Howard interviews Dr. Scott Bridges at the Kentucky Dental Association's 2019 Kentucky Meeting, and Dr. Bridges shares the story of how he converted a derelict gas station into a successful dental practice.
VIDEO - DUwHF #1235 - Scott Bridges
AUDIO - DUwHF #1235 - Scott Bridges
Howard: It is just a huge honor for me today to be podcast interviewing Scott bridges who's on the cover on Dentaltown magazine this month for finding an old gas station and redoing it and making your smile station family dentistry.
Scott: That's right yeah
Howard: First of all thanks for being a townie man you've been a townie since 2002 7,000 posts I feel like I feel like you're a brother from the same mother.
Scott: Yeah it's been a while it's been a while I was still a student whenever I first logged on asking student type question.
Howard: Is that right you were a student in 2002?
Scott: Yeah graduated in 03.
Howard: So where did you go to dental school?
Scott: University of Louisville
Howard: Right here?
Scott: Yeah right where we are.
Howard: We are right at the Kentucky Dental Association it's so cool and its right on the Ohio river.
Scott: Yes overlooking the Falls of the Ohio.
Howard: Wow and then how far down until it runs into the Mississippi in St. Louis?
Scott: Actually close to where I'm from in Paducah just about 50 miles past Paducah it it runs it to the Mississippi at Cairo.
Howard: and that's north of St. Louis?
Scott: It's south yeah
Howard: Oh okay it's probably safer for St. louis to have those two monsters meet downstream than upstream.
Scott: Yeah where I live the ohio has two rivers that run into it right before Paducah the Cumberland and Tennessee so it's a monster before he ever even hits the Mississippi it's a mile wide in Paducah so it's a big main...
Howard: It's bit right here
Scott: It's a big main river
Howard: Wow and I was reading a paper on how well you can go to any river you can see where the Bluffs are on each side to see how it stinks across but it's not a matter of if that Mississippi is gonna change direction and run over a New Orleans just a matter of when.
Scott: Yeah it's hard to stop all that water I mean they've they've done a good job over the years but you know major floods come and they change the landscape.
Howard: So talk about your journey so you saw a gas station go under and you decided you were gonna make that a dental office.
Scott: Well it's it's a little longer than that I moved back to Paducah in 2003 and I was a partner in a dental office there for ten years and I sold my partnership I bought an office in Tennessee I kept that office in Tennessee about five years in the meantime I decided not that I didn't want to move to Tennessee I wanted to stay in Paducah I got remarried I have a family now and so I was looking around.
Howard: So you did the dental divorce thing and then got remarried?
Scott: Oh yeah so but still stayed outside of it I didn't marry anyone involved in dentistry but anyway so I bought that I was looking around for an office and really close to where I grew up was an old Texaco station and over the years it had become abandoned it's been a convenience store for a while you know everything in the 90s became convenience stores and so it was a good property it's on a corner is very visible I kind of took a chance it's a little bit outside the city kind of suburban just small-town anyway so suburbia is even a little bit smaller but when I bought the building and I had no idea what I was gonna do with it I'm gonna have to either tear it down or make it look completely different than the shithole you know convenience store that it looks like right now and I was lying in bed one night and realized it would be really easy to make it look like a Texaco station again and so that's what I did and had so much fun doing it and collecting the memorabilia to put on the interior.
Howard: So what happened so the first thing I thought it was in the EPA with gas tanks underneath there that that would be a monster to get signed off on paper.
Scott: Well it's a funny story they'd already cleaned the property up mostly.
Howard: Texaco did?
Scott: No the state did the state actually charges since the 80s they've charged a little tax on gas to clean up underground storage tanks they all leak and before I went to dental school I actually worked for the company that did this company that cleaned up gas stations so when I bought the property I knew that it was going to be no problem they've done the majority of the cleanup had a few monitoring wells which are gone all gone now and I also knew that the state would pay to replace the parking lot that had been torn up so that was a financial bonus I bought the station that I could apply for reimbursement for my parking lot so they essentially paid for my entire parking lot.
Howard: So I really loved your feature store and I really loved those hot pictures so you're in Paducah, how many people live in Paducah?
Scott: In the county there's probably about seems like there's about 85,000 county and city combined. The draw area we're kind of a kind of a health and medical care center for the region and so there's a draw area of about two hundred square miles or about a 200 mile radius I should say and so there's probably about a quarter million people in the draw area.
Howard: So now does texaco were they cool with you using their logo at Texaco smile station I haven't heard from them yet.
Howard: Do they even exists anymore?
Scott: They do they do they're still a pretty pretty good size company in the south and southwest.
Howard: Are they owned by a big dog like Exon?
Scott: Yeah they were bought out years ago I don't remember the larger company that bought them so they could care less that I use it there logo well it's not really their logo it's kind of a play on their logo from you know their old logo from the 30s and 40s.
Howard: Gosh that was so big when I was a kid that is amazing then what was the one with the dragon the dinosaur Sinclair?
Scott: Sinclair yes Sinclair, I have a Sinclair sign inside my office and Sinclair still exists.
