Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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1228 Dr. Michael T. Varallo, DMD : Dentistry Uncensored with Howard Farran

1228 Dr. Michael T. Varallo, DMD : Dentistry Uncensored with Howard Farran

8/14/2019 6:00:00 PM   |   Comments: 0   |   Views: 58
Dr. Michael T. Varallo, DMD is the founder of HoHoKus Dental Associates and the Nantucket Dental Society.

VIDEO - DUwHF #1228 - Michael T. Varallo

AUDIO - DUwHF #1228 - Michael T. Varallo

Howard: it is just a huge honor for me today to be podcast reviewing Michael t Varallo: DMD he's a founder of the Nantucket Dental Society and Hocus dental associates in 1982 where he currently practices full-time his management approach at ho ho cos dental focuses on patients perspective and care since implementing is patient focused business plan in 2000 dr. verrano's business practice has more than doubled in gross revenues dr. Rallo is both fundamental and innovative in his practice and is one of the first non prosthodontist in the United States trained to restore implants as founder of Nantucket Dental Society dr. Rallo is a strong proponent of continuing education and is dedicated to the realization that we are in the golden age of Dentistry his workshops focus on the simple but proven procedures which benefit the everyday dental practice dr. verrano has been named as one of New Jersey's top dentists by New Jersey Monthly Magazine in 2009 and 14 and he is a graduate of Farley Dickerson university so it's Varallo right brother so um if you could wave a magic wand would you bring Farley Dickerson back to school we lost 10 dental schools this century 1909 we lost the Pennsylvania College of Dental Surgery in Philadelphia 26 vo so hyoe College of Dental Surgery in Cincinnati 67 it was St. Louis University and St. Louis 86 we lost Oral Roberts in Tulsa 88 we lost Emory in Atlanta 1990 we lost your dental school Farley Dickerson in Rutherford New Jersey 90 we lost Georgetown in Washington DC 91 was Washington and St. Louis 93 Leo was Chicago 2001 Northwestern and eveson Missouri what does it feel like when your dental school passes away well

Michael t Varallo:  I was interesting that was typical politics in New Jersey there was two schools here and Rutgers is now the name of school was College of Medicine and Dentistry and the funding they didn't to give either-or and that's how fairleigh dickenson the private university lost out the year I graduated we were third best in the country in numbers I think USC was in front of us and same thing and I was actually accepted to Georgetown - which closed - so my dad was a Georgetown graduate in Washington DC yes sir 

Howard: so now but they have Howard University that's in DC yes and now I mean we had probably I don't know if it's ten total new ones open but you have you know Arizona has a new one Utah has a new one Florida has two or three so there's you know some new ones opening up 

Howard: so how long have you been practicing dentistry since 1980 39 years so - 39 years so somebody's listening to you right now and she just graduated from dental kindergarten school an hour ago in four decades how has it changed and how do you think it's gonna change for her in the next four decades it you know 

Michael t Varallo: that's a that's a fine question first of all the technology is so much greater the materials that we have the  diagnostic materials the digital things I've been digital since 99 so you know all those things are wonderful but the main constant is patient relationship the probably best way to know your patient is through a detailed medical history and through all the technology all the things if you can do a detailed medical history you will be successful in this field forever 

Howard: so that's why they always say the more things change the more they stay the same because you're still a human you might have gone from smoke signals to a telegraph to a telephone the internet but you're still the human I mean it's  relationship at the bottom line it's still a relationship and

Michael t Varallo:  break it down to dentistry we were taught prevention remember they told us we were going to go out of business you're going to make sure that we're finished you know because of the you know progression however we're still in the same business now prevention and it may not just be for teeth we accept patients were clearing patients for the Targaryens the Ridgewood New Jersey we're also taking the patients from sloan-kettering before they enter treatments you know for their cancer therapy so it it's prevention again maybe a larger scope but it's still prevention it's still the same way that we should be the Crusaders for our industry 

Howard: so do you think dentistry is going in the right way I mean when we started it was gold crowns and gold fillings and amalgams and now we replaced all this stuff with these plastic composites I mean do you think that was moving forward in dentistry to replace all the gold and amalgams with inert plastic composite was that a positive step for dentistry I mean I know they're pretty there's a bold eye as a ball dentist

Michael t Varallo:  I mean you were one of the foremost guys bringing pretty to dentist so really that's it's what the consumer wants in that so there's a lot of you know we can tell people what they can have but it's also what they want I mean you could not put a gold tooth in twos number twenty nine today nobody would tolerate it probably tooth number fifteen or two would be difficult so you know do I think there's advancements I think you know with every advancement we fall short of a few steps and I think the cementation during the first couple years with zirconia were you know some issues but I think in overall I think the quality of Dentistry is better for than it was thirty years ago I really do and and 

Howard: where do you see the changes right now I mean what's got you most passionate right now changes today as we're coming up on to 2020 which next show I should see really clearly because it'll be 2020 alright 

Michael t Varallo: for me I've been on the oral systemic connection awhile and what I see is the interdisciplinary medicine switching around I'm both on the staff at Valley Hospital for Sleep Medicine and I'm on the advisory board at the Nantucket Cottage Hospital to help with the clinicians and figure out how we're gonna do things so this is a dentist you know figuring out we got a call yesterday the day before from hematologist of Ally said you know what there's a new study the study says P gingivalis causes is associated with rheumatoid arthritis so which changed when we started when I started I would call for permission today if you know what you're doing they're calling you for advice and it's a nice progression and I think we will be part of the mainstay health much greater respected than we were 10 years ago 15 years ago I think it's kind of cool

