Dentistry Uncensored with Howard Farran
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1249 Innovations in Dental Photography with Dr. Glenn Krieger : Dentistry Uncensored with Howard Farran

1249 Innovations in Dental Photography with Dr. Glenn Krieger : Dentistry Uncensored with Howard Farran

9/16/2019 6:00:00 AM   |   Comments: 0   |   Views: 117

Since graduating dental school in 1992, Dr. Krieger has been committed to staying on top of the newest and most innovative aspects of dentistry. A fellow of the Academy of General Dentistry and a practicing orthodontist, Dr. Krieger understands the challenges faced by clinicians on a day to day basis.

AUDIO - DUwHF #1249 - Glenn Krieger


Having drawn upon a lifelong love of photography, Dr. Krieger sought out the best resources to help him understand the role of clinical images for increased case acceptance. With the arrival of digital technology in the photographic world, Dr. Krieger merged his knowledge of traditional photographic technique with the advantages of digital cameras. The result was the revolutionary “Digital Co-Diagnosis” process, where patients play a much larger role in their dental health choices through better education. The cornerstone of this process is exceptional clinical photography.

Dr. Krieger has worked with numerous consultants and has spent hundreds of hours in business training including “The Dentist as CEO”, year long course at the prestigious University of Washington Business School and another full year at the Schuster Center for Professional Development in Scottsdale Arizona.

Dr. Krieger has presented to tens of  thousands of dentists around the world and has been published in textbooks and dental periodicals. He has created two DVDs to assist dentists with clinical photography and has designed a revolutionary set of mirrors and retractors too assist with image capture. Dentistry Today has named him “Top Clinician in Continuing Education” 11 times.

Most importantly, Dr. Krieger believes that in today’s competitive world the orthodontic and dental communities should be collaborative and everyone should contribute to helping one another succeed. His hope is that this blog, and those who contribute to it, will help practices around the world reach their visions when it comes to growing their market share and delivering care to patents.



Howard: it is just a huge honor for me today to be podcast interviewing Glenn D Krieger DDS MS f AG D the MS he's an board-certified orthodontist and the fa GD is he wasn't dentist for 20 years first he's one of only two board-certified orthodontists who's also at FA GD after graduating from dental school in 1992 dr. Krieger has been committed to staying on top of the newest and most innovative aspects of Dentistry a fellow the Academy of general dentistry and a practicing orthodontist dr. Krieger understands the challenges faced by clinicians on a day to day basis having drawn upon a lifelong love of photography Dr. Krieger sought out the best resources to help him understand the role of clinical images for increased case acceptance with the arrival of digital technology in the photographic world he merged his knowledge of traditional photographic technique with the advantages of digital camera the result was a revolutionary digital code diagnosis process where the patient plays a much larger role in their dental health choice through better education the cornerstone of this process is exceptional clinical photography dr. Krieger has worked with numerous consultant and has spent hundreds of hours in business training including the dentists of CEO year-long course at the prestigious University of Washington Business School another full year at the Schuster Center for professional development Scott's L who we've had on the show and he just retired and went home to Iowa dr. Krieger has presented to tens of thousands of dentists around the world and it's been published in textbook and dental periodicals he has created two DVDs so it's just dentists with clinical photography and to designed a revolutionary set of mirrors to reach actors to assist with image capture dentistry today has named him top clinician and continuing education 11 times most importantly dr. Kreuger believes that in today's competitive world the orthodontic and dental communities should be collaborative and everyone should contribute to helping one another succeed his hope is that this blog and those who contribute to it on ortho produce calm will help practices around the world reach your vision when it comes to growing their market share and delivering care to patients I want to start out with um first of all it's an honor to have you on the show yeah you are you're a legend you are you from the Seattle yeah how long were you on the Seattle study club circuit 

Glenn D Krieger: first of all thank you for having me it's truly my honor to be here with you you've been a mentor since I got out of school in a long time or 92 so what you've done for the dental industry is  be a great role model for the rest of us so thank you I was I started with Seattle study club I got in my first lecture I ever attended was in 96 or 97 and I probably spoke within the network her a little over a decade right 10 to 12 years yeah

Howard:  and what was so romantic for me as I had his son on the show his son's an attorney in Dallas in your backyard David great guy an amazing bass complete Division one basketball I didn't have buddy I mean I know his dad and now and now were so old we have sons that old I mean when I was interviewing when I was interviewing David I just like I'm like I knew your dad when you didn't exist 

Glenn D Krieger: I used to go with his dad to watch David play high school basketball at Busch Academy in Seattle I still remember those days 

Howard:so let me start with um you know when you're talking about I I've always told people and they talk about technology that the number one most important piece of high-tech equipment you should have is a digital camera because when you take pictures and put your own work on a website people jump in an airplane on Southwest Airlines and fly to the next town over to have their implants veneers done and and and and I saw this very it's very personal when it comes to plastic surgery and I know you're looking at me anything and I've had a lot of plastic surgery work done but this is all natural but when people are gonna get a face job a tummy tuck and nose job whatever that they what they're going they want to say I want to see your work and if this is your before and after phase tummy he knows what I the hell I'm Jeff on an airplane and flying from Florida to Beverly Hills to get it done and then these and the dentist not only do their websites not have one picture of their own original work they have the nerve to tell you well I don't like selling power I don't like selling dentistry man it's like well then get out of dentistry well what's the last major purchase you bought what was it a jet ski was it a cruise the girl worked for cruise line I mean if you're not passionate enough to know that when you get your teeth all fix up you should be excited the average American bites 13 new cars in their lifetime between 16 and 76 with the median average price at thirty three thousand five hundred and ninety-five percent of dentists not once in their life will sell one full mouth rehab to somebody but that person will buy 13 new cars in the nighttime so how what is it about you where you knew I want to do digital photography and I want to get you excited I want to show you pictures I'm gonna help you code diagnose and and why do you get it in ninety five out of my out of a hundred of my homies don't get it yeah 

