Howard Speaks: ‘Suck It Up, Buttercup!’ by Howard Farran, DDS, MBA, publisher, Dentaltown magazine

The patient likely won't even miss it. In my 30 years of experience, I've never had a patient come back after I've pulled a wisdom tooth and say, "You know, I really miss that tooth." Nobody notices losing a wisdom tooth. About 1/6 of chewing is on the second molars, 1/3 on the first molars, 1/3 on the second bicuspids and 1/6 on the first bicuspids. When you lose a second molar, you still have 5/6 of the chewing surface left. Only once every decade has someone told me they missed their second molar.

Pull the damn thing, give the patient his money back and say, "Come back in six months. If you really miss chewing on that tooth, we'll talk about doing an implant."

Placing an implant isn't difficult. I guarantee that placing a simple implant takes less skill than pulling an impacted wisdom tooth. I know there are probably 10,000 dentists on Dentaltown who pull wisdom teeth but don't know how to place an implant. These are same dentists who, after paying out their rent, mortgage, equipment, insurance and overhead, are referring out things like extractions of wisdom teeth, single-tooth implants, and molar endo.

What you're giving up

Do they know how much they're referring out? If they tracked on a spreadsheet every time they referred out a molar endo—the date and $800—the data would surprise them. If you can't measure it, you can't manage it. The average dentist makes $174,000 a year; the average endodontist makes $325,000.

Similarly, oral surgeons make $413,000 a year but all these general dentists—and not just millennials, but dentists in their 30s, 40s, 50s, 60s—sit here and say, "I don't like blood." Dude, I'm pretty sure you became a doctor. If you don't like blood, you should've been an engineer and worked on a chip at Intel. Suck it up, buttercup! I don't care if you don't like blood or guts, because you're a doctor, and people are filled with blood and guts.

An orthodontist makes $301,000 a year and you, carrying $350,000 in student loans, don't want to do clear aligners? It's mostly about oral scanning and impressions—the company designs the trays for you—so basically you're taking an impression and inserting trays. If you can't figure out the process, Dentaltown's online CE section has lots of courses on it.

My generation of dentists was so busy working on decay that we had a bad attitude and said, "Yeah, we don't like working on kids." It's different times now, though: The U.S. graduates just one new pediatric dentist for every 1 million people, and meanwhile the Affordable Healthcare Act made medical insurance cover children's dentistry. There's a huge market for pediatric dentistry.

If you don't like giving children shots, there are amazing hard-tissue lasers now. You say, "It cuts slow," but you don't have to numb the tooth, which saves 10 minutes and your sanity because the patient isn't losing it because of a needle. If you started with a hard-tissue laser, you've already removed all the decay and are filling it by the time that tooth would have been given an injection and numb enough for you to even start. Plus, there's nitrous oxide. Between laughing gas, hard-tissue lasers and you changing your attitude, I don't ever want to hear one person with even $1 in debt saying in 2017 that they don't like working on kids. Only debt-free millionaire dentists with fully funded 401(k) funds can have the luxury of not working on kids.

Same with periodontics: Soon we'll have 10,000 baby boomers retiring a day, and those people don't want to be missing their teeth or messing with removable dentures or partials, so the implant business is going crazy now.

So for 2017, make the decision to suck it up, buttercup, and take some CE for all that stuff you're sending out the front door!

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