Howard:  when I read about the oral systemic health I can't but the first thing that makes me cringe is I'm what percent of all the dentist after every extraction just give Penn VK 500 milligrams and  after everything and I say well what was that for I mean you know they did they have a systemic infection so just see why you know I give I give that it's like do you think what percent of dentists do you think are over prescribing antibiotics 

Michael t Varallo: lots and also opioids too so we'll do both and the answers tremendous we stop writing prescriptions for any opioid eight years ago so I said we helped Saint Joe's in hospital I haven't written a prescription we took a pain management course at Tufts for advil to extra strength tylenol works faster longer at the site and brain perception of pain than any narcotic on the arm so why would I do it there's no evidence-based but

Howard:  I'm asking you because this is a dentistry uncensor what percentage general dentists you think after every extraction and every Muhlenberg now just given pen BK and vicodin 

Michael t Varallo: at least 50% 40% yeah and oral surgeons higher on the right get it and the same thing general script now also the prosthetic for pre medication for hit the AEA and the prosthetic Association said it is now up to the orthopedist if they want to prescribe so the dentist shouldn't even prescribe not legally allowed to prescribe to premed for artificial joints so um

Howard:  so what are you focusing most on oral systemic is it is it mostly sleep there were a great I and 

Michael t Varallo: I got a stat here but there is a 259 million Americans 100 million are diabetic or pre-diabetic so you had at least 30% there now add another 30% that have some sort of heart disease added another 30% Alzheimer's 30 percent of Alzheimer's patients have the spirochete from your mouth in their brain so now take that add to cancer patients University of Jerusalem had infertility like linked to the inflammation so anything that ties the inflammation from anywhere in the body is tired from that's the most common inflammation in adults as gingivitis and periodontal disease and go ahead you say focus on it there's what Dennis don't see is that in those numbers if you see ten people in a day if there's thirty in a week there's gonna be in tenant and diabetics there's gonna be five part so when you educate those people they become patients for life

Howard: and where are you getting most of your oral systemic information from ER or what um because you started you were the founder of the American Academy of Sports dentistry I mean that is uh the Academy for sports dentistry or go to work still in there it's still working yeah well we'll talk about um your journey there was Academy for sports dentistry what made you start that back in the day 

Michael t Varallo: well I played out of state championship football team so and my fraternity brother college was captain of the Jets became captain of the Jets so when I was in dental school I went out and met the docs that were out there so they said there so then the Giants were here in the Jets were here and they both had you know their Dennis so Hugh Guardi god bless his soul quote me one day and then the devil's called me to be their team dentist and just followed through something I've done for life I give through the years we make free mouthpieces and  their custom beautiful mouthpieces for thousands of athletes pro two five year old kids always free and

Howard:   Eric Jackson sits on the board of the Academy for Sports dentistry we've had him on the show how what do they what does everybody need to know about the Academy for sports dentistry today

Michael t Varallo:  well again they'll do what our trauma issues you know how to replace teeth how to do that but really it's the advancement of science in with the mouthpieces we're what can we do how can we do it and how can we propagate it you know there's probably more there's more deaths in baseball than there is in football and that's what led to that science led to the electric you know were your heart to start you now so again will you push it out it's really a prevention organization from when I started now all the major league teams major league baseball teams and football teams have prehab you oral cancer screenings have oral periodontal screenings before they sign contracts before they go into practice

Howard:  so um what would be the the Academy for sports centers you established back in 1983 what would that be for the oral systemic link well that became later on is that I started to do this as in 

Michael t Varallo: I had a professor of oral med Abe Chasen's God rest his soul too and you know he just peaked my interest we started doing this I became the first group of evidence-based dentists in the United States selected by the ABA so when we start to pound this data the connections PO in 1990 declared with the science that diabetes and periodontal disease are bi-directional diseases the other disease I mentioned are associated with but they're bi-directional diseases so go back to my education we were taught prevention prevents tooth decay prevents and all of a sudden if you your h1c comes down if you have less periodontal disease and your gums are in better shape and it's a bi-directional D so you can help the diabetic every day so that's how it started really with diabetes and then as the literature progressed and if you want to go on PubMed any it's probably for everybody there's plenty of data for heart disease but the coolest part for practicing dentist I do that whole console about four minutes and I tell every patient the caveat is if I'm wrong if all this literature up to today is not conclusive what's the downside clean teeth there is no downside to this connection so all the dentists who fought it and don't want to hear and say it's not science and but there's no downside if we keep this clean you have a healthier body period it's easy 

Howard: so when is did the term bi-directional you called it a by reduction a Byron directional relationship when is that a terminology vent 

Michael t Varallo: I think that came in the 90s with the investigator PO and they developed that that was if you took the periodontal disease brought it down that da when C's would come down and vice versa if the gums started if your sugar started going out your ginger go would be so that Pope came it bi-directional disease 

Howard: so you know when I school they would always talk about how when they started figure out genetics and family trees they'd say you know what on these autoimmune disease if you if you can really fill out the tree long enough if you have one person with one they'll have another like if you have someone want type one diabetes in that family chair there should be a sailor exper a rheumatoid arthritis a thyroid disease multiple sclerosis so what would what do you think is that the Trojan syndrome so what do you think is at the core of these autoimmune disorders and how does that relate to dentistry 