Glenn D Krieger: you know it's funny because I firmly believe we need to pay homage and say thanks to people who've helped us get to certain places and I remember it's probably around 1997-98 I went with a dentist named Wayne and out of Seattle and he was an amazing clinician and I wanted him to go help him as his assistant in a clinical photography course and if you can remember Howard back in the days you would go take you would take up you didn't have digital photography you only had slides right we all shot slide film so people would shoot slides in the morning he would take him to a one-hour photo get them developed and then put them on an overhead to show them what they had done but by the time he'd shown them it was two hours later they didn't know how to correct what they had shot so little by little digital photography came in and I decided you know what I'm gonna start doing this but instead of waiting for slides we're gonna have a picture right there in front of us that we can correct on the spot and change it and say put your hands here or move the retractor there and the issue is that anybody who realizes the value of full mouth reconstruction or better yet full mouth dentistry real that it's a double win the patient wins because they get healthier and the doctor wins because you have a better bottom line and it came to me very quickly when I was in my own practice that it was a lot easier to provide quadrant dentistry or arch Dentistry or full mouth dentistry and it was far more lucrative and more fulfilling and better outcomes and more stability then telling a patient will do number 19 this year we'll do 30 next year then we'll come back and do 18 and so I started photographing and I I started presenting and little by little I would sort of walk them down the path of letting them discover it and that's what digital code diagnosis came along and oddly enough I had one gentleman who was so bought into the concept that you mentioned cars I shown him his case and let him diagnose it I don't sell them care you can be a Salesman if you want to you don't have to be but if you show people images of how they present and walk them down a path towards self-discovery kind of like that scene in my cousin vide right where he says what do you call those brown things he goes oh screams yeah what do you call those things that are green on the tree leaves he walks them down a path if we do that with our patient hood they will take ownership you'll no longer get asked hey Doc why are we doing this again and more importantly like the gentleman once said to me he said you know you were looking at about $70,000 to do this full mouth reconstruction and he said to me you know I always wanted Alexis but I guess a little weight because my mouth is more important now isn't that what we want from every patient to come to our door 

Howard: yeah I mean this photography's come so far I mean when I grew up it was the Polaroid and you can tell that Outkast is a little young kid because when he says shake it like a Polaroid picture you never shake a Polaroid picture the minute he I heard those lyrics I thought that boy has never ever even seen a Polaroid picture but it was a great song um yeah I just I just you know every time I got four boys every time one of their friends to this day goes out and buys a new car they got to drive it by my house you got to go out there you got to see it and they're always gonna turn on the music and I always say to myself and they're done of all the dental cripples in the world that will go through 13 of these car experiences but will never have that feeling I mean I I delivered a case one time a girl I'll never forget she had to take a knee I mean she had when she looked at me because she knew she was a dental cripple she knew she's gonna end up a denture and when she saw the final deal she had to take me I mean she could barely breathe and then and then my homey says I don't like to tell that you know it's like well if you don't like to take someone's breath away I mean I mean I just don't get it it's just it's just a bad attitude so you've got um so um there's a lot of dentists out there I want to change some he's completely you were a successful general dentist with your fa GD and you went you chucked it all and went back to school and became an orthodontist how does that happen what agustin your journey what was going on 

Glenn D Krieger: sure after the federal agents came into my own I was on top of my game I loved what I did I thought I was really doing some meaningful work you know I work Monday through Wednesday 8:00 to 5:00 and then on Thursday from 7 to 2 I would do one case every Thursday from 7 to 2 I might have a general anesthesia in my office that day or what have you but I love doing what I am doing but I was in Seattle a great city but if you're not from there the early evening sunset in the wintertime and the lack of strong sunshine for six months can really have a detrimental effect on people and my wife was going through some significant seasonal affective behavior issues for years and then one day in 2010 she came to me and said you know I love you to death but I can't be here anymore her family my family were three hours further east on the East Coast from a time perspective we were a six hour flight and the weather was killing her and she's the love of my life and she said I couldn't do it anymore I said good we're done but I'd always wanted ortho because I did a three-year Nathon C at the University of Washington years earlier and I realized it would be so much more fun for me to put teeth where they belong when people are younger or older then to cut down 28 teeth with crowns later on in life if the occlusion beat everything up and so when she told me she wanted to leave I woke her up two weeks later in the middle of the night and said hey honey I got to ask you a question you know I always wanted to do ortho and if we're gonna start all over again and relocate how about I go back to school first and she asked me can we afford it and I said not at all but she said just go for it and so I did and I went back to school in Florida nobody Southwest Southeastern University and settled here in Dallas back in 2014 

Howrad: I mean from Seattle to the other corner Miami to the middle haha how do you add you get Dallas out of out of that triangular geometry crisscross yeah so 

