Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1211 Lean and Merry Dentistry with Ian Erwood BSc, DDS, FAGD, FICOI : Dentistry Uncensored with Howard Farran

1211 Lean and Merry Dentistry with Ian Erwood BSc, DDS, FAGD, FICOI : Dentistry Uncensored with Howard Farran

6/19/2019 9:36:24 PM   |   Comments: 0   |   Views: 104

Dr Ian Erwood received an Honors BSc majoring in Biochemistry at the University of Toronto. He then received his DDS from the University of Western located in London Ontario. After graduating from dental school he and his wife – Dr Theresa Bourke opened an office in a small shopping centre located in Unionville Ontario, located just outside of Toronto. 


VIDEO - DUwHF #1211 - Ian Erwood



AUDIO - DUwHF #1211 - Ian Erwood



Having a special interest in Orthodontics and Dental Implants Dr Erwood took a part time two year Orthodontic Course – The Canadian Straight Wire and Functional Orthodontic Program. As Toronto was selected as the first Branemark (Noble Bio-Care) training facility in North America there was a lot of interest in Oral Implantology and Dr Erwood pursed as much education as possible in this field. He is a founding member of the Toronto Implant Study Club and was the past president of the Ontario Study Club of Osseointegration. He is current president of the Canadian Straight Wire Study Club. After seven years in practice Dr Erwood and Dr Bourke relocated their practice to a Health Centre in downtown Unionville and were in a cost sharing relationship with another local Dentist. When that dentist retired Dr Erwood and Bourke brought in a third partner with a hybrid of the Lean and Mean Dental Office system first presented by Dr Rick Kushner. Dr Erwood has lectured across North America on topics ranging from Orthodontics, Dental Implantology and Practice Management. He has a special interest in Mini Dental Implants. When not in the office he enjoys spending time with his family (three children, 3 grandchildren) and pursing sports such as snowboarding, wakesurfing, tennis and hydrofoil kiteboarding.



Howard: it's just a huge honor for me today to be podcast interviewing Dr Ian Erwood  BSC DDS FA GD fi COI all the way from Ontario Canada he received honors majoring in biochemistry at the University of Toronto he then received his DDS degree from the University of Western located in London Ontario after graduating from dental school we both graduate 1987 he and his wife Dr. Theresa Bork opened an office and a small Center located in Unionville Ontario located just outside of Toronto having a special interest in orthodontics and dental implants he took a part-time two-year orthodontic course the Canadian straight wire and functional orthodontic program as Toronto was selected as the first brand Marc noble bio care training facility in North America there was a lot of interest in oral pathology and he pursued as much education as possible not filled he is a founding member of the Toronto implant Study Club and was the past president of the Ontario Study Club of osseointegration he is currently president of the Canadian straight wire study club after seven years in practice dr. Earle why did dr. Burke relocated their practice to a health center in downtown Unionville and were in a cost-sharing relationship with another local dentist when the dentist retired dr. wood and Burton brought in a third partner with a hybrid of the lean and mean dental office system first presented by dr. Rick Kirchner but I have to give credit to his wife Cindy Kirschner I still dr. Irwin has lectured across North America on topics ranging from orthodontics dental implants practice management he has a special interest in mini dental implants when not in the office he enjoys spending time with his family his three children three grandchildren and pursuing sports such as snowboarding wake surfing tennis hydrofoil kite boarding oh my gosh and my gosh it's just like we both graduated 87 reading your resume and your website it's like we're the same brothers from a different mother how are you doing 

Dr Ian Erwood: great thanks hardware we're actually pretty close one  little thing back in 1995 we'll go back in history here a little bit both you and I received our fellowships that's right had me of general dentistry in Baltimore and  I'm her wood with a knee in Europe with fur an and and you were sitting right behind me at the at the convocation so that's  the first time we had met and then a couple of years after that you were lecturing in Toronto to a relatively small group at the Inn on the park in Uptown Toronto and I attended the lecture and at that time we were just building our new office and I wanted to follow the  lean and mean concept with dr. Kirchner and I was just designing the office and I mentioned to you I had the blueprints in my car and he said well you got the blueprints you're having lunch with me let's take a look so both you and I have bumps together we went over the outline of the of the office in it and I have to tell you it's been quite  successful and it was interesting the design and that we had put together I had a classmate a year before that he went out and hired up a dental consulting team to design an office he spent $30,000 just on that on the plan you know regardless of the materials and everything else and what myself and our two partners what we did was we contacted some dentists across southern Ontario where we had heard that they had nice offices and we said would you mind if we come in and take a look at your office and they're very proud of their offices so they invited us to their offices they allowed us to take a video camera in we videoed their  offices and then we took them out for dinner and said well now that your office has been running for a while what do you like and if you could change something now what would you change so we got lots of great ideas from all these dentists and then sort of amalgamated it and put our office together 

Howard:  we also were online you were both buddies with Ken Shirota and we were both early dinner internet users on his email group what was it called at root Z X Y a root C axe yeah I know Ken Sirota quite well and before that there was a an American who run a who ran a dental forum as well Dave e Dotel with the internet dental forum that was it 

Howard: yeah we met we were we met on that and gosh you probably at this point think I'm stalking you oh man this is a lot a lot a lot of going on a lot of chains out those are amazing years so I don't even know where to start with you there are so many things I could talk about let's go on let's start this dentistry and sensor let's go with the most controversial when general dentists start doing orthodontics right now if they if they start doing root canals they ended on a sudden care they start pulling a tooth the oral surgeon end column they work on a screaming kid they're not gonna get a call from a pediatric dentist oh my god you start doing this sacred ortho the seat code says the ortho temple so I imagine if you're the if you're the president of the Canadian straight wires Association what do you have to I mean is that politically correct or not anymore

