and so obviously you'd take a million dollars. And I go, "No, I wouldn't take a million dollars." And just a minute ago you were all upset because you had $300,000 in student loans. Now you won't take a million dollars cash for your incisors so it's survival and so health is the only wealth.

Kevin:  Well, I think that’s…

Howard: The only true wealth is health.

Kevin: Yes and I think that's where we keep coming back to the young dentist and I'm going to double back on something you said a while ago. Two things to really help the younger, the newer dentist. Age maybe isn't a part of it anymore, but the newer dentist is one, is to always be genuinely, well the safe assumption that we said earlier, everybody wants to be healthy. Then be genuinely worried or concerned about the patient, genuinely. Like from your heart, like I'm worried that if we don't address what's going on right now if we don't take a closer look at what we're seeing right now. I'm worried about long-term for you. I want to help you be healthy, but if I am genuinely worried or concerned about you genuinely as a human being, then I'm going to connect with you as a patient. If I pretend to be worried or concerned so that I can talk you into doing dentistry, your BS detector is going to go off and you'll go somewhere else. So one of the biggest things for a new dentist is to find the way where you can connect with another human being and be genuinely worried or concerned about them. Genuinely.

Howard: My buddy across the street from me, [Gruce Lecollers? 00:28:30] place. What's his name, Ryan?

Ryan: Brett Houston.

Howard: Brett Houston.

Ryan: Hewson, H E W S O N.

Howard: H…

Ryan: E W S O N.

Kevin: E W S O N, Hewson.

Howard: Brett.

Ryan: Brett Hewson.

Howard: Brett Hewson. You're probably wondering why he's my best friend I don't know his name. I'm senile. I admitted it. Me and him always we always talk sincerely we're across the street from each other forever because when you come into me and I tell you have four cavities, you're selling me something or how do I even really know and I want to double back around you because I want to know if in case presentation, you hate that term, but if there's any technologies that you think help with case presentation, but he has the same thing with guys like me because when the engine light comes on, everybody knows it's the idiot light because I mean I grew up with five sisters playing Barbie dolls. I don't know anything under the hood. Lots of people go in there have zero experience. Thirty years ago lots of kids were in the garage pulling transmissions, doing tune-ups, changing the spark plugs.

Kevin: Oh, yeah.

Howard: Not any more of those cars are…

Kevin: No, you just go to Gypsy [inaudible 00:29:34] that's all you can do.

Howard: He is more successful than I am. I mean his business is booming, but it's all because…

Kevin: Depends on your definition of success.

Howard: Well, I mean he's got great reviews and he's got eight bays filled and he's got long-term staff, but the bottom line is all the people around here trust him and an auto mechanic is like a used car salesman because they don't know when that engine light comes on and say, "Oh you need a whole new transmission." She's saying, "Isn't it just a dead battery? Are you sure it's my alternator?" And he has to convey trust and it comes from true empathy.

Kevin: Yes.

Howard: I'm so sorry you don't know what an alternator is or lifters or…

Kevin: Yes, yeah, but I got you. I'm here to help you. I'm here to help you move towards health.

Howard: So how can a person ... the bizarre, natural selection of dentistry, physicians and lawyers that they just selected the ones with four-point O. So it's always the introvert, geek who sat in the library for four years. If he or she was well rounded in a frat, a sorority, who had a lover, went out to a movie, had date night, anything going on they would've made b's and c's and never been a doctor, dentist, lawyer. So everybody listening to you, I mean when you tell me that you understand Geometry, Trig, and Calculus, you're a freak. Normal people don't understand that shit. How do you train them to take their introvert Trigonometry and have them convey empathy and sympathy and case presentation and leadership? I mean how many of these dentists when they get done doing a root canal go in their private office and shut the door.

Kevin: All of them.

Howard: Yet when you're watching the Super bowl, where's the coach? Right on the line, walking with the line, totally involved. I always walk out my patient to the front desk. If I'm running late, Don says, "Howard, Kevin Kwiecien, your next patient, he's not too happy. You're supposed to see him at 10:00, it's 10:15." I walk out there, "Dude, I'm so sorry."

Kevin: Yeah, you just said it though in fact, that was what the other thing I was going to circle back on. You brought it back again, which is the new dentists or the mature dentist who is an introvert that just wants to go back in their office and shut the door because they're exhausted after having to be on stage while they were with a patient, because really most of them are introverts and it's exhausting. I know that from personal experience. True success is two things. It's one being worried or concerned about a patient assuming everybody wants to be healthy and the other is developing a true, a team centered practice. It's not about you, Howard or me, Kevin anymore. It's not even about the name of the business whatever it is. It is if you walk in every day and your goal is to create a team and you, it sounds a little hokey, but I'm very passionate about it, if you create a culture in the office where you look at every one of your team members and say, man, "I love you. I genuinely, I love you and I want you to be happy." And, but that doesn't mean that the whole practice revolves around you front office or you assistant or you hygienist. It is a team centered approach. There's a book that's called, "Outward Mindset" and basically it is, and it's basically it couples on Peter Senge's, The Fifth Discipline, so throw in Peter Senge …

Howard: Outward Mindset.

Kevin: Outward Mindset, yeah by the Arbinger Institute.

Howard: Ryan, can you text me that. What's that?

Kevin: It's written by the Arbinger Institute. They also wrote Leadership and Self-Deception.

Howard: The Arbinger…

Kevin: Arbinger, Arbinger Institute.

Howard: Can you send me that, the Arbinger Institute

Ryan: Arbinger…

Howard: Arbinger Institute wrote a book Outward Mindset.