Michael t Varallo: well super is that interleukin 1 and interleukin 6 or identified inflammation genes so if you have those genes you're more subject to all types of information and if you're subject to all types of information I believe and the AEA reps of last year the keynote speakers Bell and denene it's 15 times greater to have a heart attack if you have that gene and have periodontal disease so that terms where they came with the hot blood but it's really a genetic basis that would bring it all down and probably when I said Alzheimer's or heart disease as you said if that was your defect in your genetic makeup you then that's where the inflammatory is gonna peak however if you have inflammation in your mouth and it doesn't stay there because it travels to the liver and interleukin 1 interleukin 6 and prostaglandin one and say they all start to get released the body doesn't know it's just the mouth and that's where the inflammatory response comes but I'm agin though we're

Howard:  you know I'm trying 25 percent of people listen to my podcast they're still in dental school and the rest are all under 30 where would she join to learn more about this is it like if you to say what's the one organization where they're gonna learn a most about that oral systemic recently where would you point them would it be a book a website 

Michael t Varallo: good question I like PubMed for your individual knowledge and I believe each school has had a bigger play in oral med I don't I can't tell you that each department I deal with Tufts a lot in their oral pathology department but you know something that's a good question I'm gonna find out I'll get back to you on that

Howard:  so um do you um what do you think about that we talked about OPI well that's dentistry uncensored let's talk about the other one marijuana was leaked illegal most of our entire lives it was and  now it's legal um you what do you think of that do you think that's gonna have a dental relationship there's a lot of anesthesiologist saying it they don't it you know they feel pain differently it's hard to put him to sleep what do you think about that Minnesota 

Michael t Varallo: forget that let's go to teeth for a moment the marijuana smoke the people who do smoke this the smoke itself is hotter than cigarette smoke so that actually reduces the blood flow to all the gingiva and all that so you see much more dry mouth decay and throughout for people who smoke marijuana as far as that's it's a very interesting topic you asked about data and again I'm an evidence-based then there is no real research on all of that in on marijuana so how do we accept for money how do we decide we would legalize a drug in the midst of a drug crisis without true data no double-blind studies on any of what you just said so it's right now up in here it's wild wild west and the 

Howard: other thing wild wild west I mean when I was little and I was still in dental school I mean the vaccines were the heroes of the 21st century I mean polio you know all these vaccines they took it on a sugar cube if you remember yeah and the scientists tested on themselves first yeah I mean just crazy and now um here we are it's 20/20 almost and HPV vaccines what would percenter dental offices do you think discuss the HPV vaccine and try to get their patients to take it which you know to reduce oral cancer and all that kind of stuff you know or the

Michael t Varallo:  new jersey actually they passed the bill that we you know here we should have some and then the patients at a certain grade level we actually and there's still the research out it up but we actually you can genetically test to see if you have HPP owner or rinse 

Howard: and but  what percent of dentists do you think are earth or talking percent three percent yeah so you get back to the get back to the imaginary dental student is that these are the things 

Michael t Varallo: we need to be able to get into concise to you know everybody thinks about marketing and how we can do the dental marketing and boy you've done such a wonderful job but if you're going to separate yourself in an industry you need to be able to if you can do this this is far greater when two thousand eight occurred the recession it did not dentistry stopped spending money and it didn't return to 2016 in those years I did not have any growth but we did not have a down year they were up one percent down one percent up one so we were flat so in all my colleagues and nobody understood that because everybody else was down and I think it was because if you made sure that the oral systemic can actually if you educated each patient they would want to take care of their health and that's another thing dental school actually makes you we become the owners of all this and people say all my patients don't do the hygiene I implore partnership because you can't win without apart I can fix your teeth teeth are easy to they have so many cool things cbt scans we got scientists that I can do all this I can't think she gums without you fiction without you doing it so I implore the partnership to the patient so for young people instead of you owning it you need to really reach to them and say I need you to help me fix this 

Howard: um yeah I said we talk about Gardasil I mean you know I would you started off this podcast to talking about prevention and I just can't think of anything worse than a patient dying of oral cancer that was under your care and that they came in they saw you every six months from you know birth to whatever and the conversation never came up why do you think Gardasil which is owned by Merck why do you think they aren't really changing the behavior of dentist 

Michael t Varallo: well yeah the behavior of dentists themselves if you took through in an ad a survey if you took the survey of dentist 65 70 percent said I did an oral cancer again when you took the perception of the patients ten percent said they had an oral cancer exam so the communication whether they're doing or not what happens is now in how we do a regular exam is a the hygienist is gonna look first and they do a full intra and extra oral we take photos what is really cool and I use Tufts a lot because I don't always biopsy and see something but I know that I'm well enough but I'll take a picture and send it up so we have diagnosed oral cancer we do that but you're right the industries the young people got a really turn to do that the reason cancers always have a Mark II guy and Mark II cancers colon cancer was ronald reagan he waved out the window when he got his polyp out alcoholism Betty Ford shaking her hand and we're gonna be okay so breast cancer with any of the actresses that did all these people we don't have a in a Markey person to really say that was Michael Douglas was diagnosed by a dentist in Canada I believe and it was a throat cancer and I thought he would be the guy it turned out nobody wants to talk about it so the dentist don't gravitate to that and then don't tell their patients we in other hand have handouts water'll cancer is we use a VELscope I don't know if you know Dave Pearson you know Dave Dave Pearson name sounds very familiar yeah he does a lot of the background stuff for you know a lot of companies but anyway you know I helped them launched you know the VELscope when we first put it out and you know we've done very well we'll take photos and send it to the ents we set it to Tufts so again it's an interactive thing but it's also the right thing to do but it's also good for business

Howard:  yeah but my you know Dentists tell me they I mean they say things like well Howard you know physicians they have a private room and that and I have an open operatory and this is a very private conversation and I just don't want I'm not gonna bring up because you know it's really just sex it's sexually transmitted I mean what would you see your dentist that I like that that's afraid to talk about it of course 