Dr Ian Erwood:  well I'll tell you the you need some background story that I know you had Sam there's his podcast was on today actually and I was listening to it Howard but back in back in dental school I had I knew I had an interest in orthodontics as some other subjects and our orthodontic training as a through general dentistry through our dental school was very limited and I can remember a couple of stories one of our study sessions we would be given these case studies and we be given a box with some models and a panorex and a SEF and we be asked to diagnose the case and what we would do with it and I bet one of my friends you watch this I'm gonna  get a good mark on this I didn't even open the box and I I said it'll be extract for bicuspids and we'll send it to the orthodontist and I got ten out of ten and I didn't even open the box and so near the end when we were in about to graduate a few months before we were gonna graduate at a dental school one of my classmates got up to the to the Dean of ortho and said we'd like to learn some fix bracketing and he literally said if you want to learn some fix bracketing we have we have an ortho grads school here you come back to the ortho grad school and you can learn some fix bracketing and that was his response what I did at the beginning of fourth year in our grad school and our ortho grad clinic they didn't have assistants and so I went up to the ortho grad students and said hey I'd love to be an assistant for you in my free time if that would be okay and so it's they said that'd be great so every free minute I had I went up to the ortho grad clinic I bought all their same textbooks and I started reading them and so that gave me a bit of an ortho Brack background before I graduated once I got out I wanted to continue my orthodontic training I didn't I didn't want to go back as a specialist I loved other aspects of Dentistry as well so I looked at some various programs I rode it down to about I think three programs and I talked to the instructors at each program they were all offered in offered in Canada at the time and when I contacted the one of the instructors at the Canadian straight wire and functional orthodontic program he almost tried to talk me out of taking the course he said if you're not willing to do so the cases if you're not willing to work the cases up if you're not willing to attend all the classes don't bother taking this course and I thought it was you know interesting that he was almost discouraging me saying if I wasn't gonna put in the effort don't bother taking the course we don't want your money you know just so I thought this is the course for me and so I took it and it really changed my course industry I think today still today it's my benchmark in dentistry it's taught by two general dentists who are passionate about dentistry as a whole not only orthodontics and they really stress Diagnostics and they they didn't teach you just one cookbook way of correcting something orthodontic  they would teach you three or four ways to handle it and then you decide what's gonna work best in your practice and so they tell you how to think and then and then go ahead and you turn that Hannah McDonald in Robert bond I am okay to great depths and I still keep in touch with them today and after it was a two-year program and we had we had tests after each session and we formed an orthodontic study club and that study club is still together to this day so we've been together for about 29 years now and so it's  quite a thing you know you get to hear about the group members kids and their grandkids and it's it's  a good group that is amazing 

Howard:  so I'm gonna move right into uh we just had a bunch of new graduates and man I can remember when Rick Kirchner started lecturing oh my gosh that was that guy it was the most brutal lecture ever given in dentistry to this day he won't even come on my podcast I mean oh he gets upset when he's lecturing and my dog and he doesn't like it when people disagree with him but the bottom line is Rick Kerster was a I don't know there's an evolution a revolution his lean and mean seminars back in the 80s when he the first one to realize that overhead was going to go through the roof and he knew what the drivers of overhead was and he doesn't care but anyway he now has 400 offices when he wants to see me he sends his private jet to pick me up I seriously and I go and I so what  does Rick courser Rick and Cindy Kirschner all even throw their two pug dogs would tell the young kids what lean and mean is and I think it's so cute that being a Canadian you started a lean and Merry version in 1988 

Dr Ian Erwood: so I had just been out for about a year same year I thought yeah and I said wow he's really came up to Toronto and so did Cindy and it was just radically different from anything else I'd heard and his story basically in it and a Reader's Digest version was he started in office just in in the Denver area and it was starting to become successful he would bring in an associate and then you know within a year that associate instead of joining or doing something would you know move down the street and I think that happened to him a couple of times and then he said there's got to be a better way and so then he decided what he would do is he would bring in an associate for six months and if they were compatible then they were gonna become full partners and he would sell half the practice to them and so he would sell half the practice and also they would share the patient base it wasn't dr. X's patients it wasn't dr. W patients the the  doctor shared the patient base and as the practice kept growing then those two doctors would sell a third of the practice to a new dentist so that they had a three dentist model each owning a third a third and a third and they would work in shifts for efficient see there was no overlap because he dr. Kirchner would say if you have two dentists in there at the same time you're still not efficient if you've got to expand the hours make it efficient and get that overhead down as you said and he was successful at doing that and so were we following his model

Howard:  I'll tell you the  thread on dental town that's called lean and mean it's one of the longest threads on dental town but when people sit there and say you know there are overhead is 65% when we got out of school average overhead is 50% now it's 65 and 20% have 80% overhead and they don't realize that this was all addressed 32 years ago and just go to dental town and type in lean and mean and I mean it's just I and I think Rick argued with so many people for so many years eventually got so rich to just he didn't need any one argument just doesn't care but let's talk about the first things that the industry didn't get Rick was the first one to tell everyone when your associate doesn't have any skin in the game they don't care and they're gonna quit their job in five seconds I mean they just move around so here it is three decades later and these big DSOs i podcasted half the CEOs if you own a hundred dental offices you've been on the show they say the problem is my associate say only lasts a year or two then they quit same thing in private sector you don't go to school eight nine ten twelve years to be someone's employee and Rick thinks the entire associate thing is just a waste of high overhead and the only what's a partner and I said and 