Kevin: Outward Mindset you couple that with Peter Senge who is one of the most brilliant people who look at leaders and team-centered philosophies and incorporate that into your practice because it's a business. And so Outward Mindset basically is every day if you walk in and you say, as the dentist, "Assistant, what do you need today to do your job to the best of your ability? Hygienist, what do you need to do your job to the best of your ability?" And everybody else in the practice, but everybody else does the same for everybody else. The assistant looks at the hygienist and says, "What do you need today to do your job to the best of your ability? What do you need Dr. Farran so you can do your job to the best of your ability?" And everybody does that, that's outward mindset, but then you develop systems, and I'm not a big fan of that term, but it is what it is. If every system in the office is designed so that everybody can do the job to the best of their ability, it used to be that we were patient-centered, right?  Every system was designed around so the patient could have the best experience ever. It's all about the patient. It's not about me the dentist. Not about ... it's about the patient. If we start to look at every system being designed around the team and supporting each other, that walking up to the front office, you know why you're going to walk the patient up to the front office even if you're an introvert, because Cindy, your front office said to you, "Howard, for me to do my job to the best of my ability I need you to walk the patient up and verbally say what you did today and what you want next so that the patient can hear you tell me so that's the patient hand off. Now if you go sit in your office and go email somebody because you're exhausted from doing the root canal, you're not helping me do my job to the best of my ability and now you have a reason to walk the patient up to the front because you're doing it for Cindy, your front office person who you love and respect, and that's what she needs to do her job to the best of her ability. So for all the young dentists, every dentist, it really is about looking at a team centered practice and all of a sudden the energy goes through the roof and who does get benefited probably the most from it is the patient because they walk in and they go, this is phenomenal. There is something about ... they say, I don't know what it is about this place, but it is different. It's different. And not only did you ask me about my sleep and my nutrition and my wellness, nobody's done that before. You've also looked at the way my whole chewing system works, my muscles, my joints, and the way my teeth come together. But then there's something about the feeling about this place the way you all interact with each other. You want to talk about shutting the back door that's where we started the conversation with, right? Nobody is trying to go out the back door unless they have to move or die or something because why would they go anywhere else? So that really I get a little passionate about this, but that really is how the young dentist can be different and survive. You started this podcast with the question, can the young dentist achieve what we've achieved? Can they still have that practice? Oh my God, yes and moreover because luckily this next generation, I'm not a big fan of going millennial's, but there is something…

Howard: Sorry, going millennial?

Kevin: Of using the excuse oh, it's all about the millennials. I mean they're human beings call them what they are. They're human beings, but the cool thing about the millennial generation is they do like human connection. They do like collaborative environment. They do like connecting with another human being.  So I think this works in their favor.

Howard: Did you know [inaudible 00:36:41] quarter didn't have children. They say the millennials will be a third.

Kevin: Won't have children?

Howard: Yeah. When you go to the twenty richest economies in the world, everybody's bashing immigration and immigrants and you can't get a dog [inaudible 00:36:56]. If you backed out immigration of the twenty richest countries in the world, the United States, Canada, Germany, Sweden, Switzerland, it'd be like Japan. Japan, every single ... Ryan, how many less people are there in Japan every year? That's a number you need to memorize for your old senile dad, but in Japan it's huge. I mean and it's hard to grow an economy in a shrinking population. But, God, you made me think of so many things, but Outback and a lot of these chain restaurants are getting rid of their breakfast because …

Kevin: How do you come up with this sometime...?

Howard: No, because you're saying that everybody is doing everything for the patient, but what about the team.

Kevin: Yes, yes.

Howard: And Outback was looking at their managers back in the day and they said their breakfast, lunch, and dinner, these managers are in here from early morning, late at night, seven days a week, and we have a bar and basically in three or four years our managers are alcoholics and we have to fire.

Kevin: Yep, totally.

Howard: So they started looking at lifestyle and they said we need to do a lifestyle. So they gave up their breakfast because all the MBA and Wall Street people are saying, "Well, you …

Kevin: You're missing out on the business.

Howard: Your land and building and everything's paid for …

Kevin: Yeah, the more hours you're open the more money you're going to make. Yeah, exactly.

Howard: But the toll on human capital they said no and that's another thing I look at dentists when you have an office and they're in there Monday through Friday, eight to five and half day on Saturday, they pace themselves for like a marathon.

Kevin: Oh, it's terrible.

Howard: They're just barely moving and then I'll see an office that will work Monday through Thursday from 6:00 AM to noon. They come in there, it's the hundred meter dash.

Kevin: It feels so good, so good.

Howard: Everybody's pumped and going and they'll burn six to noon without taking a break…

Kevin: And love it.

Howard: And do more production and then go refuel for three days. And I think Rick [Kirshner? 00:38:38] was the first one that showed me on that. He said, what was it?

Ryan: It's dropped to one million in the past five years. I can't find one for every year, but in the past five years a million people…

Howard: So two hundred thousand a year?

Ryan: Yeah.

Howard: Six years ago Japan was the first country on earth to sell more adult diapers than baby diapers.

Ryan: [inaudible 00:38:53]

Howard: Yeah, so they're at point nine. You need to two point three kids per family to keep the herd stable and they're like point nine. So, but Japan's problem is they don't like any immigrants. In fact the only restaurants ...  you were with me [inaudible 00:39:14]

Ryan: Yeah.

Howard: The only restaurants in our life where we were turned down because we were white was where?

Ryan: Japan.

Howard: But where?

Ryan: It was Tokyo.

Howard: It was Tokyo.

Kevin: Tokyo.

Howard: I mean and you were mortified were you?

Ryan: I was legitimately infuriated.

Howard: I mean it was crazy, it's like Japanese only. It's like we're Irish, man. Really you're not going to let an Irishman in here? And oh my God. If you went to Tokyo and you married a girl, the family would just consider her, she died and so every country has their challenges. But I still think the hardest skill they're ever going to learn like you're talking about being a great dentist, they have to be a great leader.

Kevin: No, that's what I'm talking about. Team-centered has nothing to do with dentistry.

Howard: Yeah, and team-centered and I can't tell you how many dental offices I've been in and how many seminars I've given where you were a hygienist I'll say, "Well, which one's your dentist?" And they go, rolls her eyes, "That guy." Rolling in contempt. There was a study done in Washington DC where they're still doing it. They can predict five year out, sixty months out divorce rate to like something like 96%  and what they do is during the session, they have you on high-speed like hundred frame per second deal and they're looking at your body language while you're talking and they're looking at the words you choose. If you say my dog, my friends, my night out, my checking my, my, my, my, in the mind they're not even married. But if everything is our friends, our dogs, our checking our, our, our, they're like okay these people don't even have separate identities, they can never live apart. But in body language, rolling the eyes or flaring the nostrils during a deal was the ... rolling the eyes with the highest predictor…

Kevin: Of course.