Michael t Varallo: it's not just sexually transmitted HIV can be transmitted in other ways too that's maybe the largest in vaginally and if you have parts sex with six partners or more your chances increase greatly however all of this is that you would rather have that discussion then tell them afterwards that somebody else found the oral cancer physicians don't look in the mouth nobody's gonna do that so when you brush biopsy when you photo it you can have the conversation privately but you have to educate the person where you have it can be different than but you gotta be telling I'm look by the time we're done with an exam the patient takes their tongue and sticks it out because I'm gonna grab it with her boss I don't have to tell anybody anymore unless than the new people and I'm gonna forget her name but she would come to different areas to show how to do an oral exam she came to Nantucket for us one year you know and we had handouts and gave to dentist it's they think it takes too much time I don't think so 

Howard: yeah so what else has got you really excited these days um what are you most passionate about what makes you still run twenty red lights on the way to work 

Michael t Varallo: well I got a four minute commute so it's easy but I was here at 6:30 this morning it and I started three days a week at 6:30 I'm 66 and I start one day at 7:30 I'm here until six o'clock couple nights so what makes me tick Eddie probably the most under-diagnosed and undertreated in america oral cancers the sleep and under-diagnosed billions of people going through this so the future is just exciting for people who want to embrace that rather than tooth carpentry it's exciting 

Howard: and why do you think you have that and others are burned out in fried I mean you've watched a lot of dentists come and go in 40 years white why do you think you still want to get to the office is 6:30 in the morning and there's another dentist who just wants to I just can't wait till it's over he wants to 

Michael t Varallo: I think honestly the tooth carpentry and the guy in let me tell you something when I got a call from a hematologist of the hospital I didn't know to ask me about a patient and to see if the cat scan was something on a tooth and we the  autoimmune system could have been kicked off by these she is failing root canals anyway is that that was enough for the day we I have diagnosed oral cancer on a spot me save somebody's life you every day that conversation goes is kind of fun I mean it's just it's not drilling and filling and trying to make money I also do take a lot of time off I've always taken a lot of time off from the beginning it's a manhattan-based style even though I mean you're in Ho in Hocus New Jersey and I always took a lot of time they spent a lot of time with my family it's a well balanced operation I do have a house in Nantucket I have four grandkids they all see us they do us so I never thought I had to run in and  work 100 hours a week and stuff all the money away and do all that I always it was a slow progression and I have a well balanced life I you know married to the same individual for 43 years so kind of balance the gym you need to balance it it was a crazy job yes so

Howard:  so she's scared she came out of school she's 284 thousand dollars in debt and she's looking at us two old guys think yeah you guys are lucky you graduated back in the years and it was before you know whatever um what would you say to a 25 year old a quarter million dollars in student loan debts who's wondering if maybe being a dentist was a bad idea well give you

Michael t Varallo:  I didn't know if we put this down for you I run an internship post-grad all into dental school on their first application so we do have that conversation and the Tufts graduate who came out probably I was closer to five hundred thousand so what I told you is that I think with us as a profession increasing upon the health care industry medicine is in disarray very few guys on their own practice anymore women have you know big groups only hospital owned so there's an avenue for us to take advantage we don't reach out to individuals we need to educate the populace if everybody showed up in Bergen County New Jersey which is a very wealthy county to go to the dentist tomorrow there isn't enough chairs here so you're not competition with another dentist your competition with Amazon and vacations you need to show the value if you do this you can live like this Mata's gives you six extra years of life six years which is a handout we give if you floss every day and get rid of your pair Donnell's six extra years not a single thing is double that um 

Howard: when she comes out of school you know she basically just I mean if you look at the requirements how I did like you know a dozen crowns and dozen fillings dozen extractions and she's looking at all these things she wants to learn but you know she wants there to be a return on investment I mean there's a dentures TMJ sports Botox implants pareo root canals Invisalign she's got to start somewhere um where do you think is the best place to start walking up the stairways I mean you're up there on the second floor in the loft and she's got to walk each one of those steps up over the next decade what would be her first couple of step three would be implants and vis align 

Michael t Varallo: for the dentistry I go back to that medical history so when you want everybody who comes in that you see  if we're in the production modes and every you know I worked in a clinic when I first got out to produce so that's a different story but if you're going to be in a private practice really what you want to do is the medical history and you build that relationship then the bread-and-butter dentistry then it comes we can do implants I mean they're well more averse than implants than we were when Lenny linkout was placing them in the day so they need to overcome that they have a cool thing that we don't think of they have you and you tube band broke off one of my young associates looked it up how do I push this band back on in YouTube didn't thirty Seconds and he did it so there's plenty of advancements and I think the bread-and-butter dentistry which brings a lot of people to the table is really what you need and 

Howard: you have associates work for you when you look at dsos their number one problem is they can't keep dental associates I mean if you're if you're a DSO and you got five hundred locations on any given day you got you got a dozen dental offices don't even have a dentist um what do you first of all what do you think of the DSOs cuz you've lived through orthodontic centers of America and there was a dozen I mean you and I have lived through a dozen of these things that made it to an IPO and then and November birdie think Bernie what

Michael t Varallo:  Bernie think Garden State Dental yeah Bernie feet what was it which one was he with Garden State Dental I believe he was the orthodontic friend of mine so I do live with it so no so if you look on TV right now clear choice and those senior moment on the clear choice ed Aspen are competing in the advertisement not for the same patient but they're advertising do I think that's wonderful for the GP now Heartland says the GP will take two years to get up after school what you said to get up to be able to produced to make money for Heartland they've done the study and they can crunch the numbers so what happens if you can get it a good mentor I think that can be done in 6-8 months maybe not every aspect but you can start to do it and