Dr Ian Erwood: you've got to be compatible to that was one of the things he stressed you know dentists for the most part are independent thinkers you know you it's sometimes it's hard to have two dentists you know being together and I think it's tighter than a marriage basically if you ask me but why is that why is that I maybe different philosophies and practice different ways of handling the patient's in the lean and mean concept you've got to find dentists that are compatible with each other so if somebody sees you know a bridge there the other person can't be saying old it's  a partial denture you know if someone sees a big filling and says oh just leave it and someone saying oh no that needs a crown you've got to be on the same page and you know sending the same message to the patients

Howard:  so you have three partners an m110 issue partners - partners and one your nari - right yes yes and then another partner now so so you three people what do you average in each like four six-hour shifts rings 

Dr Ian Erwood: all right so the way the way we run the office Monday to Thursday we have two shifts to six hour shifts we start at first shift comes in at 7:30 in the morning they run straight six hour shift they leave at 1:30 in the afternoon so what time what time what 6:00 a.m. seven oh seven thirty to one thirty seven and then 30 don't to one the second shift second shift comes in and starts at 1:30 and they finish at 7:30 at night and we do that Monday to Thursday and on Fridays and Saturdays we only run a morning shift 7:30 to 1:30 the second shift is 132 to watch my 30 to 7:30 right and that's the money through Thursday then Friday and Saturday just a morning shift just a morning shift 7:30 till 1:30 and we run three hygienists on each shift how many operatories we have six operatories three four hygienists and then three four doctor three DDS and three RDH yep so you have and so how many hours a week is the office open then what is that 730 a 1:30 as such twelve hours 12 times or yeah and then so how many would 7:30 1:30 your yeah you're looking you're looking at 12 you're looking at basically 12 times 5 so 60 hours a week of chair time but like the office is open running full blast you said it's on well Monday through Thursday be that'd be 8 6 hour shifts no it's no that's that's - yeah that's then then and then another another 12 hours with the Friday Saturday so you got 10 and then that's that's 6 hours each shift so that's 

Howard: 60 hours a week 6 60 hours a week now now identity oh I always say Dennis are you patient centered you know is it about the patient or is it just doctor centered and they were so calm and I'm I'm totally dentists centric dentists centered and then I say what are your hours Monday through Thursday 8:00 to 5:00 and I mean it's like it's like they say things and then eight and a half percent of emergency room visits or odontogenic in origin because no one's open so you're open 60 hours a week so you're basically doubling your availability to the market compared to our jettison and how and then and then you are return on asset if you build a dollar dental office and do one dollar a dentistry and make 10 percent that's a 10 percent RA but if you just have that same dough offices to bring in another dentist to do another dollar of dentistry and they only net 10 percent now your return on asset is 20 percent I mean you you doubled your turn on the same asset why do you think this is not utilized in dentistry

Dr Ian Erwood:  I can't understand why like people hear about the concept and they see our practice and they're basically overwhelmed and you know I think there needs to be a new Kershner out there explaining it to dentists because we we are able to work less hours I have more time off and we have excellent  staff the style will get a bit talk about the staff we have great patients that love the practice Anna and  I earn more money I take home more money and I have I work less hours than most dentists overall well what do you

Howard:  what do you think it is though I mean we say we don't know but what do you think it is that more dentists aren't aren't you yes concept yeah I 