Howard: Sinclair does?
Scott: Swear to God I was out I was visiting Ed McGrew you know Ed? He's a townie I was visiting him in Montana and saw Sinclair station and they had a huge dinosaur out front.
Howard: Arizona has on one of the Indian reservations they have some of the old dinosaurs to play on. So is them so I imagine something that highly visible everybody knew you existed as soon as it open I mean was it a big marketing play I mean if you're location is that good is that you kind of look at it as a marketing expense?
Scott: Yeah I mean location is unbeatable location is the number one as you know marketing can overcome location somewhat and I had that in the past but location is such an easy free marketing tool and yeah people were watching it being built out wondering what was coming in there so we finally got a sign up that you know they were coming in I have so many patients that come in and first of all they thank me for taking a blighted corner and fixing it and then they say man I watched this for you know being built for six months.
Howard: and you were born in that town?
Scott: Yeah I was born about a mile away from there.
Howard: You just turned 50.
Scott: Yeah I went to high school kind of across the street from it.
Howard: Congratulations on a half a century, how was the first half century?
Scott: Wild you may know that already you've been around a few years
Howard: Half a century you got to be proud of that.
Scott: I am I am but I didn't I didn't do an Ironman like you did when you turn 50.
Howard: Yeah that was my and and turned out that that wasn't my problem I did and I ran three years in a row and never got under 205 even though I was working out two to four hours a day so I heard doing that I started I learned that abs are made in the kitchen not on the workout.
Scott: I just ordered breakfast and it was a flatbread with like ham egg and cheese and ordered it without the bread so I've actually become the man that used to annoy me.
Howard: So what would you what would you what would advice would you give to these young kids now that when you started on dentaltown in 2002 and we graduated in 2003...
Scott: Oh man
Howard: If you listen to this on a pot if you listen to a podcast you're a millennial oh absolutely in dental school all them are under 30 what advice would you give you did a partnership.
Scott: I did a partnership things have really changed in dentistry as you know and you know I've got a lot to say about the current state of Dentistry.
Howard: Lets hear it.
Scott: It's you know a lot of it's not that that positive there's a lot of major problems that are coming down the pipe and you know you to me you've got a couple different types of graduating student now you've got a students that have been lucky enough to have a lot of things paid for you know their schooling or whatever for whatever reason through family wealth or something like that and you've got students who are borrowing the money and the ones that are in severe student loan debt which that was starting whenever I graduated these graduates now have serious debt and it's a serious problem because it dictates what their pot what their opportunities are I was able to take an associateship that paid pretty well and I had no problems paying my student loan back you know seriously low interest I owe over a hundred thousand but the interest was nothing now the interest is high you know they've got quarter million dollars in debt.
Howard: The average debt is over average is 287 thousand.
Scott: Yes it's insane and so you know you've got DSOs that that you know they offer you a guaranteed income but it's with a price and a lot of you know I talk to a lot of these people and you know the other big problem in dentistry that I see besides student debt which to me is the number one number two is dissatisfaction with the profession and I see so much of the people that are burnt out there in you know what they feel like a hamster wheel and when they go into work every day you know people don't automatically love the dentist it's not like they tell you in dental school you're not gonna be the respected doctor about town you know you're sunk you're a necessary evil you know it's it's like 80/20 rule 80% of people dislike the dentist 20% they're the best patients they're the ones that come in and make you smile but as far as advice for new graduates and I don't know I really don't know what what I could say other than if you've already graduated well you're you're there and you're gonna have to you know crack that nut and do the best you can and you know there's a lot of advice out there.
Howard: So what you were a partner did you think partners you know when you get married you have a spouse and travel and half of those fail when you so there's a lot of glue holding a marriage together and how is felt when you become a partner with the dentist you don't have the glues you do you think a partnership in dentistry is like a marriage or the 50 percent failure rate or do you think a partnership is a better idea so that you can cover more of the 160 hours a week?
Scott: You know I think of partnerships a great idea I was in a partnership I had a great partnership in dentistry you know I needed to change at that time in my life it wasn't it's kind it's not you it's me it is so it is like a marriage but it really gave a feeling of stability and I had been an associate for that dentist for a couple of years before we chose to pursue the partnership path and it was really a positive experience. Like any marriage you need to date for a while before you buy in because it's financial and I was in a good spot at a good time in that partnership and I do recommend that.
Howard: Not to be too personal you don't answer this and feel free to punch me if I need to but like when you I'm got remarried did you get a prenuptial agreement just like....
Scott: No I didn't
Howard: Yeah so that that's what I always say when we even if you're gonna marry a dentist you're not gonna be making love and having children and going on vacations you need a prenuptial and it needs to be a prenuptial not by your attorney recommended by your favorite pastor but someone who only does dental the nuances and you need to have an exit strategy and you need to do that in marriage TV you come out of school 500 thousand dollars in student loans maybe you don't want to prenuptial maybe you want to marry some rich girl that doesn't uh doesn't ask for one but I'm telling you you need to have a prenuptial when you get married is you're a dentist and you have a half-million in student loans and if you're gonna have a partnership I want to I want to know how many contracts did the lawyer write for other dentists and this is the first one then and there's nothing else to talk about.