Howard:  what did Bernie feat garden say don't tell it till that's where it was that one of the original DSS or what

Michael t Varallo:  yes I really really I think it could have been the original you know one of the first regional operation he was an orthodontist in Maryland and he would lecture all over and put everybody and then put general dentists and orthodontists put everybody together I don't know what the total number was but I think way back when it was like thirty million dollars so the new DSO is different the new DSO is formula is to buy somebody like me out and keep me in place and not let anybody know in the community that it's Heartland or an aspen or clear choice and clear choice is all on for and you know that you know that they're killing it they're doing lots and lots of Dentistry 

Howard: yeah so do you what does Bernie Fink think of these modern-day diso's does he think they finally figured out do you think they got a business model that's sustainable does he think 

Michael t Varallo: they're doing well now since he was doing this expanded there's more people you know there's more players in the game I talked to more of the group you know more of that everybody has a little different formula some really want the one or two men practice and then expand it some want the ten or twelve group orthodontic endodontic practice than in expanded but for a couple guys in the industry they would classify it as a baseball game in the fourth or fifth inning they're not really just beginning they're starting to take more over and that adds back to you we're talk about our graduate they're only forty eight percent of the people graduating want to own their own practice and half of those may not be able to afford it so that makes the DSO become maybe the purchaser for larger practices and maybe the hiring for that younger associate

Howard:  well they've always been about liquidity I mean the the first one the only one that made it on the New York Stock Exchange orthodontic centers of America and he saw that the only the only orthodontic practice that could sell we're about 750,000 to a million and there were all these monsters doing two to three to four million so he just went got a hundred million dollar line of credit and all those were that I sold to him because no one else could buy so they all started with about just liquidity but nowadays as you say half the dentists don't want to own their own dental office that wasn't like that when you were in dental school is it so what changed why is it the Millennials is it that half the classes girls isn't because they like yoga I mean what what why is it a more balanced lifestyle where they know 

Michael t Varallo: that is one of them I think the other is that even teachers and cops you know police officers and you know those pension job security became much more important than you know as a country got wealthier than the entrepreneur we didn't consider ourselves and for sure you're the epitome of what an entrepreneur is you know we didn't think of ourselves as that we didn't think of ourselves we thought of okay you had a job 83% of the deck dentists United States only visit their practice ever they don't go to other practices to see what's going on so when we got boxed in larger fish started to figure out if you took my office and cut the supply bill down and cut what we do for all our employees you can make 10% on your money as it is the formula was the physicians hospitals bill more than physicians so they bought them and make 10% on their money so that's where we are and I'm not sure that's good or bad it is just the reality of the base where it is 

Howard: so is your dental office in Nantucket I mean you you're the founder of the Nantucket dental side that's an and isn't it yes sir it's an island off in Massachusetts 

Michael t Varallo: no I have a house there I do I've summer there my kids grew up there we do that I live in New Jersey my office is in Hoboken New Jersey really the beginning do you know Lou Gramm the Dennis of the singer ha ha boat actually the dentist oh yes I love Lou Gramm he's a friend of mine Louie's a good friend of mine so Lou said I want a lecture in Nantucket I said well I could do that so or a farmer sponsored us and about 30 grand later I realized that wasn't as smart as I thought I was so he was the first speaker and you know then I started using the people that I'm both friendly with and how we got associated with you know all those people I mean you know Ron Jackson's been there three times you know lvi a lot so how do you get to nan tain you I mean out first of all how far how long does it take you to drive to the beach closest to Nantucket I mean you gotta go up what the 95 where are you coming from what I mean your dental office I'm coming from my dental office Hocus New Jersey I fly commercial I mean just a little what a little two-seater no no no not me fly I have a pilot Bob pilots fly yes yeah no I do actually there's oh I have found in an airline that flies out at Teterboro New Jersey but you can fly from JFK you could fly from Newark and what made you LM that that's a long way from where you're at in Hollis New Jersey so what what made you think of doing this in Nantucket well 1980 when I graduate went to the Cape I had always been a Jersey Shore guy so my wife and I said alright let's go and we decided to go up to the Cape we went to Martha's Vineyard Nantucket step the foot on the island and we both fell in love with it and then in a very another difficult place that I was at a lecture in st. Barts Lou called me over and said would you do this maybe we'll talk about catapult would you he said I'd love to come to Nantucket so that's how it started as the Congress say Lu brand myself

Howard:  and the next island over is Martha's Vineyard right yes sir I mean that is just some so I'm gonna switch you another question I think um you would handle well a lot of dentists tell me when you say you know you go rural I mean why do you want to go in downtown Boston when there's you know 13% of the towns and the Midwest don't even have a dentist but they're all in populations smaller towns a lot of people say I don't I don't want to go to a small town because that everybody knows your stuff and the other dentist you know that they  feel weird about it you  have a dental society dentists have big egos like that physicians and lawyers how do you think bigger how do you what advice do you have with these young dentist they want to join their local Dental Society and there's just you know there's just how do you keep the peace with the Nantucket Dental Society with all these big doctor egos 

Michael t Varallo: oh it's funny the people who lecture have you seen are the top guys in the world so when they come there people sit and listen and they respected the outcomes I didn't bring just guys to have a Boone dog oh these are really educational days plus we have a really really good cocktail hour bar I mean so that keeps everybody in line to Dentist you know a few drinks everybody's a little happier but and we have a clambake so it's kind of fun but it's not a membership Society per se it is sanctioned by the ABA I'm the single to the best of my knowledge that one of the single cert providers in the country so I you know we're a service provider in and another thing