Glenn D Krieger: I tell everybody San Diego needs to be my next step because I've been new you New York right Seattle Florida and now I gotta hit the southwestern corner but you know Seattle was great because I went there in 96 and if you remember 96 Seattle was the it town right it was Nirvana and Amazon and Microsoft and everything was happening and mowing and Vince co-coach and and Frank's Peter and John poisoned Dave Matthews the periodontist not the singer we're all killing it there and I figured if I went by osmosis I'd get something out of it and I did but when she wanted to get out of Seattle you know Miami Florida was like a perfect fit for me that was an ideal place for me to be because she wanted sunshine and my parents had lived down there and when I got out of school I took I had a real I did a dream job waiting for me in ortho but I looked around and and I realized that while lamb is a beautiful place and I'm a water baby there was there was just there was a strong hard to put into words there was an aggressiveness or a culture that permeated society that was a little bit more aggressive if you will than what I wanted we just tougher and I I said you know I want to go to Dallas it's in the middle of the United States it's easy to travel from I had friends there I knew the dental community and I looked around and you know I never wanted we never wanted to shovel our driveway again and we weren't West Coast people just wasn't who we were so what did it leave us it left us heartland and you know basically Dallas or Houston or Atlanta perhaps come on just get to the point man are you are you a Cowboys fan or are you still young your audience Oh New York Giants you know I always people here in Dallas give me a hard time and I say look if you grew up in Dallas and you move to New York would you suddenly become a Giants fan there you go heck no exactly I mean

Howard:  I know why you're not a Seahawks fan just because they're evil but um but you kept the giant okay um I want to this is dentistry uncensored I want to talk about I don't wanna talk about anything anybody agrees on and get a digital camera but by the way if they go if they're if they don't have their own dental work on their own website then they should go to Kreiger content krieger continuum comm krieger spelled k r IE ger i before e so it even it's even spelled right k r IE ger continuum calm and that would that would explode their digital photography skills

Glenn D Krieger:  there's two places i would recommend they go number one i would strongly recommend they go to my blog which has been around since 2007 on clinical photography it's called dentalphotography dot blog spot.com probably okay so so tell tell me again it's a www.gentryford.com dental dot blog dental photography okay uh hey wait dental photon your fee dot log blog blog spot.com calm okay i'm gonna click it now if it goes somewhere it will be a miracle Wow I did it dental photography dot blog spot.com I first got asked what the hell is dot blog spot.com why was it just not dental photography calm you know I started 2007 it was just like a fun project and I guess I should technically move it over it's like a wordpress site at this point the blogspot was like the place to have a blog back in when the steam engine was first invented you know what I'm

Howard:  can I tell you my secret website sure if you go to dental porn com that's my site I do not dental porn com yeah that's so official I'm telling you now I'm not going there Kyle's not opening no it's so funny on you know we we never call them townies they start calling them sell out and now it says it can't be reached now on photography got blogspot.com no no dental porn com oh but anyway um you know they start calling themselves Tony's and then on dental town if you have a really cool hot picture people call it a dental porn yo so if you I remember that term I used to get in trouble if I called it dental porn because they were pretty pictures but they didn't some didn't serve much purpose other than just being pretty to look at yeah so so if they go to dental photography dot blog spot.com they'll gonna learn tell me what they're gonna

Glenn D Krieger:  find they're gonna be better photographers how well it's basically it answers almost all the basic questions that I have been asked in 20 years about photography how do I get better studio shots how do I handle an f-stop how do i position mirrors why should I be doing this and so it's probably about 10 to 11 years worth of information just all articles on how you implement a good photographic protocol how do you store images outside of a program you know how do you present them so that's sort of the basis of the have the dental the krieger continuum com that's why you can pick up mirrors or retractors or DVDs or things like that but the dental photography dot blog spot.com it will help them understand much more about how to buy a camera and it's searchable

Howard: if you want to look um it's always should make an online CE course for that on dental town we've made 400 courses or about an hour long each they've been viewed almost a million times Wow well young will they're broke and they only want to study an hour and they don't I'm gonna go to an 8 to 5 lecture if they can take an hour but if you're ever into that because let me tell you guys something out there you know if you were getting a face job a tummy tuck a boob job veneers you're a dental cripple and you're really self-conscious and you you know you worn dentures for 25 years your husband's never once seen you without your teeth in and you have a deadbolt in your bathroom door and she wants to go get implants she's scared and she goes these websites I mean I got friends that are dental legends and implantology and you go to their website you wouldn't even know that they place implants and then you go to some other guy and he's got all this photography of his own work it builds trust because it says right there this is my own cases and people say well and people who live in a city like Dallas will fly to a city like Kansas City or Phoenix when there were plenty of dentists in Dallas that could have got an a on this case and no one's going to them because you didn't establish the dress there's no better trust than dental photography so you can learn about it at dental photography blogspot.com and then you can buy the toys and stuff at krieger continuum com yes sir and and I agree and

Glenn D Krieger: you know in defense of some of them because you and I are built at the same cloth we're like no excuses kind of guys right it's like what's the mean I will tell you I'm redoing my website now why because for the first 4 years I didn't have a ton of finished cases but now I'm redoing my website so I can put my work on there and if you've been doing it for a year or two and you don't have a lot of pictures I get it but if you've been doing it for five 10 15 years you've got to start showing your cases you got to start showing you work and the other thing 

Howard: I don't understand is um you know the hygienist comes in gets in says I need a hygiene exam room five and then what we do is we always measure about how long does the hyejin's have to wait for you to get there and in an average dental office in America it's ten minutes and you know you got to cut that in half so while you're doing ID check why can't your assistant do the photography or do you not buy anything 