Scott: I absolutely agree and my partner and I used a pretty large dental company that did that it was Kane waters.
Howard: Kane waters out of Dallas.
Scott: We used Kane waters this is isn't a recommendation or anything and I have no financial interest in Kane waters but we use them.
Howard: I do I own almost 0.00% company but.
Scott: We had an agreement that was two inches thick and it had all the exit rules everything I mean it covered everything.
Howard: You know and I love about Kane waters they only do dentists.
Scott: Yeah
Howard: but anytime a company is in Dallas or Chicago it's a two-hour flight from anywhere in the country.
Scott: That's true
Howard: You know if it's in San Diego, Miami, Boston or Seattle it's hard to get in and out of but my God Chicago in Dallas any American can get there on Southwest Airlines in under two hours for a hundred bucks that's right so can you show you found someone that only does dental yeah I had a two inch contracts that's how many nuances there are and then you marry and then you had a partner.
Scott: Yeah you know and we had we had a partnership for probably seven or eight years and up until I needed the change in my life to be happier and that goes back to the problem in dentistry today is to be happy...
Howard: So you were burning out?
Scott: I was burning out in the type of dentistry that I was doing the type of practice that we had plus I was at a pivotal
Howard: Low fee high-volume, low-volume what...
Scott: It was kind of a high fee it was heavy sedation a very heavy sedation.
Howard: because you have your diplomat in DOCS
Scott: Yeah we did a lot of sedation and sedation has its own issues where it brings in all the fears and the stresses of the patient they put them on the staff and the doctor you feel that it brings it in your office there's a downside to everything sedation is a wonderful adjunct in dentistry it's helped a lot of people I mean I hate to see what's happening you know a lot of the state boards are starting to restrict sedation in Kentucky it's happening too there was strict sedation and typically it happens when oral surgeons get control of the state board they start restricting things to almost protect their own profession and you know they called oral sedation unsafe which is not in any way but you know I've done IV and oral and all the sedation's anyway back to the I needed a change from that.
Howard: So it was stressing you out?
Scott: It was high-stress, well it was partly that and partly you know I was going through personal changes divorce and all these things I just needed to make some big changes and so ultimately you know got where I am now...
Howard: So you sold your partnership
Scott: Sold my partnership
Howard: to another dentist?
Scott: No back to the original partner I hired a dentist to replace me I stayed on there for a year working part-time and ended up going full-time in my other practice and then part-time when I had had with there a slew of associates in my Tennessee practice. Word of the wise don't buy a practice a hundred miles away that you plan on working in.
Howard: Well let's talk about that because when you know I always think the people like on Hartland always get a rapidly bad rap because if something happens to them everybody knows about it but when it happens in private practice you know they live in a huge aquarium.
Scott: Yeah they live under microscope.
Howard: They live under microscope I feel sorry for Rick Workman and Pat Bauer because I'm half the stuff I read about them saying okay well that happens in all the offices all time but that employee turnover it doesn't matter it's not just DSO's its private practice I'm keeping an associate and I mean the average dentist associate is right about one year yeah so why do you think you had a slew of turnover associates why do you think associates...
Scott: I had a particular problem when you when you're a when you're a private practitioner you don't have the deep pockets that say Rick Workman does or say a Heartland you know a DSO has with practices so it's difficult to find associates because you're competing with the DSO CR offering large signing bonuses more stability guaranteed incomes and I had a you know a struggling practice it was a hundred miles from home and it was heavy heavily insurance based and I'm I wasn't used to that I was used to fee for service which is what I have now so I had this practice and I was trying to find associates and location I was 45 minutes from Nashville not in Nashville where everybody wants to go 45 minutes from Nashville in an army town where it was really hard to get people like people would come and they would say you know it's just a little far from Nashville I want to live in Nashville just a little too too long of a commute and I totally agree you know but eventually I sold the office the new new owner has a great associate he has multiple offices now and good for him. I feel like that I've made every mistake I've tried every type of practice I associated I bought in I bought a dentist out and I did a scratch start up.
Howard: So this so this is your a third office?
Scott: My third office
Howard: and it was a scratch start up?
Scott: Scratch start
Howard: So did you already you didn't have restrict covenant against your old partnership that had expired?
Scott: We did have one it was probably unenforceable because it was so severe but I respectfully that was one of the reasons I bought the office so far away when I left it was out of respect for my old partner.
Howard: So how long were you...
Scott: It was about I was away about three years and that was enough time and my new office is 15 miles from my original office so he has no problem with and we're still friends.
Howard: Well that's cool so you're saying the the the millennial associate wants to live in the urban Nashville not rural?
Scott: Well I'd say a lot of them do not everybody I mean there's no one way to practice dentistry and there's I don't like to pigeonhole Millennials or Gen Xers or boomers you know because people are different now there are some trends that we see that we like to use as stereotypes. I think Millennials are more likely to want to go to urban areas than my generation was because urban area just so damn much better now I mean they're a lot better yeah you know urban dentistry offers a lot of things a lifestyle that's it's different you know did you read the thread I think you saw it going rural is financially stupid?