Dr Ian Erwood: I think they don't have the I don't know if you want to call it guts but willingness to do it I looked at Kirchner's concept and I just said this makes so much sense and I said you know when I go when I do something I study it and then I go all in and I was lucky enough before we were opening and using this concept I would actually send some emails to Kirchner and he would email me back and you know I was just amazed and for it was just outstanding and so some of the things in in Unionville which is basically a suburb of Toronto rush hour is a problem getting around and if we had opened if we had basic hours say 9:00 to 5:00 our staff and our patients would be just stuck in rush hour an hour just to get down the street basically it's ridiculous but because we start at 7:30 our staff can get in just ahead of rush hour hour our patients who need to get in early get out early can get in there and then that first group leaves we have a turnover of doctor hygienists assistants receptionists at 1:30 there's a mass of going in going out clogged you know for about five minutes there's pandemonium and then it all settles back down again and then that second group they finish that they finish at 1:30 or sorry 7:30 and they go home in no rush hour traffic they can get home and we've still provided service for those patients that may need an evening appointment so nobody can tell us doctor I can't see you because your hours just don't you can't accommodate me there's basically no one that can say that say that to us and then  other thing with with the lien and we call it as it said Kirchner calls it lean and mean we call it the lean and marry concept we sort of Canadian eyes dit a little bit and Kirchner says you know if you do a hybrid of my concept and it doesn't work don't blame me which is fine we've we sort of made a hybrid of it a little bit but it's it worked and it is working but some of the things with the  concepts he has a whole dynamic on  patient psychology Kirchner understands the way patients think and that was another thing that I picked up from him so our our new patient exam will have a patient come in and we don't spend a lot of time on the phone with them gathering information we just want to make sure they know where the office is and they can get there we usually get them there maybe 15 minutes ahead of their appointment time because we know they've got forms to fill out and make sure they get to the office once they get there but they fill out the forms and the typical dental office will just maybe the assistant will come in take the patient back into an operatory doctor might come in may or may not start some treatment and  that's how the patient new patient experience starts with our practice what we do is we have the dentist go out greet the patient I like to yeah I like to personally shake the person's hand and I start picking up vibes from the patient are the palms cold and sweaty are they nervous are they relaxed and we bring them into a consult room first and I'll sit the patient down and for the first five or ten minutes I just want to know about their social history I want to know you know what they're you know if they have any hobbies or activities and I ask that of the patients do you have any hobbies or activities and you find out all kinds of interesting things about  patients and  about their family and we just get to sit and chitchat for five or ten minutes and I can see them relaxing in the in the console room their shoulders are easing up and they just feel more accompanied and they start to they start to like us as well and then after that I'll go through their medical history and dental history and I want to find out you know did they last see a dentist two weeks ago and something went wrong in the run-happy or they haven't seen a dentist for five years I want to know what what's been happening with them so once we've got it gathered all that information I like to try and do the new dental patient exam myself if I can but if I'm too busy then it goes to the hygienist so if I do bring it to the hygienist I introduced them to the hygienist I make sure I say the patient's name a number of times and I say the hygienist name a number of times to the patient so they remember who's who and they get comfortable with it and the first thing that I do I'll do a TMD exam on them and then the first thing we look at when we go to their mouth is I'll say oral cancer check is negative and that'll spark their ears up right away and I know the patient's thinking god I saw my last dentist for 20 years never said anything about cancer and  so I know from that point on and the new patient exam the patient's going to be listening to every word we say after that so we'll  do the dental charting and we put everything in plain English for the patient be a white filling a silver filling white crown and then we'll do a full six probing on each tooth periodontal exam and instead of saying it's bleeding we'll use terms like hemorrhage or pus and so the patients start to get an idea of hey something's going on in my mouth here that you know I wasn't I didn't really know about after that we'll do a full intraoral camera exam and you often ask doctors you know and for advice for new dentists what would you buy would you buy an intraoral scanner first or what did what are you gonna buy anyone opening up a new dental office I think the first piece of technology you need to have is an intraoral camera and  everything else will fall into place after that because still to this day I've had my intro camera you know 25 years and the patients think it's the most modern thing out there and you put up a fractured cusp or something up on that TV screen and for the patient now it becomes real you just can't be having them you know hold up a mirror and look at this over and in the you know in the fourth quadrant can you see that little broken tooth there you I think you need the or intraoral camera first piece of technology you need to have in your office and things will fall into place from there so we do the intraoral camera exam and I like the  staff if it's my hygienist doing the exam I like them to leave something a picture for the patient to remember so it might be a bleeding gum or it might be that fractured cusps up on the screen I'll come back in the end and I'll say to them you know the average the average patient coming in for a new patient exam i quiz dentists on that's but I ask them you know what's in the patient's mind what do they think is gonna happen well in the patient's mind the new patient's gonna come in they think they're gonna get a little scale polish a little pat on the shoulder and say see in six months or nine months whatever but that's the last thing we do in our practice so after we've done the intraoral camera exam we even get study models that day if I need them I'll say to mrs. Smith mrs. Smith I need a chance to look at your x-rays and once we look at your x-rays we'll get you back in we'll go over the findings and then and then we can start treatment would that be okay 99% of the patients tell me that'll be fine let's do it for the 1% that say no I came I phoned up I wanted a cleaning I gotta have a cleaning I'll say to the mrs. Smith we normally don't start a cleaning on the first visit we'll start a little bit here and then we may need to continue at the next appointment but that's one out of a hundred patients that we get that responds and so we finish the intraoral exam we bring the patient back to the front desk and all I want to do at that point is book the new book a consult with the patient and if they're a pretty standard case they don't have any emergency situations will book will book a visit with the high-g and then we don't ask them for any money at that point we collect their insurance information but we don't talk about money so we've got the appointment booked patient leaves still to this day I send them a handwritten letter with in the post that goes out that day and I'll say mrs. Smith just a note to thank you for choosing our dental office we are for your continuing dental care and I like to put the words continuing dental care we look forward to seeing you at your next visit so the patient goes home I know the dental visit is the new patient exam is going to be one of the topics of conversation at the dinner table that night so she'll be talking with her spouse and that and the kids and they'll say well you know how was that new dental office and said wow they were they were really good they were very friendly they didn't hurt me and I got some things going on in my mouth I had no idea about and so when the patient comes back well before the patient comes back they get that letter in the mail and they'll see our letterhead on it so what do they think it is before they open it we haven't talked about money with them yet they get our letterhead in the mail a couple days later and they think oh here comes the bill you know they didn't they didn't mention anything but now so they're opening it anticipating getting the bill from us instead they open it and they get a handwritten letter from me thanking them into the practice and so I know the next visit I see them they already have a feeling that they like the office they like me and they're more willing to accept treatment you know patients don't have to love you but they have to like you before they're gonna proceed with any treatment and I present them a treatment plan with everything basically and I'll tell them listen your this is the total amount and I don't break it down into there's so much for pareo there's so much for fillings or so much for crowns I give them one number and then I might say you know we'll give you a five percent discount if you pay for everything up front today and some of the patients especially the ones who aren't on insurance and they may have some money socked away well we'll go ahead and pay for everything upfront and it does happen sometimes the other thing that it allows me to do is most patients are used to seeing the  the hygienist maybe once every six months once a year and if you start hygiene on that first visit and the hygienist turns around you and says this guy's got a lot of sub gingival calculus I'm gonna need two or three visits and then you go and say to him listen we've we need you back for two or three hygiene visits he's gonna say well I only went every six months to my last dentist why do I have to come back two or three times who are you guys so by not starting the hygiene getting all your information first then going back to them and at the console visit I like to say mrs. Smith the calculus builds up in layers and you've got multiple layers here and my hygienist is gonna need three visits to clean that away and we also like to involve the hygienists in the treatment plans so they'll put down how many visits and how much time they're gonna need so that the hygienists have a sense of ownership with the patient as well and that's part of our team philosophy 

Howard: the dentist um I mean they can just learn so much from mean and lean I just think I think they don't want to have a partner I mean I mean look at these DSO is that they don't hear that their employees are gonna quit every year or two because when you say well if you gave them stock and made them partner well they won all the stocks oh so when Wall Street wants to own the whole company with one CEO that you know they're both billionaires they  want everybody to be employees and what Rick and you are saying is that everyone has to have skin in the game 