Glenn D Krieger: yeah that's what we do all day long in orthodontics we constantly have the assistant state the photos I used to think I had to be the do everything and that's short-sighted sort of micromanagement not your city and that's why I have a DVD so that people can just go and and create their own 

Howard: you know cleaner out there in Dallas where one of the my idols I live Herb Kelleher founder of Southwest Airlines who died this January please and I got to meet him a couple of times in in the Southwest Airlines plane and he even was sane and clear back in the day you know one day I'm not gonna be here but Southwest Airlines will be I mean Ray Kroc is dead but 40,000 McDonald's woke up and made it Big Mac and you  can't have your dental assistant take the picture I want to go do a totally separate subject one that's you've been on both sides deal um so she graduated from dental kindergarten school she went back home she's gonna work with her mom her mom's our Idol she wants to be like her mom but her mom is one of these dentist TMJ people you know went to pinky boys spear whatever they and it's just it's just their culture that the orthodontist don't know occlusion they bull out the curve of speed they blow out the curve a well so that what they didn't they didn't finish the occlusion and these little girls are telling me that why why is occlusion so damn confusing and you've been on both sides you've been a you been an FA Gd you've been at worth Adonis why is occlusion so controversial why do you guys have no problem you know straightening out the curve of speed the curve a Wilson whatever the act and then I and then I and then the next question after that is the most controversial and that is for bicuspid extraction I mean I I have seen cases where if you didn't pull for bicuspids you'd have to what what would you do remove their their sinus or their spine I mean I mean they just don't fit but there are a ton of my homies where if you told them you weren't orthodontist up the street and you did a for bicuspid extraction they probably want you throwing out of town I mean so so there's those two subjects for you occlusion why is occlusion so crazy and what why do and why do the TMJ people always complain about orthodontists not finishing the case in occlusion and then for byes so you know I I did as you heard

Glenn D Krieger:  I did three years in ethology right so mythology for those who may not know much about it was really designed for dentures you know 70 years ago where we would do fully adjustable articulate is we I would do cussing custom ground fossa boxes you know condylar tracings I actually tattooed people's know you know what I'm talking about on a full Stuart articulate and I'm fully adjustable so if we want to talk occlusion you know I'll grab a beer with anybody who's listening right now and will dive as far into that sort of rabbit as they want but here's the thing as much as I love occlusion and I love the idea of occlusion there's no literature that supports anything objective or quantifiable about what causes we know that a high occlusion will cause someone to start grinding potentially but there's no proof that if we remove that occlusal experience things are gonna get better we don't know for sure why people click or pop in their joint and we don't understand the genetic susceptibility of TMJ problems so the problem is it's a passionate topic that people get really excited about but you can't prove it one way or other it's like me having an argument who is better you know Larry got a Larry Bird or Magic Johnson you you can't you can go off numbers but you can't ever make a case for one of the others so in going to the concept of occlusion I would go on record and saying that 99% 95% of dentists think they know occlusion but really don't they know what they learned in a two or three day course they don't really when you start talking lateral pterygoid and masters in temporalis and the impact that contralateral impact you know balancing interferences and muscle firing which is what you learned in the ethology nobody wants to get up into that discussion because now you're getting into the mud you're getting into the weeds and if you do that it means you've got to look at your own work if you start seeing those things you're gonna start raising questions about why it is heavy where and the lateral incisor usually match about a balancing interference which you see but there's no proof to this so we we have to assume that the overwhelming majority of patients are going to do fine with whatever occlusion we put them into it's that small percentage you are not going to adapt and we don't know who those people are before we treat them so we do our best to try to treat them to the best we can to a mutually protected occlusion now that being said this is not a simple subject and in theory it should be simple but when you died into it you get into practice with the neuromuscular envelope of function and all the other things that these experts talk about it takes practice it takes discipline and at the end of the day again you can't prove anything and so it's a controversial topic and when you get two years of an orthodontic residency you've got to learn the biology facial growth you've got to learn all the different ways to move teeth how to avoid the the downside and what happens when to make those decisions like for a bicuspid extraction and honestly it is really  hard to also shoehorn in significant occlusal training which would sound like it should be the  bedrock of a good orthodontic training but it's not there are some programs that do dive in a little bit to know tholly but Nathon orthodontics so in sort of a broader perspective most orthodontists know what they know from occlusion from dental school and the boards and they we understand cusp it protected conclusion we understand the true Civ protection but to be honest when I was a GP I would see tons and tons of general dentists who did cases where they said they got the occlusion dialed in and I'd look at and go this is miles and miles away from where it really should be but here's the kicker the patients were doing fine so I don't know why it's such a passionate thing I don't know why people get so excited about it this is not transplants this is not neurosurgery nobody's going to die from what we do and very little of what we do is irreversible but when you've got forestland breaking on a central incisor on a $70,000 case and it's breaking repeatedly you better understand why it's happening and I think that's what we really really need to be careful now going to your other question about for bicuspid extraction it's pretty simple if someone has severe crowding and we go to straighten their teeth and we bring everything forward we're gonna make their face look like hell because if you don't take out four bicuspid sometimes there's no room in the arch to add the teeth so if you do that it's gonna look term end ously bad now it doesn't lead to TMJ problems there's never been a literature to support that and it can often help a face it can help you know somebody who can chew better are there times historically where orthodontists have gone much higher in for bicuspid extraction percentages absolutely have there been times they've been lower absolutely but most of the really good orthodontist who I know which is the majority of them they really don't want to take teeth out unless they absolutely have to and my suggestion would be for any doctor any general dentist or specialist who doesn't like the idea for bicuspid extraction I think they should sit down with their local orthodontist and have a real tete-a-tete you know like a real talk about why are you taking out teeth and give me the scientific rationale about why because I got to be honest we don't like doing it unless we have to but when we do it we do it for a reason and I think if general dentists understood it better I think they'd support it because it sounds barbaric but many times the harder case to treat is the one where you should have taken out four bicuspids and you didn't the face never looks right they're in treatment two and a half years and you just can't get that occlusion to come together properly because the answer your teeth are sticking out like clam shells instead of sitting the way they should like this so sorry for the long answer but I hope that explains it a little bit and it just comes down to communication I think we all need to just sit down and ask the questions and get an answer and just communicate because there are so many assumptions on both sides of the equation 