Howard: Oh yeah it was a great thread.
Scott: It's a great thread and brings up some great points you know I'm semi rule now the guy that started that thread he's got a good office and he's got a nice home he's a great guy but he's got himself in a situation in a rural area where he's trying to sell his home he's got a nice home there's not a lot of buyers because I mean when I say rural this is really truly mountainous rural it's...
Howard: Where's he at?
Scott: It's in West Virginia I can't remember the name of the town but it's a beautiful place and it's just difficult to make changes in a rural area like selling something you don't get as much return on.
Howard: It's not liquid.
Scott: It's like you know in my town I could build a big house well I may never get my money back so you have to look at it in different ways when you go rural, you can be really successful if that's what you like if you're where you want to be you can be super successful really and sometimes it's easier but there are some drawbacks and one of the big drawbacks is trying to liquidate.
Howard: Yeah
Scott: When it's time to leave or finding a buyer finding an associate finding a partner it's a lot harder.
Howard: You know it was I still think Jack Dillionerg was the the only Dean that got it, like you know public health always had to have dentists offices on Indian reservations because there weren't any Indian dentists...
Scott: That's right
Howard: well why because the dental schools didn't accept any because they didn't have the 3.85 GPA like a little kid grew up in downtown Phoenix. So Jack said anybody that applies from any reservations gets in when they graduated where did they all go right back to the Navajo Reservation right where they always wanted to live in and these dental that the nation always talks about a rural underserved no access whatever and but they but they never you know if you accept a kid from downtown Nashville he's not gonna graduate the rule so it so it all comes down to if you want more rural dentists you got to accept rural dentist and I see it all over Arizona like I was up at a mine by and a Seligman Arizona and I was talking to the management time so what is your biggest constraint they said man we can get mechanical engineers I said why is because ASU only hires you accept you on your GPA and it's all about just Scottsdale Phoenix Tempe kids and they don't want to come live here but every time a kid from our Kingman Arizona applies to mechanical engineering so that they don't have a high enough GPA again and I and it's like I'm the every all these universities they just want to compete with US News and World on who has the best University and they need to sit there and start saying okay well these small towns mean a mechanical engineer will accept anybody from your town to be a mechanical engineer your town needs a dentist will accept the kids a dental school you know so the mismatch between that.
Scott: You know you asked me a question earlier on and it kind of caught me off guard I really didn't have a good answer what advice would I give Millennials these people that are currently graduating dental school, well the dental school debt is high and when you first start out it's hard to make a lot it's in it's easy to go down a path of you know a path you don't want to go down to try to pay your loans back. I would really recommend the armed services.
Howard: The what?
Scott: Armed services
Howard: Yeah really the Air Force, Marine
Scott: Because they pay your loans back for you and you get practical experience and you get to travel and then when you come out you're done you don't have any loans you've got experience and you're a veteran.
Howard: but they just announce massive cutbacks.
Scott: Yeah I mean I'm sure they're it fluctuates like it didn't 90s remember in the 90's way down but yeah that's you know that's something that that is a real benefit and I know it's not for everybody but I think it's if I had it to do over again I would have absolutely tried harder to get in because I applied for the army scholarship my first year the recruiter lost my application.
Howard: Oh yeah
Scott: Yeah the day it's due he shows up with a new application I'm supposed to fill up I'm in the middle of clinic you know in class anyway he didn't get it there I didn't get the scholarship it didn't get there in on time which was not my fault and I didn't I never realized I just kind of...
Howard: They have fun camaraderie every military dentist I know really likes their homies.
Scott: Well they're you know there's a townie fish net who make Mike Trout who just retired he's an endodontist he stayed in at the full you know he's retired of colonel you know he's he's got the benefits and he and he's gonna go back and work part-time now and he's what 40-something you know he's essentially retired 40-something 47 years old probably.
Howard: So you got your diplomat in Docs?
Scott: Yeah
Howard: Some young kid wants to know what you think of that, would you recommend that?
Scott: I absolutely recommend sedation at least in a limited basis because then you know
Howard: or IV
Scott: You know either one IV is not my favorite because I don't like being the anesthesiologist so much I don't like starting IVs very much now they have training classes in Kentucky where you can have your assistant trained to start the IV's but in my experience with it IV works very well for short case dentistry like third molar extractions or something like that but for large case dentistry I found that oral sedation works a lot better it lasts longer and it's easily reversible there's a lot of benefits to it and as far as IV goes it just wasn't for me I mean I've got people that are afraid of needles they don't want to see me sticking a needle in their hand or their arm you know but I am IV certified.
Howard: You are on the cover dentaltown this month I want to talk about some of the articles they're talking about a fully digital dental off you want to be fully digital?
Scott: Mostly yeah I'm working toward that because you know in truth you know scanning is the future of Dentistry whether it's orthodontics whether it's single unit crowns multiple units I mean you can do I mean the world is going digital and I've got the medet scanner now Medit i500 and...