Howard:  I always um see with doctors that are a cut above the rest they  have Hospital relationships what was going on in your journey where you wanted to go get involved with your local hospital 

Michael t Varallo: well interesting in my local hospital we had a staff so this is back in 1980 so when I became in first of all my there was a neurosurgeon he died when I was young he was chief of oral surgery at st. Joe's in Paterson so that was my hometown that's probably back to that roots of the oral systemic things so for me it was a normal thing to be part of a hospital then the oral systemic some groups that you joined said okay good and then Valley Hospital got rid of its dental department everybody else in the country is adding it they get rid of it so Nantucket asked me the  director asked me if I would help on the advisory board and they were building a new hospital so we put the Advisory Board in for the physicians there so that's out and then Valley came back and said you know you've been doing sleep for since the 70s so would you come on on into disciplinary board so we entered back so it's kind of that's a very important thing for today for the young people to get involved in their Hospital associations

Howard:  yeah I'm only talking about money you know they come out of school these student loans and the dental marketing media convention as make them believe that if you want to be a great dentist you're gonna have to buy $150,000 cad/cam under that was not a laser you're used by all this stuff I'm what does she have to buy to be a good dentist oh 

Michael t Varallo: I mean any digital x-ray so that you know that's a thirty thousand dollar thing but that's minimum standard and I think the opposite is that you really need a really good software you know in your office you know so that you can run both digital records the next you can build as you go I mean I have bio lasers I have you know I have a lot of toys that actually now make money but you start out obviously I don't think anybody takes filming or less twenty percent take film in the dental industry so you would need the and then a good software system 

Howard: okay what would give her a name-brand you said digital x-rays you said software system what did you use would you go I wear

Michael t Varallo:  Eagle soft is my you know software I don't first of all I don't think anyone there's a couple I just and I can't tell you but there's a couple coming online that are very good and we have we have a cat kid we have vortech as is our things and Jen Dex is our digital x-rays and eagle soft that's in the same that's in Effingham Illinois that's the same birthplace of Heartland those guys are and the town has only 10,000 people and has spawned eagle soft and Harlan I mean they had to rename the from Effingham to dental I am an unbelievable well maybe you'll franchise the name out there give them a little you know dental town you know you could 

Howard: so is the bio lease laser is that boys and their toys or is that really something that a dentist should consider 

Michael t Varallo: 100% consider which one last class six restoration a lot of dentists don't even know it's a sturdy meant Class six or anything it involves the incisal edge so I would not take any more rotary instruments to in a size allege so we have where facets on the incisal edges that I can take a trough less than one millimeter wide and make it two millimeters deep and protect those in size the ledges and make them look beautiful we do class fives I wouldn't prepared tooth with a diamond I had brass or do a study brass or did a study that carbides produce more micro fractures than diamonds and diamonds produce less violas produces none my laser heart tissue lays I don't just let's say violates so once you use it and then in my office some because New Jersey is a little backward we don't allow hygienists to use a laser so we don't use it as much as pareo as addicts you can use that as Paris so then you have a dual action for I would do the refractory cases when they can't fix them I tend take them and use the bio lace with our radio firing tips in the protocol that we've established and I got my first buy lace there was no manual so I had to help them write the manual yeah 

Howard: so yeah they're having a bio least they're having their meeting eyes they're gonna have a really cool meeting on San Diego I love San Diego it's October 1819 when you live in Phoenix you need zero excuses to go to San Diego in fact half my team wants to just move to San Diego so again I'm gonna go but more to technology because it's  so darn expensive what about um cone beam technology I mean she just got out of dental school she bought her practice she bought her mom's dental practice she's got digital radiographs but she's got a pano machine do you think you really spring for a cone beam 

Michael t Varallo: no not right away again the cone beam becomes in do I need where I'm gonna place an implant and again in in those areas if you're going to do the surgery yourself you may consider but there are places you can actually ask for images if you build another relationship if you we needed that I mean you know we make 3d models we ship them out to the lab you know at the beginning I'm not quite sure our vodka machines in the hundred thousand dollar range is the greenest machine on the planet the least radiation and the software is and continued upgrade so we don't pay for that whereas some of the others that's a problem when they all wind up soft grading themselves out soft wearing themselves out and each time you have to upgrade probably and I used to scan I scanned the first model is crown in the United States we uploaded to think to a laboratory in Florida and had it sent back in two days so we didn't do I didn't touch it we did it  was through 3m I don't even scan now and we have because I didn't like the way everybody wanted to proprieties their own format in that share the platform it's much more open now in the last six months to a year and hopefully it'll open more but nobody wanted to share the platform like I couldn't send it here couldn't send it there so I had I had issues with even technology itself 

Howard: but you do like to buy a lei so just I use it every day that's the only piece of equipment and I beg that at one time I was a key opinion leader for them I don't do a lot of that much for fthem it is the one piece of equipment that if I if it's never been down and I'm 2001 to whatever the first ones out I'm you know I'm a long time generation that I would cancer I would not do a class 6 or a class 5 restoration on a Handy's Wow 

Howard: any other technology that you're on that you like yeah I mean you know we do have you said no and

Michael t Varallo:  I don't want to entice anybody but you know with the CBT scares you know you I mean now we upload those to the laboratory and they can make a stent for my oral surgeon I can now upload we do when we talk about oral systemic we use beam readers and they'll upload my scan and they tell me every pathological thing that's wrong in that scan so from penal glands to carotid artery calcifications too so we kind of use that a lot you know both for our sleep because it measures Airways so even though I told not to get that because that may not be the focus and you can get out to that but I mean zirconia crowns you know for the posterior I'm almost doing all sarcone Ian nothing in the aesthetic zone