Howard: well I mean can so you studied in anthology three years so tell me if my definitions right a gnat is a small to wing fly that resembles a mosquito gnats include both biting and non biting forms depending on their master query system including its physiology functional disturbance and treatment did I get that right 

Glenn D Krieger: close if you studied them harder like I did the three years yeah there's also the red and the green I had one

Howard:  of the biggest gurus and CR on this show who just passed away recently the man himself Dawson and and he was amazing and but but I even asked him I said well you know everybody something to buy in the occlusion all this but you know her she's going through a divorce her daughter is in jail her son's on opioids she or credit cards are maxed do you think that might have anything to do with her and he said no he said no said no Wow and I'm like I'm like okay I mean so some people you can take my two older sisters are Catholic nuns I mean you can take anything to an extreme I couldn't even I couldn't even convert my sisters to Lutheran's you know I mean I mean let let alone a Baptist you know what I mean so so it's extremely them is bad it's them this is 

Glenn D Krieger: the battle I fight is don't entrench yourself in a position so tightly but you feel emotionally you can't retreat let's be fluid biology is fluid biology is dynamic no two people are identical and I will go on record and say any study on a human being in clinical terms is flawed if you do a bench study a microbiological study you can control for almost everything but you can't if you look at any landmark literature we can rip it apart because there's a human being involved and so let's use it as a guide but let's look at the person in front of us and treat them based upon what we know and what's worked in the past 

Howard: so I'm gonna go right to the next most controversial subject and because I just fearlessly again I I know when I know what they're arguing over you're gonna mean and there's two big areas are arguing over I'm gonna take the easy one first and then they're both hard oh my oh my oh my hell what would they call this guys am i oh functional myofunctional people my god and you're talking about your friends on the show that orthodontist frost when I asked him what percent of orthodontists like to do an email functional anything and he's like none zero I mean so so my all my friends that are orthodontists have nothing to do in my own some people like my own function feel I know a lot of people that do a lot of it I know a lot of moms that are so happy they took their daughter to this their baby to this mile functional person and so I see this a bunch of people seen a lot of patients or give them a lot of money and everybody's all happy and then I see a bunch of Worthen are saying that those guys are the that's not science its voodoo it's crazy so what what is it what is that nonsense is it real is it made-up is it make believe

Glenn D Krieger:  the answer your question is yes all of it right because here's here's what myofunctional therapy is all about I've been married to a speech pathologist for 23 years she has a master's degree she doesn't practice anymore so I've seen speech pathology from really you know the training all the way through application myofunctional therapists just assist I can give you the same definition that you gave me like about nads but no but a myofunctional therapist is somebody really helps somebody understand the muscular function related to the automatic masticatory system and so I have a my functional therapist who's a vital part of my interdisciplinary team now here's the thing for years they've been around with swallowing problems you know the kid who's walking around with low muscle tone perhaps a child who's down syndrome which has very low muscle tone and they've helped them train them at a swallow right lip close your mouth breathing converted to nasal breathing but in the last 10 to 15 years the concept of airway centered treatment is growing now in my opinion there's two sides of it there's a side that's based on the literature that we can follow and there's a side that's on the more touchy-feely which doesn't have a lot of literature behind it that people are just as passionate now that in the scientifically based side of airway and sleep disordered breathing the myofunctional therapist plays a very strong role why because let's just say a child is tongue-tied at age 4 or 5 their tongue has never gone up to where it belongs they're putting in a 2 stone straight out as they swallow maybe there's an airway issue related to it if they get a fern ectomy a lingual frenectomy done somebody has to train this child to swallow properly again because if they don't the tongue is going to come forward it's going to open up the anterior bite like that in many cases and we need to myofunctional therapists to help that child swallow properly I also see kids who come into my office who are wetting the bed at night who have night terrors who are sleepwalking or they're grinding or they're sleeping with their mouths open and their head tipped back trying to get an airway and I take a CBC tea and I see giant adenoids or giant tonsils and I refer them to my ent now the literature has been around awhile any of those things I just mentioned are literature based signs of possible airway of sleep disordered breathing issues now that requires a team you can't give somebody an oral appliance and expect to solve all their problems I have a general dentist I work with I've got an ENT I work with I've got a myofunctional therapist I work with I got pediatric dentists and an oral surgeon these kids are slipping through the medical cracks right now and we in the dental industry dentists and orthodontists have the ability to pick up on this now the mild functional therapist can definitely help but there are some out there who don't follow a traditional speech pathology path towards my functional therapy in the state of Texas if I understand it correctly you don't get a license as of my own functional therapist anybody can be a mile functional therapist speech pathologist needs license so there are people out there who might be a dental assistant or a dental hygienist who goes and becomes a my functional therapist they're gonna look at it very differently than someone like my wife who's done speech and language pathology for 23 years so the reason why I think myofunctional therapy gets a bad rap is because there are some people out there who've taken a couple of weekend courses who have some minor training in this and are going out and trying to write me eight and ten page reports on all these problems with a child who might otherwise be thriving and I sit there and I scratch my head and go they're gonna be signs or symptoms what's wrong with this kid why is a mild functional therapist involved and that's when you start asking the question about wait a minute it's not the myofunctional therapy in general that's the problem it's the congruence between one and another and seeing you know the training being the same in the backgrounds being the same because if if I want to make a diagnosis or somebody else wants to make a diagnosis if we're not on the same page someone's going to look at diagnosis ago you guys are out of your mind and I think that's why myofunctional therapy has gotten a bad rap but remember even today there are many many dentists and orthodontists and specialists of all who don't fly into the air wing sleep disordered breathing issue and as a result if you ask them out of myofunctional therapists are gonna say it's garbage so I think we just need to again let's not entrench ourselves and emotional positions let's open our eyes let's look at everything that's possible and I don't know what you heard but for me when he said how many years are you been in dentistry thirty-two since 87 thirty to me to wait I'm willing to wager somewhere in your career you reverse your position on a specific thing as I have and I think it's important particularly for younger less-experienced doctors and dentists and orthodontists to understand that what they think is dog with today is likely gonna be different for them when they look at it ten years later and and you mentioned him Pete Dawson was famous for saying when you quote me give a date