Howard: Of divorce within five years and every single seminar I've ever gone to some staff members up there rolling their eyes about the doctor and it's, okay how do I know that your assistant is toxic in one second. And she's on your payroll and every dental office because only I ever talk to, one of the biggest realms is there's always a toxic person in the office and half the time it's the dentist. Half the time the nightmare is the dentist.

Kevin: I would agree.

Howard: But getting team harmony those patients feel that.

Kevin: Oh, they do.

Howard: When you walk in there anybody who's been in the bus thirty years when you walk into a dental office, you can feel the successful office instantly. It's just good karma, good vibe, everybody's smiling.

Kevin: It's love, but it is. Like there's this energy of everybody loves and respects each other here and that is the outward mindset. That's the team-centered approach and…

Howard: And you have to nail that. You have to nail that and it's…

Kevin: Well, it's pretty darn helpful if you do.

Howard: It's everything because it affects your stress. Your [inaudible 00:42:11]

Kevin: Yes, you don't feel like you need to go into your office and shut the door after the root canal. You don't, it's a game changer. It really is and going back to your Outback steakhouse example, I mean, I remember vividly…

Howard: You did not see that coming, did you?

Kevin: No, but I liked the example though. Back in my Portland practice I had a practice in Reno and then in Portland but my Portland practice, there was a time where I was moving more and more into academia and that was where my energy was. I loved my practice. I loved doing the dentistry, but I got asked to do some things at the dental school, so I started giving. I didn't get paid for it at first. I didn't get paid for my Wednesdays at the dental school. I started giving my whole Wednesday and my team was like, "You're what?" And I'm like, "Well you can still do hygiene here because we're in Oregon." And they could still do hygiene and it allowed the assistant to get caught up with lab work. It allowed the other assistant to get organized and then I was really doing dentistry Monday, Tuesday, and Thursday that was it. Do you know that the energy in the entire office was through the roof? The Wednesday when I wasn't there was awesome for everybody else. I recharged because I was at the dental school and I never practiced dentistry more than two days in a row, Monday, Tuesday. Went to the dental school, Wednesday then back on Thursday. Production went up, efficiency went up, everybody's energy went up. We all supported each other. I mean and that really is going back to the Outback, yes, you have to pay the bills. You can't just work one day a week and make everybody happy and say, now go have six days off. There's a happy medium in there, but if you are looking at helping everybody be healthy, helping them have time for their families and encouraging them to be healthy.  One of my biggest, it's not new, but it seems to be new in the world right now I don't know why is if we're asking our patients to be healthy but we're not helping our team or ourselves be healthy that lack of congruency shows through so quickly to most human beings. So if I treat you my team member, if I say, "Are you getting enough sleep? How are you sleeping by the way? Are you [apnic? 00:44:21]? Have we dealt with that? Are we dealing with the way you're sleeping? How about your nutrition? How about your wellness and by the way, how about your mouth. How you feeling? How do your teeth look?" Right, and then if I'd done that for myself, but if we create an environment in our practice where we really love our team members and care about their life outside of dentistry then it shows and by the way, why wouldn't you? Your slaves, you would care about them as much as you care about your kids. You should and when a young dentist realizes that that's what a big part of being a leader and a communicator is. You don't have to look at what do I need to do to be a leader? How am I, good communicator? Mostly it's about being genuine and vulnerable. It's about having human connection and then that is a good leader and that is a good communicator. So if you're just vulnerable and genuine, you just knocked out two things that dentists don't like on a regular basis, which is leadership and communication.

Howard: I remember two big lecturers back when we got out of school were Jim Pride and Walter Haley.

Kevin: Of course, yeah.

Howard: Remember those guys and I remember Jim Pride was always saying, "Why can't you sell all these big cosmetic cases and these orthodontic cases and all this stuff?" And then the guy next to you'd be saying, I mean Jim had some of the worst teeth I'd ever seen in my life. Walter Haley and Jim Pride, brown, cricket, gnarled, mangy, and I was the one who called Jim [inaudible 00:45:43] and I said well if it's so easy to sell, why do you have the darkest brownest, gnarliest teeth in the room. And I always saw that a big part of selling ortho dentistry in the cosmetic dental offices and what we did in our offices, is that when assistants came we fixed up their teeth. We gave them braces, bleaching, bonding and it was so cool and people say, "Well, does Invisalign work? “And they go ... you know.

Kevin: [inaudible 00:45:34]

Howard: Go back to 1987, "Well does bleaching work?" I'm wearing it right now. "Well, can you wear it at work?" "I'm wearing it now." And when you go in the offices, who's the guy out there in Beverly Hills, Century City, Bill Dorfman.

Kevin: Dorfman, yeah.

Howard: Oh my God every person in his office has a million dollar smile and sometimes they will have the rocking hot person to do this, but she doesn't have the teeth or he doesn't have the teeth and they redo the teeth so it's a mixed signal.

Kevin: It is.

Howard: When they pull up to the office and your two dental assistants are having a cigarette break out the back door and then they're running in there smelling like smoke telling you to quit smoking and …

Kevin: Yeah, it's funny though there's a…

Howard: You remember Walter Haley's teeth though?

Kevin: No, I don't.

Howard: My friends that worked there had said every single seminar he ever gave at least one dentist volunteered to do all his dentistry for free.

Kevin: To do his dentistry for free.

Howard: At least one and he'd say. "Don't have the time." He was a character.

Kevin: Yeah, but you know what's interesting about that is so if you can look at all the practices and we make everybody optimal, which isn't just smile, right, because form follows function so teeth that look good usually function good. It's not just about making them look good, which is one of my issues with this male home Ortho these days because you can make them look good, but if they're not functioning well they're just going to break and crack and create muscle pain or joint pain or loose teeth or whatever.