Dr Ian Erwood: you got it and by the way when you lecture I know you let your all over all over you always know who the owner Dennises because they're sitting in

Howard: the first three rows looking right at you you always know who's better so is cuz they're staring out their phone on snapchat Instagram they never have a question and if you walk up from behind them you just it's just on Facebook so the person who has to pay the mortgage is taking notes and the employee is not taking notes and that's another thing we've learned on income inequality people you make 10 to 15 dollars an hour are motivated by bonuses if they were motivated by money they would be making 10 to 15 dollars an hour most operators just they want to just put all the incentives on the store operator the office manager you know the person in charge of this Outback location right here that one guy is gonna drive the whole thing and splitting up all this money with the bartenders and all that stuff isn't doesn't plan I want to switch to a completely this ministry in concert I like to talk about what no one's gonna agree with you and I were both honorees of a doctor Charles English I mean English born 1946 to 2005 he was an implant prosthodontist who died early from cancer at Ames was like fifty nine or something yes but um he liked many implants and you just can't like many implants because on dental town we've only had to separate the heard two locations ones and in Atlanta we had to sell it separate mini implant from implant the other one was in CAD CAM we had to separate all the Sirona people from the the what's the one plan mecca at a Dallas efore T because any time any 4d guy would post a case the plan mecca people have to get on say well you're sure to bought the other one it's like dude were past that he owns a 4d shut up okay so minny implants they're so controversial why would you why would you what do you think of these controversial miny implants and which one you like

Dr Ian Erwood:  so my background in history and that is that as I said Toronto was one of the first test centers or was the first test center for Branagh mark back in back in the 1980s and so we were well we were fairly progressive at the University of Toronto a lot of the research was going on for North America and I had an interest in in implantology again right from when I was still in dental school and we weren't getting any lectures at all and I can remember our removable prosthodontics exam for complete upper dentures we had to design a case or something and I designed it with six implants and I'm sure I shocked the professors at that time but I got a good mark on the exam so I guess they thought it was okay but when I first went out and wanted to learn about implantology it was basically closed to specialists oral surgeons and maybe some prosthodontist to restore it and for me to get into a course I had to sign up not say who I was and sit at the back and just be quiet and that's what I did for the first little while and started gaining some knowledge and it was it was interesting I  joined the Toronto implant study club once it was formed and my wife she actually got a case where a patient needed an implant she had a an oral surgeon put it in but she restored it before I had even started and I said okay that was the straw that broke the camel's back if my wife's ring over stored an implant I got to get moving and I quickly restored some some crowns on implants and then I was fortunate enough to have a professor invite my father and I down to the University of Toronto to watch him place some implants and we went down we watched him placed some implants we both walked out of the operatory and said that's how that's all there is and so we said we can be doing this so I found a an easy first case and upper right and left missing first bicuspid I place one implant my dad placed the other they both were successful and that's how I started my  implant career and I had been placing and restoring regular diameter implants for a little while and then I was out on an IC o---- eye implant convention down in Florida and it was a three-day convention and I saw this mtech booth with these mini implants and I went up and I looked at them and I thought this is kind of different from what I've been used to and one of the guest speakers there was  dr. Charles English and he had he had he was like a morning speaker he had about 300 people in the lecture theatre was talking about different ways of restoring implants and troubleshooting that was one of his fort he was because he was getting cases sent to him from all over the states and how to figure this out and what can we do it's on a bad angle there's not an angle to bump in here and he would figure it out somehow but I had a couple of questions to ask him after the lecture and there was about 50 people in the line waiting for him and I was number 50th so we got through the line I was the last guy where the rooms still dark we're just standing there he goes do you mind if we sit down and I said sure doctor English let's sit down together so he answered my questions and I said to dr. English did you see that mtech mini implant booth out there and he goes yeah I've been looking at it he said if those things work they've really got something out there and then I thought to myself well if dr. English is interested in it I better go back and take another look so by the end of the convention I only I wasn't gonna buy the full kit they had oh they had a full kit special on at the convention I just bought a few of the parts and pieces and I brought it back it was designed for only dent lower denture stabilization at the time I did three cases right away all extremely successful it was you know and but my training was basically a ten minute video you know and that was that was it but I soon realized I needed more of the parts and pieces so I bought the rest of the kit started using it and I sort of kept it on the quiet didn't tell any of my other implant friends that I was using these mini things and just slowly had more and more success and it finally came to a point where mtech needed a speaker in canada and they were broadening their horizons so they asked me to do it and that's where i started speaking about mini implants in canada and i was literally doing lectures coast to coast and the one of the founders of the toronto implant study club as a periodontist and dr. murray Arlen I don't know if you've had him on this on the podcast or not great periodontist places a lot of dental implants and he would have a with his study club he would once a year a case night and he phoned me up and he said would you mind bringing some of your implant cases for the study study club and I said well I'd like to bring some mini implant cases and he said okay bring some mini implant cases so I brought two cases to the study club one patient had four mini implants stabilizing a complete lower denture and I didn't prompt the patient to say anything but he told the audience having these mini implants stable his lower denture it was as good as having his own teeth of course it's not but that was his perception the other patient I had placed she originally came to see me she had a partial upper denture with her missing upper incisors laterals and centrioles and had the rest of her remaining teeth and she hated this partial denture and she was she was tight on funds and I said listen I think we can place four mini implants here and I can put on a fixed bridge and she was over the moon about it so I placed place four mini implants I did it with a template they were in the perfect position and I this was my very first fixed case so this had to work so I left it in a acrylic temporary bridge for about nine months and then everything was stable everything was integrated I removed it put a porcelain fused to metal bridge in and it's still in her mouth today and it's going on like eighteen years now and so I gradually started using mini implants in more areas but I think most dentists where they get into trouble is that the mini implants are a small wonder not a small miracle and too many dentists try and use them in inappropriate places there they're only designs where you can probably do immediate load and you've got to have decent bone and in the maxilla most of the time you don't have decent bone especially posterior Sylla so you get dentists who purchase a kit they do regular diameter implants they find a case where posterior maxilla patient doesn't want to do grafting for regular diameter implants and then they say oh I've got these this mini kit I'm gonna put these mini implants back there they put the mini implants in they all fail it's and it's not designed for that that area and then they say all those mini implants are garbage I've got cases for stabilizing lower dentures going on 1920 years now so you can't tell me that they're not successful but you have to use them in the appropriate place and so you really need to take a course that stresses that there are also some dentists on the lecture circuit who will tell you they slice dice through julienne fries and you can do anything anywhere with them and I personally don't agree with that philosophy I try and be fairly conservative with them and so that's part of my success and and part of my philosophy with mini dental implants so they work but you've got to use them in appropriate places and you should take courses that have that philosophy and then you're successful 