Howard:  right right look I love Pete I'll never forget after the first time I went to his lecture I was talking to someone in the hall in some anyway long story short he said it was so cool he said yeah I just talked to Howard he goes he's 28 and he was talking to Irwin Becker  so those guys were at the time they were probably both 65% but everyone was all upset because I didn't agree with something and he was like dude he's 28 just chill and and a lot of the for muds he's like like when I went to college I mean when I was in dental school they teaches there were a hundred to two hundred thousand genes in the human body and now it's down to 20,000 genes and now and they think that it could no probably under it'll probably go under eighteen thousand genes and another couple of years so you know everything's changing and it's sad because when a scientist or a businessman when a businessman goes the market they're gonna sell all red widgets and they don't sell and they change into blue and they sell he's a genius but if you're a politician and you change your opinion now your waffle now you're an idiot and you know everybody else gross um I want to go to another a new controversy you were talking about how your wife has a license as a speech pathologist and a myofunctional person doesn't have license right and I'm saying I believe that right right but now but now we have smiles drug Club which is doing license which is do an ortho with  that without anything I mean it Stella dentistry um how do you wrap your amazing mind around smiles direct club 

Glenn D Krieger: so I can't well I can because you and I both know that if  the consumers of this world were driven by quality they'd be specific doctors in every town who would treat every person but the unfortunate part is they view many people view what you do what I do what their physicians do as a commodity and I've written about it a and for those out there who don't understand what a commodity is basically you can go to a 7-eleven and buy it a can of coke and you can go to your local grocery store and buy a can of coke or if you're at the ritz-carlton and you're thirsty you can buy a can of coke and it will cost you three times the cost at the ritz-carlton than it does at 7-eleven but it is the same exact product right so where you can get it the cheapest doesn't matter but the public seems to believe that orthodontics or dentistry or any of those things are the same that if I provide Invisalign or braces to a patient that if they go online and buy it from somebody in whatever manner they want whether it's smile direct Club or any of the other companies that are out there that somehow the quality is the same and because it's cheaper it's better and  you would think you would think that this is really lower educated people who don't know better or people who are broke and really want to smile and willing to spend their last penny but on the cons we're seeing affluent intellectual individuals go and do this and they're actually going for their IPO they're gonna launch our IPO billions of dollars on a company that I don't believe is made a penny yet I believe their earnings last year we're down what there was 17% this year versus 22 last year and so what about the model appeals it's purely money driven from what I understand now the bigger question I would say is Amazon pulled their unlock that at home circumcision kit there actually was an AK home circumcision kit that Amazon used to sell maybe a bad idea I don't know I would guess it probably not a good one they pulled it what makes people think that at home in a liners to straighten teeth without a dental exam first to assess periodontal stability without a dental check first to assess for caries with no active supervision during the treatment as far as I know I don't know what makes people think that's a good idea but all I can tell you is those patients who I have treated who've come from that model have been rather dissatisfied and I was able to solve their problems quite nicely so again are they public enemy number one it's hard to say because it's just the product and you and I both would agree that there's no emotion behind a business decision it's a product I can dislike the fact that they're reaching out the patients at home I don't have to support them in any way which I don't but it's the general public misunderstanding of what's going on and the lack of protection from a federal government standpoint a state government standpoint and from organized dentistry standpoint that bothers me more that they're allowing this to happen because we would never allow somebody if the technology were available to hold their mouth up to a screen and get a periodontal diagnosis but why is this okay for mallet or home aligners where are the loud voices screaming from organized dentistry state legislatures and federal legislation to protect the general public from what really could be a real problem 