Howard: You got which one?
Scott: Yeah the Medit i500 you get it through CAD ray it's a CAD Ray like a supply company.
Howard: Okay
Scott: Yeah
Howard: The oral scanner?
Scott: Yeah the scanner
Howard: Okay so the oral scanner is what?
Scott: It's the Medit i500.
Howard: Okay
Scott: So the price is pretty good on it and the software is great I mean it's it's it's constantly updated.
Howard: So did you already buy it?
Scott: I already bought it I bought it back in the spring.
Howard: and so now you're doing your oral scans for crown of bridge?
Scott: Yes I just started
Howard: and you're sending your scans to the lab
Scott: Yes to the lab I don't have a mill yet.
Howard: and is that so does your lab do they like to oral scans instead of the vinyl poly impressions you used to send or
I guess they do you know I didn't I didn't have any trouble with you know triple tray impressions I didn't have any trouble with the Crown's that I received from those you know after doing it for so many years you get into a routine but I just wanted to push myself a little bit and I have some other plans for it as far as ortho stuff and because nowadays you can scan you can do a full scan of the mouth you can download it to a site that they will print a model print your orthodontic models for you so you never have to take an impression.
Howard: So are you talking about worked out where you want to do clear aligner trays or you know about brackets?
Scott: Brackets
Howard: Brackets
Scott: Placing brackets
Howard: and how long have you been doing just ortho?
Scott: Not very long that's something that I'm pursuing now through Tom Garrity ortho course but I've got some friends who have in dentistry who have done that and enjoy it and it's something that I'm interested in so.
Howard: So why did you pick the Medit i500, I've noticed that people pay a lot more attention if they pay a lot of money. If your going to spend a lot of money on a CAD CAM or...
Scott: You know I went to midwinter this past February and I went to a class where we tried out six different scanners the Medit was not one of them and but six different scanners I tried them all you know I think my favorite of the Sriona I tried was this Sirona the new Sirona scanner I cant remember the name of it it's morning I haven't enough coffee but I on the trade show for I tried out the Medit and it was as high quality and speed maybe not as the Sirona but pretty damn close and the price we yeah the price was great.
Howard: What was the price?
Scott: It was around 18,000
Howard: 18,000
Scott: Around that it's between depending how they had a show special and some differences.
Howard: So what was the main thing that made you spend 18,000 as opposed to going back and using empurgum and triple tray?
Scott: Tax write off, Just kidding.
Howard: Really
Scott: Well yeah I mean you have to buy equipment from time to time you get good tax write-offs.
Howard: So a big part of the decision was a tax write off?
Scott: You know a small part of it was but the biggest part was I just want to stay current man I just went to you know continue to grow to fight the burnout I don't want to do a bunch of new procedures like when you're a new dentist and it you know I think it's probably a good idea to get out there and try a bunch of procedures to expand you know you know how much your your earning potential to expand and find out ultimately what you like and don't like then we get to be my age you start cutting shit out that you don't like to do I don't like to do I don't like to do molar endo I don't do it I just refer.
Howard: and it's just a preference thing isn't it.
Scott: Yeah I don't like it, it's stressful to me and so when you get around 50 years old you start trying to cut your stress out a little bit you know dentistry is a stressful job I got a family I got a two-year-old you know that's stressful too and so I've started cutting the things that I don't like and exploring some things that I might like like ortho and for you know for teens and kids I've done add or adult ortho for many years I did six month smiles I did clear correct, Invisalign.
Howard: Six months smile so you got into when Ryan was...
Scott: I did absolutely
Howard: Was he your teacher?
Scott: Weah went down to it went down to Palm Springs or West Palm
Howard: I mean and that night that guy could think outside the box more than anyone in dentistry.
Scott: Oh I know that dude is something else I ran into him a couple years ago at a podcast meeting and
Howard: In Scottsdale?
Scott: Well it was in Nashville
Howard: Oh okay Nashville
Scott: Yeah I don't see Ryan much anymore but now see him on Facebook and stuff
Howard: Yeah does he got a podcast?
Scott: I don't know he's got some a lot of YouTube videos and stuff like that.
Howard: It's amazing there's no 60 dentist uploading their podcast on dentaltown 60.
Scott: That's awesome
Howard: I know it's just a new way of communicating.
Scott: It really is you know you've you've really taken it and run with it and I did one with Sean Keating a couple of years ago and enjoyed it.
Howard: Is he still doing his fantasy football is that this year?
Scott: I think he does it every year I've never done it but I think he does it every year.
Howard: Are you into fantasy football?
Scott: No its too addictive it would kill me.
Howard: Yeah I only got into one video game when my boys were young in a Nintendo 64 came out I'd come home from work and I had four station my baby was too young Zach was only like two but he loved to watch and then the four six eight dad and we and I thought I will buy this game and it'll be fun and you know we'll get out to work oh it turned out it was like two to three hours every night for like six months before we got all 120 stars and when we finally got all our stars I walked I said I'm never playing again I tried one totally got addicted.