Howard: so 3m and they close down their MD I am only dental implant and everybody was just I mean out of nowhere they just closed it why do you think 3m closed down their mini implants 

Dr Ian Erwood: yep my and I don't know the exact inside story but I was doing some presentations for 3m and they're up a shareholder stock trading company they had a new person in charge of their prosthetic division and 3m Dino impression material they know composites and things of that nature and the mini implants were just a little bit too outside the box for them and  3m sometimes as hesitant to make changes to things unless they're a hundred percent comfortable with things and they never truly got comfortable with the mini dental implants so they didn't even sell their sell their rights to it they just as you said overnight they just closed the whole thing down which was unfortunate and they also when they purchased mtech originally mtech had up had a an implant will say looked similar to an Astra implant and it was very successful I have lots of them placed and 3m was gonna utilize that as well and they got a knock on a door from a legal company saying no another company's gonna go after you if you bring this implant I don't think the company cared when it was mtech a little mom-and-pop shop but once 3m was getting into the business I think they got concerned and so 3m backed off and never brought in the regular diameter implant which they had you know the possession up at the time so what do in plant are you using today so today there's there's  a few of them what  happened was a company called Stern gold er a attachments they produce a number of regular diameter implants as  soon as 3m stopped producing or announced they were gonna stop producing the mini implants Stern goal brought out a very  similar implant that is compatible with all the mtech kits that is compatible with all the with all the 3m kits and within two years of bringing it out they are the number one market seller in in America with many implants in two years they went from zero to number one

Howard:  so what do you think of the the Todd shatkin of shatkin first dental implants and New York what do you think of that many in plaid that's that's another

Dr Ian Erwood:  that one works well and again it's very similar to the mtech very similar to the 3m and the stern gold what so what do you think about 

Howard: what do you think of Todd's odd new business model yes

Dr Ian Erwood:  well I think some of Todd's philosophies that they make work in his own practice and he's fairly aggressive in some of his treatment planning much more than I am and so that you know for the average general dentists just starting off in implantology I would start off conservatively and and build on that

Howard:  but if you have you heard about his on the the mini dental implant center of America franchise which dows up to 77 locations I've just heard about it recently yeah I'm in Phoenix and they just opened one in Tucson but that what I think's the most interesting about it is the whole thing's based on these  infomercials because TV is plummeting basically there's basically no one on television under the age of 50 and so you can buy three o'clock in the morning for a half an hour for 1020 dollars and so they're doing all these telemarketing ideals and I mean this it's just it's basically it's a low-cost alternative to clear clear choice clear choice is the clear choice it's a Mercedes it's $25,000 it's 50,000 full-mouth and Todd's doing it with many for half the price right and they're placing yeah so do you have do you think all that say I mean are usually doing minis under removable or are you doing minis in mixed in addition

Dr Ian Erwood:  I doing them in both scenarios you know the  standard is the complete lower denture stabilization as long as you've got bone on there you know you've got extremely high success rate up in the 90 percent Isles easily once you start varying from that I do some fixed with them incisors lower incisors because you have you have cases where sometimes like a three and a half millimeter diameter wide implant is too wide to go into lower incisor region and so are you gonna you know do a Maryland bridge are you gonna cut down those teeth you know completely to do a full coverage bridge I can I can place a mini implant there and still have my 1.5 millimeters of bone mesial distal to the adjacent teeth put a crown on that and and again I've got ten years plus success with those cases and so there are there is a place for them but I don't I don't as I said I don't put them everywhere

Howard:  I think we both have to be romantic right now and pay homage to our charles english why don't you why don't you say something

Dr Ian Erwood:  yeah so charles english was that was a mentor of mine we actually became close close friends and he he was he knew his literature he knew his research papers inside and out i would meet him at meetings and he would start quizzing me have you read this paper have you read this paper he knew his stuff cold and he was a great person he was always willing to answer your questions and before he became ill we were actually coordinating starting to speak together because again he was a huge fan of the mini implants and he was a prosthodontist you know probably the most definitely in north america you know the most experienced prosthodontist in the field of implantology and a great a great mentor of mine and anna and of close friend as well hi yeah go ahead yeah and another person another prosthodontist that that is is a big advocate of mini implants as Gordon Christensen right and if you go to any of Corden's one-day seminars where he covers A to Z in General Dentistry he spends about half an hour telling general dentists if you haven't incorporated mini implants your practice you're missing the boat and he tells them that and so it's interesting the mini implant companies should be having seminars about four weeks behind Gordon Christensen schedule as he goes across North America so to follow up on it 