Howard: China has 1 million Muslims in a prison correct if you say so I didn't know that but you know and I haven't heard one leader of one Muslim country say anything people are people are people are strange but but but and then the other thing that's I've even more bizarre is um you know the biggest Procter & Gamble Johnson & Johnson of Europe with Siemens right and then some wonderful CEO said you know we're over weighted in health care and we need to be more in consumable so they spun off Sirona of course the building didn't move is all same there and then so Sirona was sitting out there alone for 10 years like you know we're lonely and so finally they married DENTSPLY and now they're publicly traded as X ray and now you have Dan or her the largest holder of dental assets saying you know we don't really want to be in dental so they're spinning off their entire dental division and so what if you were 25 and you just walked out of dental school two hundred eighty-five thousand dollars in debt and you're reading about how Danaher doesn't even want to be in dental and they just own all the biggest dental names you can think of from cave o to curd all these things like that what would you because a lot of times she's looking at you and definitely me she's I mean I'm I'll be 57 Thursday she's like me saying Howard hee-hee graduating the golden years I came out and it's totally different I mean I mean she's got $285,000 student loans she thinks 60-year old you graduated golden years and she didn't and then she sees Danaher spinning off dental and smiles direct club going direct do you think she made a bad idea going into dentistry

Glenn D Krieger:  I don't think so I think you know I I think that you you can always I think dentistry is a is obviously a respectable way to make a living the question is why did you go into dentistry right if you went into dentistry because you expected gold bricks to be laid on your front door right like the delivery comes every Thursday and they leave the gold on the front door and then you go to work and you just put the money in the safe and everything's good you know I watch my father who's a dentist I watched my grandfather who was a dentist and times have definitely changed there's no question about that um I I do see some disturbing trends that have bothered me personally for instance you know I'm I'll be 52 November we're contemporaries of each other you and I and you must have taken a multivitamin now it's like or in grey you wouldn't right I took the picture the picture is anything somewhere but I'm not but thank you and happy birthday by the way oh but you know I see a lot of the older doctors you know 10 years older than you and I so to speak who are sort of pointing fingers at today's Dentist you're advertising so much you're on Facebook you know and they and they don't want to sell their practices they've done well financially they're riding they're dinosaurs into extinction they're not living the younger doctors buy them they're not upbringing in associates you know in 2009 I understood it because of the 401 KS that it plummeted but we've had a really sustained economic growth anybody who's gonna retire in 2009 should easily be able to retire in 2019 and that's the trend that bothers me is the young gal and guy who coming out of school in debt from a school that allowed them to get into debt without any business training or any restraint in terms of saying let's go through some counseling before you get out of school to teach you how to repay this debt and and you know you do face the things like the companies you describe um but at the same time the older Doc's are pointing fingers and I want to say all of this happened on their watch all of this happened on their life well people say Invisalign is taking over orthodontics or the general dentists are doing all these procedures or a smile direct clever Canada all these other companies are coming in or student debt has skyrocketed or there aren't enough practices available or all these other agnus that have been enacted these all happened on their watch right they didn't happen on the 25 or 35 year olds watch these things started years ago and I think there's some culpability now nobody went to jail technically except a few execs after the 2008 meltdown on Wall Street and nobody's going to go to jail for what's going on in dentistry today do I think it's a great profession absolutely but I think some of the older generation actually gave a raw deal to these younger docs and allowed you know their their student loans to get out of control with no counseling and less chance of buying a practice absolutely and I think we need we need to do something to protect today's younger doctors now you're doing it with this podcast and what you're doing with dental town ortho town and all those wonderful things I'm trying to do through our through preneur and all my stuff because at this time we need to come together as professions not just as orthodontists or general dentists but who's to say that five years from now we don't have a mixed business model as the business model where a general dentist and an orthodontist and an endodontist all practice together kind of like what we see in medicine today and I think we need to go away from being a mosaic and become more of a melting pot and start talking to one another and start relating to one another so it's smile direct Club and all the other companies are just companies and they can't sort of get through our armor because our profession is so together but I'm watching us go further apart and rip each other apart and I think things like what you're trying to do and things like what I'm trying to do are trying to pull people back together and what do you think about that 