Scott: Oh yeah
Howard: and that was a fun time but yeah I never got that gambling or the both.
Scott: Yeah there's one of my classmates heckling me from show floor here
Howard: So and so but the point I was gonna make it is preference like I don't know why but I love removing wisdom teeth and molar endoI just love it but I would never do IV sedation because I that the thought of doing a Michael Jackson and he never wakes up or I've met a couple of dentists where you know things went south and so it's just preference so you're you're not so that didn't stress you but molar endo did what just shows that it's just a person preference thing.
Scott: Well honestly IV sedation stressed me out you know we used you know fentanyl and you know benzodiazepine and you know it things happened fast in in IV sedation and I didn't want to go to deep sedation because it's you have to do it if you take him into deep first of all you're out of your box there you're illegal you know unless you've done a residency. So you're trying to keep them in moderate sedation and you know people will do what their bodies are gonna do what they're gonna do and things happen fast in IV sedation now you can titrate it like they say and you can reverse it and that's true but I found in oral sedation things move a lot slower and it's still reversible and I've reversed a couple you know just because I didn't quite get the response I wanted from them but you know for me IVs not the thing I stay certified in it facility certified.
Howard: The other thing I don't understand at all about the IV station is so legally in all the hospitals you're not allowed to do the IV and the surgery. So every hospital in America it's two separate deals and...
Scott: but in dentistry you got to be the anesthesiologist and and the clinician and the surgeon you know and it to me that's just too much man.
Howard: When was your you have a two-year-old right?
Scott: Yeah
Howard: What time of the day was he born?
Scott: He was born at nine o'clock in the morning.
Howard: Okay well but if he'd been born at 2:00 a.m. they would page an anesthesiologist and they'd show up they just sit at the Ihop or the waffle house.
Scott: Well he was born I mean he was c-section so it was you know it was planned you know the day and everything.
Howard: So you can have an anesthesiologist show up at your dental office.
Scott: but the cost is prohibitive I mean
Howard: Is it?
Scott: Yeah it's ridiculous you know most places where am I gonna find somebody like that in Paducah Kentucky it's not gonna happen so somebody wants an IV to get a wisdom tooth out or a single tooth I mean I send him to the oral surgeon I got some great oral surgeons there in fact I ran into one of them last night over proof on main great guy Don Hein and you know I'd rather the experts do that.
Howard: Yeah
Scott: You know I'm not the expert at that.
Howard: So are you in cad/cam too are you doing can't resent a goal in your office?
Scott: The goal is for me too yeah the goal is for me to mill crowns I don't have a mill yet my dentist has done three milled crowns on me and so I'm all for it it's awesome I mean in and out in an hour and a half.
Howard: Because the same thing I found with same day crowns that rural dentists who aren't close to labs it's more important to them yeah I mean then someone like me in Phoenix it has 3.8 million people...
Scott: We don't have we have a couple of local labs but all they do is PFM. They don't do it so they're always yeah they're old-school this is old-school stuff so I've I've shipped out my stuff since I started you know 16 years ago and I now have a practice that I do a lot of single units and I always said to me it makes more sense cad/cam makes more sense for someone who does a lot of single units because you have a lot of temporaries out there now my temporaries typically don't come off but sometimes they do and I think it's just a model I mean it's pretty much the model of the future you know not to have a temporary.
Howard: So there's a lab in Paducah that makes pfms?
Scott: Oh yeah
Howard: Man you should buy that.
Scott: No get him something to mill some zirconia
Howard: Thats been on of the biggest changes since I got out of school, theirs 15,000 labs in the United States were over half just have one or two employees.
Scott: How many are there now?
Howard: Well all those are gone.
Scott: Oh wow
Howard: So the it's gone from about 15,000 to 7,000 but who losses all the one or two guys.
SCott: Oh yeah
Howard: Like I remember where I opened up and there was one guy that had an apartment complex 1 mile from my office in his apartment he made PFMS in house.
Scott: Wow really
Howard: Really good but those guys have all get away please.
Scott: Get away with it what about what about the guys that used to cast their own gold crowns?
Howard: Well I had the best story on that there was a dentist on who in Phoenix who bought out an old guy who did all of his cast gold and about five six years the guy had died he bought it from the spouse five six years later he wanted to remodel the lab when he when they pulled out the casting deal the guy every time he got off his sprues he dropped it in the whole there and amount of sprues filled up 5 pickle buckets and they were worth more then what he bought the practice for.
Scott: The sprues paid for the practice.
Howard: The sprues paid for his practice.
Scott: Meanwhile gold went from forty to four hundred to eight hundred thousand dollars an ounce.
Howard: and that's why it's not used anymore.
Scott: Its too expensive, the biggest change I've seen is probably zirconia the last seven years I've been using it for seven years almost exclusively for molars it doesn't break.
Howard: and are you bonding it or cementing it?
Scott: I cement it but what I do is I use that Ivoclean and then silane I've never had one come off out of thousands of these things Ivoclean the purple stuff and then silane with it's Montalban.
Howard: So the Ivoclean is that hydrofluoric acid?