Howard: But do you think it's going forward with Smile Direct Club or do you think there'll be legal interventions. I mean the American Orthodontic Association, the Association for Orthodontists obviously there's lawsuits flying.

Kevin: Oh yeah, but my guess something like that is here to stay. That's my slightly uneducated I would say, but slightly educated guess is that it's not going away. Some form of that is…

Howard: America always pretends it's about truth, liberty, and justice. It's about money is the answer, what's the question and this whole country is based on build it faster, easier, higher quality, lower costs, and the low cost. Southwest Airlines, Walmart, Ikea, Costco and Smiles Direct is where this country will always have. This country doesn't care if the rich king has enough limos, they always want to get the most limos to the middle class so that's the direction the country's been going for three hundred years so you're not going to put that genie back in the bottle.

Kevin: No, the good news is and I'll come back to everybody having perfect dentistry in the office, but the good news about money and the way the system is changing is honestly one of the good things is, these days because of digital dentistry and the way we are practicing dentists can, if they want, they can start to charge less than they used to. They can help keep the cost of dentistry down because of advancements in materials and technology. So…

Howard: Can you give some examples.

Kevin: Oh, for sure I mean the obvious one would just be cad cam dentistry, right. I mean you can certainly do a crown, I hate to because we always talk in crown units, but you can certainly do a crown for less than you used to right now. Even if you're still paying for the cad cam unit, when you look at the big picture you go to, and I'm not saying this is optimal I'm saying that you have an opportunity to charge less than you used. You don't have to set up the operatory twice. You don't have to have an extra hour two weeks later, you can be doing something else at that time. The materials are…

Howard: But would the doctor be the one scanning, designing, milling, staining, glazing, or would that all be an expanded function?

Kevin: Well, I love the idea of empowering others in the practice to do that because that's when they love their job more, right?

Howard: Because I think it actually costs more money to do cad cam if the doctor does it all. I mean I've seen…

Kevin: Oh yeah, it's pretty close, right. Yeah, it's not an obvious, oh you're making, but yeah it's about systems that makes sense and you really could. You could say, "You know what, my buddy next door is charging two thousand twenty-two hundred bucks for a crown or whatever. And yes, I used to as well."

Howard: Well, economists thinks it's pretty damn cool when the dentist is buying $100,000 cad cam and giving it to an American worker and building your skill set you know what I mean?

Kevin: Yes, oh for sure.

Howard: That's raising human productivity.

Kevin: Absolutely.

Howard: But my problem with the cad cam is so many of these dentists stated they're control freaks they can't delegate. So when they actually buy a cad cam and do it all their selves I cringe, but it's like [inaudible 00:51:01] teaching a cad cam up the street here, and I'm in Phoenix, he's up here in Scottsdale teaching and stuff. The dentist that goes there alone to me that's frightening, but the dentist that brings the two assistants and sneaks out and goes to the golf course three times during the week that's the guy that could make money off it. Cad cam do you have any brand names that you like?

Kevin: Well for the past four years I've been dealing with almost strictly CEREC because I was working with Sam at Spear.

Ryan: CEREC, which is Dentsply Sirona.

Kevin: Serona, yeah.

Howard: Is that company called Dentsply. Sirona?

Kevin: Yeah.

Howard: Yeah, are there any others? At the last IDS meeting in Cologne, there's a lot of new participants.

Kevin: Trios and 3Shape is phenomenal.

Howard: For scanning or cam?

Kevin: Both.

Howard: So Trios and 3Shape have the milling machine?

Kevin: They don't, as I sit here right now I feel sort of stupid because I don't know the answer because I've been so sort of in my own little bubble. No, I mean there's several milling machines out now, several.

Howard: Yeah, because like everything in America when I bought my first DVD player, you wouldn't even believe it was eight hundred bucks and it sucked. And then two years later it's $400 and it was twice as good. Now they're under fifty and they're perfect. So I thought cad cam would be becoming down because that's why Sony used to have an exclusive with Patterson and they canceled that.

Kevin: Yes, they changed the world a little bit.

Howard: Because Patterson wouldn't be able to carry 3 Shape and Trios and all the stuff like that.

Kevin: Yeah, exactly.

Howard: So what other [inaudible 00:52:50] technology that dentists are able to do lower cost dentistry.

Kevin: Yeah, that is materials and supplies and everything. We just talked about the flow in the office, you really can. You could do dentistry for less per hour now than you used to do.

Howard: But any other technologies or materials come to mind.

Kevin: Well think about a printer. Think about a…

Howard: 3D printing.

Kevin: 3D printing and creating a surgical guide that you can do that. You have your own CBCT unit you've scanned the arch in with your own whichever scanner you want. So you have a CBCT, you've got your implant software in there. You know where you want the implant. You've got a 3D printer. You can now real quickly and efficiently print out your own surgical guide.

Howard: You know how I'm going to get really, really rich? I'm going to buy a 3D printer that prints out 3D printers and just sell them out the back door of my dental office.

Kevin: Oh, that is a good idea. Talk to me about that one before you go there. I'll give you ten bucks for that investment.

Howard: Okay, back to materials you and I when I was in school, cosmetic dentistry was the PFM.

Kevin: Yeah, mine too. We stocked porcelain.

Howard: Yeah, if it wasn't PFM it was gold or amalgam and I never saw it coming in 1987 that someday that PFM would go the way [inaudible 00:54:13], but when we started doing [inaudible 00:54:14] composites I mean they took forever. Layer, cure, layer, cure, layer, cure, a lot of people were wondering with these bulk fill composite. I mean they seemed attempting just to fill that baby, fill up the boxes, cure. Fill up the rest, cure as opposed to all those incremental errors. Are you a fan of bulk fill or not really?

Kevin: Well, you ask an interesting question. Two of my really great friends and mentors both our Jack Ferracane and Tom Hilton from Oregon.

Ryan: Jack who?

Kevin: Ferracane.

Howard: Spell that.

Kevin: F E R R A CA N E, Ferracane.

Howard: And he teaches at Oregon Health Science.

Kevin: Yes, he's one of the Associate Deans.