Howard: well I just I just have to say somebody on Charles because I'm the  thing that I thought was just so amazing is you got to remember that when we that when you started doing implants they were extremely controversial and so talk about minis or root for more that I mean back when we started there were Ramos frames or subperiosteal Zoar all these things it was crazy and the pano was the high tech radio but what I loved about Charles is the implant teachers of the time were just filled with who could do the biggest case and the most bone and  the most this and the most that and Charles had so much self-esteem he would only lecture on his cases that failed and he said he said when you when you do anything that works you didn't learn a damn thing and he would sit up there and go through all these cases sometimes your you would cringe and  then he was so high self statement then I'm and then that was probably the nicest uh fun time I ever had after a seminar he was in a that green laboratory in Heber Springs Arkansas Little Rock Arkansas and back at the time I don't know if it's still that way but it was a dry County so what so when you said there were 50 donors asking questions all over I said what are you gonna do now he says I want to get a drink and I said it's a dry County he goes I know it's about an hour drive I said can I go with you on the liquor run and we drove an hour and a half to go get all the liquor and refreshments but it was so cool that he didn't have to show off anything no and he was commanding the room because you could then I'll give you another example so who's who wrote a good to great good degrade whose yeah so it was um it's a who is that the best Jim Collins so Jim Collins writes us you know back when I was out of school the first one was built to last and then it was good to great but you know where I learned the most was his smallest book how the mighty fell and Jim even said and as Dooley says Kevin three amazing books I had to go from good to the greatest but when I started so I reversed it and I said well what you know what makes the mighty fail and he said there were less data points in that on houses day on how they fail but um so yeah just what it amazing that I want to ask you another couple things a lot of these dentists they just got out of school there two hundred eighty seven thousand dollars in student loans on average you and I met for the first time getting our fellowship may EGD why do you think going back do you think joining the AGD and getting your fellowship was that a good idea

Dr Ian Erwood:  totally I signed up with the Academy of General Dentistry before I before I got out of dental school in my fourth year and I like their philosophy of continuing education because I realized once I was in fourth year you think you know everything but you don't and so III joined up because I wanted I wanted to continue my education and the other thing was I wanted to document my education as well because at the time our licensing body there was no criteria you didn't have to go to two hours of continuing education to maintain your license and in my neck of the woods but I wanted some hardcore documentation and it was funny a few years after I had been in practice they did a survey of dentists and they were just starting to formulate our licensing body on  continuing education and ours and they wanted to get an idea of what dentists you know what courses you were taking and I think they sent out a survey with like three or four lines list listen list the courses you've been to in the last two or three years and I can print out my AGD page with 500 hours on it and I said here take this and so that was that word that was two things that I thought about the AED one was I wanted to pursue continuing education and the other words I wanted to document it as well and I've been a member of you know lifetime member basically and  that was you know part of my incentive what about yourself

Howard:   I think it was the  biggest game-changer because number one you know here's Phoenix with six thousand dentists in the state and you're gonna join me I knew all those guys had their FA G being that I'm a GT they are always great dentists and they always made great money and  then when I start digging into it and it just it just it just is and but not only that but it was the best networking like you know I'll give you another Charles English I encourse he was great friends with Carl mesh and uh whenever I would go to I went to Duke Carl's seven three-day weekend thing one time and  he was there but I look back at that thirty years ago yeah I can't tell you how many legends I met at that seminar we were all babies so sorry so in dental school you're hanging out with a bunch of people who like to drink and bitch and kamon and complain but you got skin in the game you're a dentist now you're a doc and you  can't you can't hang out with people who don't care about dentistry and so it was a very much networking and that that's another thing that I am see errors all the time when people are going to these great courses and they just fly out of the course go right back to their hotel room it's like no dude it's not what you know it's what you know and who you know and you're gonna open up so many more doors of opportunity pressing the flesh and running to Vermeer another thing that you did you're reminding me of tom warrant I remember when I was in Boston everybody was complaining there were too many dentists in Boston they got so many dental schools up there and he started doing demographics and realized that everybody in downtown Boston spoke Portuguese and was from Brazil and so he actually learned how to speak Portuguese and then he oh and then he started running all of his ads in Portuguese in Boston the other Dennis II didn't even know what his ads were and you you did that you you saw the Asian persuasion what's happening

Dr Ian Erwood:  when I I moved into you know Unionville and just down the outskirts of Unionville new subdivisions being built and my practice was slowly growing and then then we had the recession and then boom every you know people's mortgages were more than the value of the houses and people were disappearing overnight and then the people that were snapping up these houses were all coming basically from Hong Kong because at the time Hong Kong was being taken over by China was losing its British rule and the citizens of Hong Kong were worried about how China was going to relate taking over Hong Kong so all of a sudden we had this huge influx of people from Hong Kong and most of the people in their 20s and 30 spoke fluent English fluent Cantonese but the young kids and the elderly people from Hong Kong you know spoke broken English a lot of them if at all and so I thought if I learn you know I better adapt to the scenario around me or I'm gonna become a dinosaur so I actually started going to some Cantonese classes just to learn some phrases and to pick up some some Cantonese and two little stories one the person sitting beside me turned out to be a dentist he was the boat this is a it was a year younger than I was he had grown up in Toronto he was Asian but he had distanced himself from the Asian community and he moved into a started his practice in a pretty p suburb about an hour away from Toronto you know sort of a waspey community and that's he didn't want to have anything to do with the Asian community but as he got older he realized he couldn't speak Cantonese and he couldn't converse with his grandma's grandparents and so then he was coming back to learn Cantonese so he could converse with his with his grandparents anyways we ended up becoming extremely close friends and we're still best of friends to this day and that was over 25 years ago and then a another story what happened was I had a an elderly Cantonese grandmother in my chair and I thought okay I've taken my Cantonese class as I can I'm gonna try some of my Cantonese on this patient and luckily her son who was about 30 years old was in the operatory as well and she I wanted to take a look in her mouth and in Cantonese just the intonation of the sounds changes the meanings completely and so I want I was telling her in Cantonese this isn't gonna hurt a bit and I've got her reclined in the chair and she just sort of looks at me with a bit of a startled face and then I repeated the phrase and then her eyes kept getting wider and wider in it the third time she was almost trembling and so I turned around to her son and I said he had a big smirk on his face and I said what does she think I'm saying and he said well you're telling her this is going to be very expensive okay so I had to make sure I really was careful with what I was saying in Cantonese now we have a staff of about 22 and Toronto is the most culturally diverse city on the planet we have every race color religion you name it we've got it and it's a great melting pot everybody gets along and our staff reflect that we speak about five or six languages in the office and it's  great and it reflects our patient population as well so it's it's interesting