Scott: I don't know what it is.
Howard: The purple stuff?
Scott: I don't think it's acid I don't know what it is maybe I'll have to ask somebody here.
Howard: I like that Danville micro etcher
Scott: Yeah
Howard: That shoots out the white aluminum oxide and it just cleans out everything but it just makes a huge mess.
Scott: Well there's been a you know there's been some research on micro etching porcelain and I'm no expert on it but they don't really recommend it on a lot of the porcelains I don't know if they recommend it on zirconia or not but my system is I clean the tooth with with chlorhexidine like the kind with no oil in I can't remember the brand of it so I use chlorhexidine to clean the tooth and I use the Ivoclean on the crown this is after it's been tried in because saliva changes the molecular surface of the zirconium. So Ivoclean rinse silane dry and then I use Maxm elite and cement it and I mean they stay on they don't come off.
Howard: Yeah
Scott: Yeah that was the recommended thing when I first started doing it and that still works.
Howard: So when your talking to dentists and their under stress there's clinical there's business but this seems like it seems like the human part is the most stress on whether it's dealing with the human patient or the human staff and these young kids they come out of dental school and they learned all the chemistry in geometry algebra but when they have to start being a leader and working with staff what advice would you give a 25 year old kid trying to hire staff lead staff manage staff it's a lot of times the staff are old enough to be his parents.
Scott: Well that's a toughy the the best leaders lead by example obviously but the best leaders are not the ones that are generals the best leaders are the ones that clear a path for people to succeed and in dentistry it's so hard on a daily basis to be everything because you've got to be you've got to be perfect you've got to be a jack-of-all-trades right to own a practice or even to manage a practice or even be an associate in the practice and the biggest problem I think the biggest cause of stress in dentistry I've got a real theory on this we have to perform at the top level every day you're essentially a jet pilot because if you walk in the operatory and you say man I'm just not feeling good today mrs. Jones I mean what's she gonna I was she gonna stick around probably not. They expect us to be perfect every single day we were taught that our margins have to be perfect our impressions have to be perfect everything has to be perfect what every human has a bad day so you've got a job where you're expected to be perfect every day and you're not and then the patient's given you hell because they don't want to be there and you're having to deal with employees who don't care as much about your practice as you do and all this stuff adds up and it can cause a lot of real problems stress can cause a lot of problems depression and different things like that and we can't ever be good enough you know in our own heads sometimes and so I think this is the thing to be aware of to balance your your working life like I don't take dentistry home with me maybe I'm lucky I just don't take it home it just I mean it just goes away as soon as I walk out the door I don't think of it again if there's a day that I have a bad day I might think of it you know might bug me bother me but you gotta keep it separate and I don't have all the answers but I just know that dentistry is a very stressful job and managing the stress no matter how you choose to manage it is so important. Now I don't recommend managing it with like alcohol or you know illegal drugs or anything but like Donna you know Donna that's right, like Donna you know does the meditation thing Donna lankowski.
Howard: Yes
Scott: She does the meditation thing and you know she's found that as a way to manage her own stress and probably helped a lot of other people.
Howard: Did she do meditation or yoga?
Scott: It's meditation
Howard: Meditation yeah
Scott: Yeah maybe both but I know she it's a lot of meditation.
Howard: I finally figured out I mean for me for me it was Bikram yoga yeah but I was because you're always thinking about it you don't know how much your mind's wandering but in yoga yep in Bikram you have to do 26 poses twice well if you start thinking about something else you fall or so in order to do the pose you can't think about root canals fillings crowns business people...
Scott: Thank God
Howard: So when you walk so when I would walk out of there I would just feel so relaxed that took me like a year to figure out what was going on.
Scott: To clear your head
Howard: So I think for I think meditation really is what can you do like you're a pilot I can't imagine and it's so funny because I would think that'd be the most dangerous thing right here you're way up there tens of thousands of feet of sky if you start daydreaming about something at work next thing you know you're gonna eat the ground so well it's I imagine it's different than that has been like meditation is good for pilots.
Scott: Well you know autopilot helps but no being a pilot for me is a way of escaping the ground and the problems of the ground and you have to concentrate I don't fly for an airline or anything like that I fly for myself but to be safe as a pilot and this relates back to dentistry to be safe as a pilot you follow a checklist you ever go into your treatment room and shits not set up the way you want it because your assistant didn't follow the checklist or you they don't have a checklist I mean checklists are very important to me they make the difference in dentistry too but that being said a little aside there being a pilot you're above everything and you can daydream a little bit of it because you know a little bit cuz you're not gonna run off the road but you need to be aware you know spatial awareness and stuff like that so it's a challenge to me that that I've always enjoyed but I kind of grew up flying my dad's a pilot he's 82 and just stopped flying last year and my granddad was a pilot as well so because I'm gonna run to the family.
Howard: The checklist is what is the thing it pilots pilots do everything with the checklist because they were if they were 99.99% accurate there'd be four crashes a day.
Scott: Probably so
Howard: Yeah
Scott: Yeah I mean it...