Howard: Ferracane?

Kevin: And then Tom Hilton is one of the authors of one of the books, Operative Dentistry and both have done a lot of research on composites and I tend to abuse my ... I don't abuse it because they're happy to share it with me, but I tend to utilize my relationship with both of them to stay up on composites and the research that they're doing. There's the snowplow technique where you put a little flow-able in their first and then start to layer it up, but the bulk fill, what they do now today is that absolutely the bulk fill it's curing a good solid four millimeters in depth. So if you use warm composite, if you can warm it and you can with bulk fill you are going to get a great adaptation and a great depth of cure. So it's getting easier.

Howard: Can you send them an email and cc me howard@dentaltown.com and see if they'd come on the show and talk about it?

Kevin: Sure.

Howard: Because it's a very common question because…

Kevin: Well, Jack does a, well they both do a phenomenal ... Jack this past year, I mean, Tom is absolutely amazing one of my very best friends. Jack did in this past year where I saw him at the American Academy of Aesthetic Dentistry and Restorative Academy this past year and did a great update on today's composites and it's one of the best presentations out there right now on today's posterior composites. So…

Howard: Because it's one of those things where people want to believe. They hope it's true.

Kevin: Yeah, oh yeah. I have the research like I say when somebody asks me a question, I don't know the answer, but I know who to go to and so when somebody asks me a question about posterior composites and I go, I don't know, but I know the guy to ask. And so they make me look sort of smart, but everybody knows I didn't know. I just asked Jack and Tom.

Howard: I'm going to send you an email on that because that's a million dollar question that people are wanting to know.

Kevin: Oh yeah, they're great people.

Howard: [inaudible 00:57:13] so I'll be haunting you now with email.

Kevin: It's okay.

Howard: So what are my homies going to learn if they go to your website, which is www.ksquaredfacilitation.com? What are they going to find? What are they going to learn? What do you do for them?

Kevin: Thank you for asking. What I do for them is the exact same thing they do for their patients, which is do a comprehensive exam to find out what's going on with the system in the first place. There's nothing cookie cutter about it. It's who is the person just like you do your patients, all the dentists out there. Who is your patient as a human being? How are they working right now? How is their whole systematic [napic? 00:57:58] system working? That's what I do for the practice. Who are you the dentist? If you came to me right now I'd say, "Howard, who are you as the human being? Why are you coming to me? What are you struggling with? What are you looking for in general?" And then just like I would if you were my patient I would do a nice comprehensive exam. I would do the same if you were a dentist. I look at your whole practice. I look at how it's going on, all of your systems and then come up with a treatment plan and the treatment plan is even though, and that comes back to where we were talking about teams earlier, does everybody in your team have to have the optimal smile and function? It would be cool. It would be awesome, but maybe that's not appropriate for everybody. But we can take steps to move towards health as opposed to doing nothing and what steps are appropriate for you. So again I keep going back and forth between patient and what I would do for practice or a dentist because it has to be congruent. What I'm doing for the practices is exactly what I've done for teams and patients my whole life, which is care about you as a human being. Evaluate how you're doing. Understand what optimal looks like and decide what steps are appropriate for you to move towards health. And that might be leadership, it might be communication, it might be systems, it might be dentistry. You might just be suffering because you don't have the confidence in dentistry. You don't understand occlusion. You don't understand joints and muscles and how it's connected. I can help with that. It might be to help your team understand that and create team centered systems so that you can do the dentistry that you want to do. And it might be helping you become a better leader, communicator and it's probably all of that.

Howard: So again, on your website, so what do you actually do? I mean do you go to the office or is it your website. Is it lecture, is it videos and CD Roms? Is it…

Kevin: There's no CD's, no. No CDs.

Howard: No CD Roms.

Kevin: That I can say no out loud. For sure, no.

Howard: Is it one on one? Would you call yourself a practice management consultant? I mean obviously you're an international lecturer, but what tools are on your website?

Kevin: Yes. On my website?

Howard: I mean to my homies if they call you up, do you go to their office?

Kevin: Yes.

Howard: Is this over the phone?

Kevin: It's whatever's appropriate.

Howard: It's what they need.

Kevin: It's whatever is appropriate.

Howard: So you have like a cafeteria.

Kevin: Yes, I do.

Howard: You can go to the office.

Kevin: Yes, absolutely, yes go to the office. I look at numbers. I always look at the business side of the practice because the business tells you a lot about how the practice is moving along.

Howard: I want to back up on, okay you say you don't like case presentation. What word do you like? 

Kevin: You know I like to on the day where you would call it a case presentation day, it is a day where going back to Bob Barkley co-diagnosis and co-discovery. Yeah, I know sorry I bring that one up but we forget about that. We think the young dentists out there think that they have to have a treatment plan and the day they present it they've got to be ready for every no that the patient says. They have to have a backup plan to the backup plan, to the backup plan and be ready for whatever the patient says and have thought about everything the patient might say. As opposed to if it starts out early on that we are co-discovery with you and co-diagnosis that the day that you would call case presentation it's the obvious next step towards health. It's us coming up with a plan that is appropriate for you as Howard Farran, that patient on that day. So it doesn't have to be stressful because it started the day they walked in the door.

Howard: The thing that I have so much passion about, Bob Barkley, who could be the father of preventive dentistry. When he was going around, he died early in a plane crash off to a lecture back in those small planes. Back then ...

Kevin: He wants to help his patients get worse at the slowest possible rate.

Howard: Yeah. I mean we all end up dying. My goal's to be the first person that doesn't die.

Kevin: Nice.

Howard: It's my goal. [Inaudible 01:01:59]

Kevin: You know what I'll be second. I'll be watching you.

Howard: But back in his day, you're not going to believe this when dentists were talking about setting up a hygiene department they'd always say I'm too busy extracting teeth and doing immediate dentures and right now at 2018 you think no way, no way. Way, I mean that's what he was up against, but he wasn't digitized so he was in lectures so he's gone. And I have always asked homies out there if you got any of these old classics. I mean I'm so glad I got to do a podcast with the infamous Carl Misch, Bob Ipson, the pediatric laser dentist legend, Margolis in Chicago. I mean I've already done three podcasts where they passed and I'm so excited because most podcasts they do audio for iTunes, but I always do video because YouTube and Google are the two biggest search engines and our views on video are amazing.