Howard:  so now these are visor coating and that's another thing she you know she has he student loans she just bought a practice and she's looking at her crown abridged lab and she sees labs low-cost labs like Glidewell - high-cost labs what would she should be thinking about cuz she's thinking would I save a lot of money if I switch to well talked about labs

Michael t Varallo:  I use a master lab technician and I always have because the least amount of makeovers the least amount things that you have to do the least that you have to go through you'll make more money in the end China there are some traces of lead in some of their crowns so I don't do that I never did it but I don't do that with materials either you know we when we use implant you know we're a strawman implant and again I was a key opinion leader for them so I get that out for you but I don't need their knock off because my success rates in 97% so in any of these things use the best and the least that you need to touch it is best in probably 95% when we used to and I used to lecture for 3m 95 was said of the crowns we take the temporary off the place it on and they fit perfectly fit in occlusion I make them a little tighter than normal so some that would be the 5% because I don't want any food getting caught but other than that it's a master lab pictures do I pay a little more yes I do but that chair time is valuable 

Howard: see in my view on guys like Michael is that whenever you meet a guy like Michael the one thing all the successful people have in common they all got into continuing education I mean he said when we started a man Tucket Dental Society so you have these kids come out of school they say Michael I just did eight years of college I don't want to do see I don't have time for that stuff I need to drill Phil and Bill did you do how important do you think dental continued education is over a 40-year career to keep you happy and productive happy 

Michael t Varallo: one or two you know and I would tell you us I had a great dental education I learned nothing a dental school meaning we learn technical stuff but not really how to into relation with the people and how to do it had it and what I told you is that dentists we trained and I always obsessed with the word trained because that's what we did but really were doctors we read should be educated so when we were trained in the cubicle in the dental school all right we never got out to see what the rest of the world was what an educational experience should be not just to learn but to see what other people do and where your comfort level is never be happy with your comfort level I never I you know if you look at the CEOs of the world everybody's Howard Schultz said if you come to my first 15 minutes of a meeting you know we're making money if you missed the first 50 minutes you think we're going out of business how do I get better what do I need how do I do this and you can't do that in a cubicle you gotta get out you gotta see it you've gotta be enticed I mean you saw last year Michael Gill comes I knew Harold I knew his dad so Michael comes in gives me a big hug we didn't really you know we had a mutual cases a couple over the years but you know like what am I doing wrong he said no no what am I doing wrong you're doing this we're doing that so the sharing of ideas is not just it's not the learning itself but learning of what surrounds you and where you swim in the water I really believe that 

Howard: so what are the biggest changes in our careers is that who we go to school we just build Delta and they paid a hundred percent for clean exam x-rays eighty percent of our work now and filling fees and half on crowns now that's reversed they send you the fee schedule do you think that's a race to the bottom over time I mean do you think that's just because they're not gonna give you more money but inflation is gonna keep going up and up and up do you think being insurance dependent is the biggest threat to dentistry or do you think it's DSOs and corporate dentistry what's a bigger threat insurance or corporate dentistry 

Michael t Varallo: to dentists themselves and i'll tell you that is that's inside inside 48% of the people who have delta dental don't go so it's not where the dental didn't pay you it's getting those 48% that don't use the benefit every year to come what happens is and we only work we're thinking of taking actually a few more we only take two dental insurances and Delta is one of her I've been premier dental provider since eight nineteen eight so I but I don't think I think in the transactions today the way Millennials want they wanted to know exactly what it is so when the dentist's go and say okay good hey by the way this is good of course you a thousand dollars and your insurance gonna cost you fifty year bills nine hundred fifty dollars I don't think if they had the value built in that's the problem forty eight percent the people don't go to the dentist they're my Delta once a year so with fifty percent went twice a year you'd be packed so it's really us as the dentist in the individuals to develop that that scream that that coerciveness and I think the excitement helps to

Howard:  well I mean but you're an American in America we never take personal responsibility everything is someone else's fault I mean we're all victims I I'm thinking I'm seriously thinking about suing my mother I'm gonna call my mom and say so I loved it I mean I said is it Delta's at corporate dentistry and you said no it's the man in the mirror that's awesome and then and then one other thing I'm a lot of a lot of these young dentists they come out and it's almost like they got out of a monastery or they don't want to they don't want to get associated is they say I don't want to sell dentistry I didn't go to eight years of college to become a doctor to sell dentistry I don't believe in that what do you say to a young dentist who says I don't want to sell dentistry I don't want to be a business person I want to be a sovereign profession of dental doctor 

Michael t Varallo: unfortunately after two oh eight there is no more sovereignty left so and I don't you know again as you know I'm positive so what happens is I don't think the terms that's what happens and everybody has to sell but really what you're doing is education  did a program about two years ago and the more you educated the patient base the better your patient base was so we give handouts we I still use cases and we still present everything on the board we still go through a consult with my assistants and pictures and notes before I walk in a room the old size Sims the educated consumer is my friend and that's really what you don't need to sell people want you know smile makeovers people want they it's what they come in to do so and the other part is the people who don't I'll tell you for me all about eight years ago I had a patient have 12 laminates placed in Florida not mine and she came back and she was talking to she said what she said well you never said you could because I didn't think you needed to sell and the answer was you don't need to sell you need to say I can do this I can educate I didn't really want to I didn't love the idea of being you know I'm the first guy in Jersey trained to do serenade laminates which was you know hundred years ago in between I didn't want to sell that as cosmetic dentistry I thought that was kind of wait a minute what's wrong with the cosmetic that everything I do is cosmetic so as you start to round those edges and think of the high profile that you are it's more important to educate your people and tell them what you can do what's wrong with being the best you can be