Howard: So 99.99% is not good enough for a pilot that's why they always do checklist and so do you I recommend using a checklist in dentistry?
Scott: I recommend using a checklist in dentistry not for routine procedures but I recommend checklist for staff because with a checklist you can you don't forget things things aren't forgotten and there's also accountability if the checklist that you have are signed you know like checklist for closing the office say somebody turns the water off but doesn't turn the vacuum pump off well might burn the vacuum pump up you know things like that somebody sets up set you up for you know an implant but you're gonna place that day and they forget three things because they didn't use a checklist and you it adds to your stress adds to your stress checklist can eliminate stress by taking out the question marks.
Howard: So you flew in from Paducah to Kentucky and landed at the major airports in the press you know for 30 years you've heard where the commercial airline pilots some say they don't want they don't do you think the 737s and the single props should share the same airport is that fine? Is there much push back on it?
Scott: The way I actually flew in most large cities have reliever airports for small planes because number one we don't want to deal with their stuff and they don't want to deal with our stuff because we're slower they operate on a different level we operate on a different level I get both sides of that well so I flew into the old Louisville Airport what's called Bowman field it's about five miles from the gigantic Louisville Airport I think it's called Muhammad Ali now used to be called Standiford so when I come in from the the West they take me right over the middle of all the runways at about 1,500 to 2,000 feet to get to Bowman so I go over the big runways of the bigger court right in the center because all the airplanes the big jumbo is in the heavies they're taking off under me and they're you know they're flying straight up you know in a 45 degree angle so I'm looking down you know preparing to land at this other smaller Airport and I'm watching the big guys take off under me so it were actually works pretty well.
Howard: What's the initials of this big airport Louisville?
Scott: STD
Howard: No SDF
Scott: Yes I'm sorry SDF, STD
Howard: So that means Louisville is home of silver diamine fluoride.
Scott: Oh god
Howard: It's just the silver diamond fluoride
Scott: Apparently so but
Howard: I saw I landed in Louisville Kentucky said Muhammad Ali international SDF which I assumed that silver diamine flouride.
Scott: He was a great man Howard he was a great man but I flew into LOU lima Oscar uniform which was the Old Louisville International.
Howard: Is there really an airport that's STD?
Scott: No I was it's again it's morning I haven't had enough coffee it was SDF.
Howard: So your the first person on Dentistry Uncensored Muhammad Ali was the first person to do silver diamine flouride...
Scott: Invented SDF
Howard: What a legend.
Scott: Oh absolutely
Howsard: My gosh so back back to the back to the kids any more advice for the kids like say it send me an email Howard@dentaltown.com tell me your thoughts, what you want to hear about or leave the comments under the YouTube section but every time someone sends me an email there one in four in school the rest are under 30 yeah half are probably in the Western Hemisphere and half are in the Eastern.
Scott: Yes absolutely I've noticed that.
Howard: We open up our it's great podcast on our RS feed so they're downloaded from the University of Tokyo Cambodia Malaysia France all kinds of places but they're all under 30.
Scott: Well you know dentistry can be a very isolating profession which is why you start a dentaltown and I would say to find a mentor group or find a group of like-minded people whether go online in a private group and bitch bitch bitch or you go online and talk about the intricacies of silver diamine fluoride you know it doesn't matter find a group of people that you share interest with like the Townies that we used to hang out with and keep that as your escape from the drudgery or the stress of Dentistry you know Venting really helps a lot like you know it's like I've got a two-year-old so I have all this Daniel Tiger stuff it helps the Daniel Tiger and you know Mr. Rogers it helps to talk about your feelings yeah but it really does even if they're negative feelings it helps to vent that you know get it out in dentistry again stressful profession vent your feelings you know you'll get through it.
Howard: Yeah well okay thank you so much for being a townie.
Scott: Man it's always a pleasure Howard I don't see you enough but when we do see each other it's like no time has passed.
Howard: Yeah it's a virtual relationship with people's posts but I've been a huge fan of yours I have always loved your transparency you you live in an aquarium on dentaltown and you don't care and so many people they want to help but like that you'll post like will you help me decide if I should buy this practice or that practice but they don't say their name was.
Scott: How do you make a decision with no information.
Howard: and I think that the people that aren't into transparency it's you realize that 95% of all the humans that ever lived or dead and which is about a hundred and five billion that would be more than the last fifty thousand years and have the almost 8 billion humans alive today you're never gonna beat 99.99% of them so why does anybody care right what anybody thinks when nobody will ever even know you existed.
Scott: Yeah
Howard: Ninety-nine point nine nine nine percent of all the homos will never even know you existed.
Scott: Yeah 100 years you're forgotten.
Howard: So every time yeah Americans can't even name the President of the United States 100 years ago today.
Scott: No
Howard: So a hundred years ago today who's president hates no one knows you don't know you'd have to google it so I love I have always loved your transparency I've just always saying what you think whether it was politically correct or not.
Scott: It's negative or positive
Howard: Negative or positive thanks so much for all you do for dentistry and thank you for being on the cover.
Scott: Thank you, appreciate it.