Howard:  so we went way over I need to stop this but we just had six thousand kids graduate you graduated from right up the street they say Western University so the Dean is dr. David Chang Dean of the Schulich School of Medicine and Dentistry and that is that the only deal that's the way Dean I know who's an MD and not I am a dentist yes they combined after I left they completely combined the medical and dental school together so it's under one umbrella now is that the only one in the Western Hemisphere that doesn't it's the only one I'm aware of in Canada I'm not sure about down it yeah I'm not sure sure of anybody so so that um that oral health and the and oral health continuum that that was that our school London Ontario to put him back together yes and you know who separate him was Baltimore and if you go back and you go to the Museum of Dentistry Baltimore's the first dental basically what it was it was architects I mean that they the medical school wanted you laying down into bed and the Dennis wanted sitting up in a chair and that was actually the crux of why they got separated was the bed in the chair and now a lot of people didn't the reason I don't like them separated is because the Soviets they were the ones where you're just a doctor and you just became specialized in odontology but what I liked about that is dentistry is all surgery whereas dust whereas most physician work family positions no surgery so when you're a dentist and you lose an eye and have to de or you get disabled or whatever to switch from a dentist to a family physician or an ear nose and throat or a derma it's just unbelievable but in basically in Russia or the old Soviet bloc you want to you want to get a Dentistry you just go back to the Mets go and do different rotation right and that that was so I like the more fluid II of  the worker option but uh so let's say you were giving the commencement class for dr. David trained as the Schulich School of Medicine and Dentistry in Ontario what advice would you give those kids

Dr Ian Erwood:  for the for the dental students just graduating now I would I would say continue with your dental education you're just getting started even thinking even though you think you have a lot of knowledge behind you enjoy dentistry but also enjoy your relationships outside of dentistry stay fit stay healthy eat well and love your families and put everything together join some study clubs and you'll love dentistry as well it becomes part of you but have a separate life outside of dentistry as well you know when I when I come home even though my wife's a dentist we try and you know as soon as even I do post-op calls at night and a lot of times I'll sit in the in my driveway and do up my post-op calls to check on my extraction patients and my endo patients my implant patients and then once I you know turn that cell phone off I go through the doors we try not to talk about dentistry or we'd be doing it 24/7 so you know there's a place for dentistry for you and then once you close your door into your family you know make it your family time 

Howard:and what would you if you had to describe your dental philosophy and just a few words what would war to be would it be lean and merry or what would it be Lean 

Dr Ian Erwood:  you could call that Lina Mary I mean I enjoy practicing my patients know that my staff know that I come in with a smile on my face no matter what I've got a face every day I'm usually one of the first people through the door we have a huddle in the morning to get get things started and and we go off and you're really the you set the tone for the day if you come in kicking and you're not in a good mood well that just reflects right down to the rest of your staff if you're bright you're cheerful and you're carrying the mood and you're setting the tone for the day and you've got to do that day in day out so that's that's my message

Howard:  and what do you think is the root of so much burnout I mean there's just it's amazing I just lectured in on New York and the other day they're just amazing how many dentists just claimed or burned out what do you think that's all coming from yeah

Dr Ian Erwood:  I think they're  working too many hours getting caught up in too much stuff with  our system working a six-hour shift I can work hard for those six hours then I'm done and then I can do something and the office is still running I'm not the one taking the emergency calls after I leave the office someone else is there and so I have a life outside dentistry and so I think that helps me be more productive and my chair time is my chair time if I have to do we're always doing casework ups and I do that I might come in a couple hours early one  morning a week and do some extra case studies and look at things and I have time but I'm not using up my chair time so we're productive but we don't burn ourselves out

Howard:  yeah and that was another thing on so many consultants had told me that when they see these mean and lean guys from records they just do like four six-hour shifts they go in four times and just crush it like a sprint yes and then you go and then your next client works on Monday through Friday 8:00 to 5:00 and they never spread they're just pacing and by the time you get a dentist who does Monday through Friday eight to five and a half day on Saturday they're just crawling and envy and one of the most interesting things is how they could they could stack these guys by the number of watches so they go into a hygiene checked I guess says I got a stick on to my gosh  yeah and there are there are consultants that can do a dental review you know how you your samples is as important as your sample size or more and the backward of his charts they take a ruler and they put a ruler to pull a chart ruler pull a chart and they do that and they would audit the charts every chart for and by the time they got to so many watches they knew the dentist was clinically depressed yes and that we weren't even dealing a data we were dealing with depression so if and you look at it you know when you go when you're trying to do the hundred you run as fast as you can when I start out on a marathon I mean when I've done three marathons I usually start holding a beer and walking you know I mean you got it you got a long six hours out here so you pace yourself so the more you run the slip the longer you go the slower you go and but I just want I am man it's been so fun reviewing our 32 years of Dentistry together thank you so much for all that you've done for dentistry and thank you so much for coming on the show and sharing your story with the kids today yeah Dr Ian Erwood: Thank You Howard it's been a pleasure alright have a great day

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