Kevin: It's fun to watch.

Howard: And plus on Facebook, if you upload a video ... I mean we've had ten where we upload the video on Facebook that had over a hundred and ninety thousand views, but if you post on Facebook a link to leave Facebook and go to iTunes or YouTube, they kill that. It will not go out. So I've already got three RIP podcasts and I always wish I could find a Bob Barkley and a LD Pankey. It probably be on a VCR. By the way, a VCR that's a small thing that uses a tape.

Kevin: Remember, well there's Beta and VHS.

Ryan: I got an email from Omer Reed. I think he said his last email was, "Oh I have the Bob Barkley video that your dad would want." [Inaudible 01:03:33] Barkley tape, so we actually just…

Howard: Nice.

Ryan: [inaudible 01:03:46] Omer Reed has a videotape…

Howard: Nice, Omer, we did Omer. So will you call him on that?

Ryan: Yeah, I did. I said how can I get it from you? Over there and pick it up.

Howard: And I know his email where he says he can't call that I've missed no calls from Omer. He's in my phone, but yeah, you go pick it up. You're young, you can drive clear across town. See what's weird about Phoenix is, you're not going to believe this in Phoenix but I have friends in Queen Creek which takes me an hour to get there. And then I have friends in Sun City, sunlight takes me an hour to get there. So Phoenix is a metro of three point eight million people and on an interstate driving sixty-five miles an hour from Queen Creek to Sun City's damn near a two-hour drive. I mean this is crazy so a lot of people they always say, "Well, oh, do you ...?"

Kevin: Just pop over.

Howard: Dude, Omer is an hour away.

Kevin: Yeah, it was fifty or so minutes for me to get here today.

Howard: It was fifty minutes?

Kevin:  Yeah.

Howard: Thanks for doing the drive. I want to go back to you know I've learned more in my journey from basic Science, Anthropology, Sociology, Psychology than I ever, I still don't know what I learned from Calculus, Physics, Geometry. I never use that stuff, but when I look at treatment plan presentation I just think, earlier you're saying makes much sense because you're saying that they need to be empathy and sympathy. And when they have empathy and sympathy they have guilt and they don't want to tell you have fourteen cavities. So the young ones that are the most empathetic just picked the worst tooth and they do two dentistry and then, later on, they get a little more sophisticated and they go to quadrant. So how does an empathetic guy like you do case dentistry because they're mortified. Could you imagine I walk in and you love this person and you know they're having through hard times and their husband lost their job and you got to be the one to tell them that they can't have a regular cleaning, they have gum disease? They have nine cavities, they need three root canal. How do you be empathetic and present a $20,000 treatment plan?

Kevin: If they don't I will ... one of my other mentors is…

Howard: I mean do you agree with that assessment or not?

Kevin: Mostly, mostly yeah. I don't know if I'd put those exact words to it, but mostly for sure. I would say that if we don't have an idea of what optimal is, we can't even have a conversation about how to get there. The conversation will never happen. So Joan [Undershoots? 01:06:06] and Mary Osborne who are two of my other, I have so many mentors, will say if you come in and you just say, just fix this one tooth and I just fix that one tooth, then we have no idea what optimal looks like or how we can even start to move towards optimal. So the empath in me says, you know what I understand there's a lot going on in there and I understand and maybe we can't do it all right now because of where you are in your life. But if I don't look at everything that's going on and have a vision of what's optimal, then we'll never even have a conversation about what this looks like and how we can get there, right?

Howard: Right.

Kevin: So even if I say yes I am just going to fix that one tooth right now, I empathize with you, but maybe I can fix that tooth and I can put a little composite on a couple of your front teeth to help your guiding teeth protect your back teeth. That's it. Just help your guiders do their job to protect the squeezers in the back for a while and that's going to help us move towards…

Howard: The guiders in the front... 

Kevin: The guiders.

Howard: The guiders in the front to protect the squeezers at the back?

Kevin: Squeezers in the back, yeah.

Howard: I like that. I never heard that.

Kevin: That's their job.

Howard: Thirty years I never heard that.

Kevin: See and this is what happens though this is the conversation you have with patients. It's like, you know what, your teeth have a job. It's cool and they look good, but teeth that look good usually function pretty well, and teeth that don't don't. You got your guiders in the front, their job is to protect the teeth in the back that are the squeezers. And your guiders up in front, I'm not saying you're ugly Howard,  but I'm saying your front teeth look like they're pretty chipped, which makes me think that they're not doing the job that they could be doing to protect the back teeth in the back. So if we don't look at what it's going to take to get your guiders guiding and your squeezers squeezing, we don't even know what steps to take to get there and that's when it goes back to yeah I'll fix that one tooth, but I'll bet you for pretty inexpensively I can put some composite on some front teeth and get those teeth guiding real nicely to protect your back teeth. And in the meantime, one of the reasons that your front teeth are probably getting beat up because it's probably related to your apnea some kind of sleeping disorder. So maybe you could see your physician or we could look at what is going to help to make you sleep better so that you don't beat up your front teeth so that they can guide better. And so I guess my point is the empath in me is not afraid to talk about what optimal is. In fact, I would be remiss and sort of a hypocrite if I didn't.

Howard: I've been calling and predicting, you know we talked earlier about those guys in Washington DC that can predict 96% success rate on their marriage five years out by how their body language and the words they choose and everything. I'd been predicting successful kids come out of these dental schools for years, especially the two in town. They've been there a decade and I'll just sit there and go you're going to crush it and your buddy I'm worried about. And it was always because they had the people skills. They could talk, they could communicate, they looked you in the eyes so they'll end up being good leaders.

Kevin: But the guy that's going to suffer, by the way, can learn those skills. 

Howard: Yeah, absolutely, and I had a column on a couple months ago. I called it Doc Hollywood because a lot of people always telling me, well, I'm not like that. And I say, well, look at the most ...who's my two famous actors that...?