Howard:  and last but not least I'm I have noticed that you know they just aren't good employees when I meet somebody I've been out of school five years they've worked at five different dental offices and they usually just keep bouncing from job to job to job until they get so rock-bottom and so depressed they opened

Michael t Varallo:  I had a 45 year old guy come in this morning the same way dentist he said hey Doc said I'm dr. K's friend she said you know I never bought a practice he's still looking for somebody 45 so go ahead I'm saying yes you're right

Howard:  so so how what do you say to someone who just they change jobs every years a dentist because they're - they just don't want to set up their own office you think it's fear-based that they're afraid to set up their own dental office even why do you why do people quit their job every year and work for five different dentists in five years as opposed to guys like us I graduated May 11 I had my dental office open September 21 and that was on because the construction people III got five bids and like an idiot I got the lowest bid and so they worked about every fifth day where'd you go to school yeah University of Kansas a UMKC but looking back I should have got I should have taken the highest bid and I would have been open in six weeks but  what do you say to that person who just doesn't want to own their own practice again 

Michael t Varallo: I think part of it there it's not that they even are afraid it's their mentality that that's not the entrepreneur that needs to be you know when we were there the entrepreneur was you were gravitate towards being a physician you would be independent to be a professional now guys really grow up and say but it's the same main corporate America you know we're losing that slow nobody wants to put I hate to say it that way but nobody wants to put the effort in to be the one percenter everybody think you should be in the 1% without busting your butt look at you you built the magazine how long did it take you two weeks forever I know like you know nobody sees the forevers and guess what see the problem is I enjoy the journey I'm having a cool run this is really cool you know I mean I was this was a privilege to talk to you know it's the end of my days the thing is exciting so I get a kick out of all this and it's not the end product that's the destination so if you don't want to you know and today dentists do go out of business I had a father-son team that the son had a move Marilyn and the father sold the practice right up the block and I woke Asst one of the wealthiest thousand Jersey

Howard:  so final question we went way over an hour final question there's a 40-year old Dennis listen he's burned out fried and he just he's just burned out well what advice would you give them 

Michael t Varallo: rejuvenate yourself take a little time if you have money regroup and think about it think about see Dennis where the chief cook and bottle washer you do the lab work you have to you know do there isn't anything you don't do as the owner so embrace that if not there's plenty other things than just doing tooth carpentry there's education basis Rutgers has a wonderful dental school and why you always got people to read you I mean you could be influenced other people in that area so you don't have yes you can go into sales I just did a consultant for a guy who left dentistry 10 years ago he's probably not 50 and they're launching a new software company you know so do because we were trained in that box doesn't mean you have to stay in that box you can you could do whatever you want well you know you're gonna want a magazine to do you were gonna be on TV never how did you get there I mean you 

Howard: seriously yeah I I love dentistry more than anybody I knew and I I was reading these dental magazines like who rates his stuff so I thought well you know what you do I'm the problem so I would write these articles I would submit them to Jetta and all the other ones and Dhoni Angelini yeah and shadow people published four of them but they  would just they didn't like him so finally I started meeting them I realized oh my god none of these dental magazines are owned by a dentist these are it's all non dentist not and I thought you know what dentistry needs one magazine that's actually owned by a short fat bald real dentists and Phoenix is doing this so I did it and we started 94 no one even knew who it was till we added dental town to it in and 90 st. Patrick's Day 99 so yeah the first five years I mean it was very hard but I did it selfishly for me I wanted it better day yeah me too it 

Michael t Varallo: but what I'm saying is that the journey you exported do you you didn't believe in the cubicle you saw in a cubicle and said I gotta get out and that's the cool part we're educated with that education you don't have to be in a cubicle your whole life get out and find out smell the flowers do stuff I mean I I'm really right now and we took this new social because I really wouldn't want to do some more on the headaches and more on sleep and TMJ I'm just too busy so when we start to grow and I'll get some little that time I'm not gonna take the time off I'm gonna take the time to do more cool stuff how do help people 

Howard: well we are well over an hour and Michael series art it was it was an honor to podcast you thanks for coming on the show with me and sharing your wisdom from four decades of dentistry and someday you and me are gonna have a beer on man tuck it all right you're said Alice I'll send you the information how we do it and we'll figure out how much I get what you have to drink before we tried to swim to Martha's Vineyard from Nantucket

Michael t Varallo:  uh you don't have to drink a lot you know a case or two before in the morning and then in the afternoon you have I'm actually starting a rum company are you early rooms do I have his room company started with my son Wow well I can't wait I will see you on the beach all right listen we'll make up well we'll keep it communicated

Michael t Varallo:  I'll keep in touch with this what do you know clear choices foundation I'll let you know everything we'll keep you posted on that yeah I'm clear choice you said starting the arch of Hope Foundation yeah I'll get you  know let's see if Gina wants to reach out again these are worse traveling people they were all done phenomenal they're all really sharp people they do their homework in you would the testimonies okay do you know what are you looking for the podcast guys yeah why are you thinking I can get you a guy from clear choice that you love yeah let's bring him in you got my email Howard it'll take calm yeah he's real sharp guy he was president of scrambling so really sharp guy and hewed he's easy to talk to and nice or I go have a beer what time is it in Phoenix it is 1:15 she's at 4:16 I'm past my bedtime I'm 66 will you you're looking great thanks for coming on the show the other way thank you very much 

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