Ryan: Anthony Hopkins.

Howard: Anthony Hopkins, but no those two girls, Meryl Streep.

Ryan: Okay, yeah.

Howard: And that Jane Bateman, or who's the one that played in The Color Purple? It was the one about the Clinton's, the Clinton's.

Kevin: That was not Color Purple.

Howard: Yeah, what's that called?

Kevin: I have no idea.

Ryan: [inaudible 01:09:55] it out. Hillary Clinton, the Movie. [Inaudible 01:09:57]

Howard: Movie about Bill and Hillary Clinton.

Ryan: The Clinton [inaudible 01:10:04]

Howard: The color of money or ...John Travolta was in it. Movie about Clinton's with John Travolta.

Kevin: What?

Ryan: [inaudible 01:10:1] Primary Colors.

Howard: Primary Colors.

Kevin: Oh, that's a color.

Howard: Primary Colors.

Kevin: I see where you're going.

Ryan: [inaudible 01:10:27] let’s see, John Travolta, Emma Thompson, Kathy Bates.

Howard: Kathy Bates. Is it with a K or a C?

Kevin: Wow.

Ryan: K.

Kevin: I can't believe you guys. Well done.

Howard: My two favorite actors or actresses are absolutely Kathy Bates and Meryl Streep.

Kevin: Where are we going with this anyway? I can't remember that.

Howard: Because Kathy Bates can play a nurse that's tied up her patient beating and breaking his knees and she can play the sweetest, I mean they're characters. I mean Meryl Streep's one movie she's a fricking batshit, crazy alcoholic, looney and the next one she's the Iron Lady playing Margaret Thatcher. And I always say okay Anthony Hopkins really doesn't enjoy putting people in a cave and torturing them and all the stuff like that. You can go to work and you're now onstage and you become an actor and Meryl Streep, I remember there's only five movie producers who have done more than fifty movies and one of them, Oliver Stone is right now and they're asking him about who would he like to work with the most? And he says, "I like Utoli." He says, "For instance, Meryl Streep, she doesn't have to look at the script. She didn't even care about the script. She knows I'm doing the movie and whatever I give her she'll be that person and she'll nail it and it could be a sociopath, a loving wife, a murderer it just doesn't matter." And I remember Meryl Streep she was interviewed one time when she's with another person. I think it was Kathy Bates when they were in the same movie or something. I think it was those two. And one of them said, "Oh, I can't do this one. I really, really want to do this one." And Meryl Streep said, "I couldn't care less." So you can go to dental school, I mean you can pull up your dental office an introvert, geek listening to Beethoven, but when you walk through that door, you're the leader, you're Mrs. Personality, case presentation. And the way I look at case presentation you have to tell them everything's wrong. I don't want to go to the doctor and the doctors thinking, I can't tell Howie he's got prostate cancer and he needs a bypass.

Kevin: But it's not telling them everything that's wrong because nobody wants to feel like they're broken. You don't want me to tell you that you're broken. Nobody wants to be broken. It's the things I'm worried or concerned about and giving them hope that they can be optimal. It's really different that way. It's verbiage, but it's critical I think.

Howard: And another mistake they do is they bad mouth previous dentistry, which means, "Oh, remember the last dentist who told you needed this and you got it done? Well, I'm telling you that was a bad decision. It's all shitty." And then this one here does another bad one, "Oh and I want you to buy a bunch of new dentistry for another dentist." So I'll go in there and say, "That's cool you got your four wisdom teeth out. How old were you when you got your four wisdom teeth out and man, that crown back there that's really nice. Who did that?"

Kevin: It's good looking, yeah.

Howard: "That's nice. Who did that? That's good." You got to encourage them that all their past decisions of accepting treatment from dentists was good and then they secrete Dopamine, Serotonin, and Oxycontin and buy more. So when you go in there and bad mouth other people's dentistry now they're secreting Adrenaline. Norepinephrine. They're in fight or flight.

Kevin: Fight or flight, yeah.

Howard: It's just insane, but sorry I'm in overtime with you. Can I keep you in overtime a little bit?

Kevin: Sure.

Howard: Is there any technology that helps them with case ... some people swear by intro cameras or digital x-rays or ... do you think any technology helps with explaining to the patient their needs?

Kevin: Well, I go back to, yes, I go back to Bob Barkley again. I go back to co-discovery, co-diagnosis, and photos. Photos are a big deal. Just looking at what's there. Then...

Howard: When you're talking about photos, intra-oral or extra-oral?

Kevin: Well intra-oral, not an intra-oral camera, but you can get everything you want with a DSL these days. You can get it all there.

Howard: A DSL?

Howard: Just a regular like a Nikon or a Canon.

Howard: But when you say photos are you talking about taking intraoral photos and putting them on the screen or are you talking about taking extra-oral photos.

Kevin: Taking photos of their teeth and putting them on the screen intra-oral, but not with a wand per say I guess is what I'm saying.

Howard: Okay, but with an extra-oral camera?

Kevin: Yeah, right.

Howard: Taking intraoral photos with an extra-oral camera.

Kevin: Yes.

Howard: Okay and what camera do you recommend?

Kevin: I like the Nikon 7200 is one of my faves.

Howard: Okay, digital?

Kevin: Yeah, with just the ring flash. It's simple. They can set it up so easily and it's easy to use. That's one of my faves. But that is it and you're probably asking about DSD or those type of things. I think it's nice to have patients see what it might be able to look like, but it's more about helping them co-discover, co-diagnosis.

Howard: I got one final question.

Kevin: Bring it.

Howard: And I'm going to throw you under the bus on this one.

Kevin: Okay, please.

Howard: I call it dentistry uncensored because I don't want to talk about anything everyone agrees on. I like to talk about the debates, the confusion for the kids. Okay, the kids out there when they start looking at Spear, Pankey, Dawson, Nash versus [inaudible 01:15:27] Dickerson. They see this device of line that most of them are in this camp called CR and another one's called neuromuscular and it confuses them. And do you do agree with him that being a kid in dental school it looks like there's like two different camps on occlusion?

Kevin: Yes

.

Howard: Neuromuscular CR.

Kevin: Most dental schools don't teach neuromuscular so they're not confused.

Howard: So explain that because some of them are confused and some of them are real confused because maybe their mom is a dentist and she's huge neuromuscular.

Kevin: Sure, well then they're confused.

Howard: And then they're in school, so what would you say to a twenty-five-year-old female dental student who's like, "Well what's the [difference? 01:16:11] neuromuscular and CR?" And I feel like I have to pick my camp because like LVI is neuromuscular. Spear, Kois, Dawson is not. So explain the difference and they're at a fork in the road. They can't afford to go to all the camps. What would you tell them?

Kevin: Yeah, you didn't throw me under the bus and I think for me if you look at Pankey [Man 01:16:32] Skylar philosophy. If you look at Kois, if you look at Dawson, you look at Spear there's a reason that there's more of those that are if you want to call it centric relation or a fully seated [collar? 01:16:52] position. Call it what you will. It just makes sense to me and when you look at the way the body functions with the ball in the socket and the muscles pulling the ball into the socket so that it hinges open and closed. If your shoulder was always at different parts out of the socket and your muscles were having to hold it there all the time, you're asking the body to do a lot that's probably not stable long-term. You're just not. Now, that doesn't mean that ... so for me, that makes most sense. It's common sense. It just makes sense to me. Now that doesn't mean that neuromuscular doesn't work because what if you have jacked up joints? What if the ball can't go up into the socket because you've had some destruction or breakdown? Then at least you understand neuromuscular dentistry and you understand how it's done and there's benefits to everything. So for me, I think that the greater the breadth and depth of knowledge that we have, the more we can help our patients move towards health. You can't pick one and say the other one sucks. You have to look at them all and go, Ooh, that sort of makes sense. I get that. Or that makes sense. I get that and I could see where I could use that for you. If you got jacked up joints, I'm going to think about what I learned in neuromuscular and go, oh, that's going to help me figure out how to restore you with your jacked up joints. If you've got muscle pain and tenderness and solid joints, well, for me a fully seated collar position for me personally, it just makes sense. It's a repeatable position and why wouldn't I restore you there?

Howard: So your website, www.ksquaredfacilitation.com. Is that on Twitter or do you have Twitter? 

Kevin: No, I am not a tweeting guy. No, you'll find it on Facebook and you can find it on LinkedIn. But I don't tweet like a bird yet. I don't follow anything.

Howard: Can I throw you under a bus on that logic.

Kevin: Yes.

Howard: Okay, I'm going to go hard on you right now. So…

Kevin: You're not throwing me under the bus, you're schooling me.

Howard: I'm going to school you on it. So basically if I made a post on LinkedIn, it'll go to all thirty-six thousand of my followers. I do it on Twitter all twenty-five thousand. I do it on Instagram all forty thousand. They're direct feeds, they're not pay to play. Now Instagram is owned by Facebook and as soon as Snapchat dies, that's going to turn into Facebook and what is Facebook? I have three hundred thousand fans on Facebook and if I upload two hundred and ninety thousand forty- three when I put this podcast on there, it will only go to a thousand. If I want it to go to a hundred and ninety thousand I have to boost it for about three hundred bucks. So Facebook is all pay to play.

Kevin: Yes, it is.

Howard: Now our president of the United States, love him or hate him, I don't talk about religion, sex, politics or violence, but the only reason he's the President of the United States is because at seven o’clock at night only a million people are watching CNN.

Kevin: He's tweeting.

Howard: Only three million are watching Fox and what did he do? He disintermediated the middleman, the fake news and went direct. How many millions of followers does he have?  I don't even know, but I'll check right now. Twitter, I think he's called yeah, "Real Donald Trump." He has forty-seven million followers.

Kevin: That's a couple.

Howard: So Fox News and CNN has four million and then Potus has twenty-two million followers. So the bottom line is he basically disintermediated the press with social media so you need to build up LinkedIn. And LinkedIn was just bought by Microsoft and Twitter just turned a profit for the first time so I think they're in M and A activity right now. I think someone's going to pick them up and you're going to lose Instagram, so if you get in bed with Zuckerberg it's all pay to play. And I don't care if it's social media or women you don't want a lover whose pay to play. That's a whole another podcast, but the bottom line is I would really get in Twitter and Instagram.

Kevin: For sure, yes.

Ryan: Because it's doing nicely.

Kevin: Well maybe by the time you show this it will be.

Howard: And when it does text me and I'll push it out to my followers.

Kevin:  Okay, thanks. Appreciate it.

Howard: And thanks for following me on Twitter. I like that. I don't like Facebook because it's pay to play.

Kevin: Pay to play, yeah.

Howard: And but hey, I want to thank you for all that you've done for dentistry. I want to thank you for coming on this show.

Kevin: Thank you.

Howard: I'm so excited about your ksquaredfacilitation.com. And you live in Scottsdale, dude.

Kevin: I do.

Howard: You should come down to Dentaltown and talk to the editor, Tom G. Coby. He's been our editor from 2000 to 2018 so I really have nothing to do with that. What I do I find the best people and get out of their way. I don't micromanage Tom. He's never asked me in eighteen years. A lot of people say, "Oh, I'd like to get posted to Dentaltown." Dude, I have less to say than you do. You probably have a better chance of getting Tom to post. In fact, if I told Tom to [inaudible 01:22:06]

Kevin: [inaudible 01:22:08] the wrong way, yeah.

Howard: And I'd sure love to get an online CE course out of you. We've put up four hundred and eleven courses. They're coming up on a million views and what Pankey figured out is that they have six one week sessions, so they put a one-hour highlights film of week one and it was the best marketing they ever did. And so that might be something you can do, but love to network with you more.

Kevin: Me too.

Howard: And thank you so much for driving an hour to come on the show to talk to my homies.

Kevin: Thanks, that's easy, thanks.

Howard: I hope you have a rocking hot day.

Kevin: Yeah, you too brother.

Howard: Alright.

Kevin: Thanks, man. Appreciate it.