Howard: um well I always um agree with what you're saying but I oh I always think competitions good for any industry and the light like orthodontic centers of America um they went public and what what your we saw that was mm well you're they go but was it mm before my time OCA came in before before I came into orthodontics I actually 2008 yeah what year did OC that was it pulls up the Orthodox Church in America I guess I'm - no what year did or orthodontic centers Google not know how did Google not know I was searching dentistry I mean come on Google I've only done two billion trillion dental searches and now he thinks I'm a Greek Orthodox yeah 1994 I got a nano 794 yeah did you ever meet Gasper lazarre's I did not he's the guy who did that so so so Gasper basically what he saw was it's a typical liquidity play I mean when you go to sell your house a three-bedroom two-bath house sells instantly at the dental office for 750 thousand cells instantly but he saw these two three four million dollar dental offices that were never gonna sell ever so he went got a big line of credit about all the big boys out and so he bought earnings but it's but what he told you had to stay there three years at three years in one second you retired and then he had to replace you with some kid that just graduated and the whole thing fell apart but I but he had a great innovation and that is um if you would to go have your mani-pedi done and the lady said to you well you know a mani-pedi is $100 you get one every month so for two years I'd be $2,400 I need a thousand down and then I'll finance remaining 1,400 you'd say finance what yeah yeah I'm just gonna pay you and I come in yeah and Lazar said well that's not how they Worthen on to see it they I mean they need a thousand dollars down or 59 and Lazar just walk out there and say you know what it's ortho it's it's $1.99 down it's $1.99 a month for 24 months 0% interest 0% financing and a million mom said oh my god cuz my orthodontist wants an economic barrier to entry that everyone with the PhD in economics says please stop doing that and and then you want to finance the economic barrier to entry when you didn't I mean when I pay for my or throw in advance are you gonna pay out the assistance two years advance you get a prepay your rent electric build-out computer insurance right so the whole financing a service yeah I mean you can't rationalize finance so that was a great innovation he did what I like about smiles direct Club is two things number one they have five of them in my backyard they reject 80% of all their cases they don't want to they don't want to take a step and try to figure out they don't they don't want to call Einstein and ask for this 12 year olds gonna look like in 20 years they want non-growing adults class 1 molar class 1 k9 5 millimeters crowding or less they want the no-brainer stuff and then they're like well I don't have to see you every month to give you a tray in fact I don't need to give you 24 trays I'm gonna give you a 14 trays and I'm gonna give them all you say so what I think they're genius at is finding out where the bowl of gravy is and let everyone else fight over everything that's difficult and so so I do like the fact that organizers in America I mean look how they sell furniture all day have you seen furniture right now they're advertising Arizona no payment for the rest of 2019 your first payment is until 2020 they figured out how to sell stuff and I get excited when people sell stuff because that they always want to buy a new car and but they just don't want to fix up their teeth but when you talk him into fix up their teeth and they look in the mayor and they like because here's what I learned about teeth Americans or people in general you either own your own bowling ball or you haven't been bowling in 10 years I'm out here in Arizona we have all these big lakes out here you either own a boat and go every other weekend or you've never seen one of those lakes and a day it's all or none with people and I noticed that in the bleaching phase when when the bleaching came out it was I came out of Arkansas it was Omni international carbamide peroxide and I noticed right out of the gate that once you bleached a person's teeth they were into teeth and then they were coming in saying well what's that what's that and I realized oh my god the people that haven't been in for five or ten years they're not into teeth so if you don't get him into teeth they're not gonna I mean you know so I want to I wanted to get into their teeth and that's it and and it's weird sometimes because they come in for cosmetics you say okay you you have gum disease 11 cavities they say well can I bleach my teeth and your psyche hi yeah well bleach emit the bleach won't work until we get rid of the bizzy's fluid in the cavities and so so I like competition for an industry and I think they are gonna make some innovations 

Glenn D Krieger: yeah if you go around and ask orthodontist today what's your minimal down payment the days of the $2,000 down payment paid three thousand over 24 months is gone I mean there are some people out there who do that but the overwhelming majority of people in my circle who I know charge a fair fee for orthodontics people don't care about the total fee as much as they care about how they can afford it right all right so you know the $500 down the 250 down the zero down I don't see that much of but the 250 or 500 down you'll see that all over the place in good ortho offices knowing from the studies that have been done on in some industries that if people are gonna default on payments they're gonna do it within the first three months the person who's been paying you for twelve months is not going to default in month thirteen they're gonna default in that first three months so if you're gonna put $500 down and let them pay out over time they're likely gonna make all their payments and they're gonna they're gonna do a good job with a friend of mine said John fams the innovator of embrace the new lingual orthodontics system he's got a great saying because he believes that were in the age of the smile that a smile is the new ab the new six-pack what would see what's his name John Pham pH a.m. pH is a Vietnamese or Vietnamese [Laughter] you're right on one he's a human being innovator on Pham orthodontist yes yes yeah oh there he is coal furnace with health systems yeah embrace inb r AC e it's only yeah there it is Ernest yeah 

Howard: you know my 32 years of lingual is every time someone tries it and the tongue is Curious George and just plays with it to the raw do you think you got you think he got around that yeah I think he has you know 

Glenn D Krieger: I'll be the first to admit I haven't done one of his cases yet I know I've seen them I know a number of people have done them and loved it lingual ortho the biggest probably North other reason for implementation wasn't necessarily the brackets it was that you needed to see a chiropractor when you were done tying and untying because you're gonna wrap your head around upside down to see it the nice thing that he's done is in direct bonded trays right so you can bomb them indirectly and second robotically bent wires so that you don't have to sit there and put bends on wires you bond the brackets you put any series of wires they're gonna move the teeth where you need them to do and in today's millennial and older generation who don't want to show braces but don't want to wear plastic he's really come up with a really really great idea and the company's been growing tremendously I went to their course in DC a couple of months ago for two for a day and the cases I saw were beautiful but again I'll be the first to admit I haven't done any of it yet but many of my colleagues who are doing it really see some promise with it and he is a remarkably smart man a real true entrepreneur after your heart and when he said to me and I'm gonna butcher the same but he said that today a smile is the new six-pack and that back in the day people would spend whatever they would we have a closet full of abdomenizer x' ab roller of the abba fire you know to get abs now people are really more interested in getting that smile it seems to be very important and going back to what would i tell that young young dentist i think today's a great day to be a dentist just learn how to market yourself appropriately and treat your patients well and satisfy the need that they have not the need that you have and i think that's important to keep in mind ah yeah that is a and he's in huntington beach california california a

Howard:  ha that is amazing well let's I want to switch to ortho because um we post these on ortho town and there's we have a ten thousand eight hundred registered orthodontists on ortho town and and by the way on on ortho town I I had the date on I mean they all are on dental town but but but they like like any tribe to have a place to go for themselves you have a couple places for them to go to themselves you have a Facebook group Facebook Ford / groups for it / ortho preneur / members is the slasher forward / what do you call it anyway I don't know I can search out or through premieres but it says if you want to join our Facebook group you need only to be an orthodontist or orthodontic residents go to facebook.com and you got a couple of websites um you have ortho preneurrd.com what's our December's that resident regional dominance it's a 

Glenn Kreiger: it's a geographically exclusive non-disclosure group meaning in a in a big group like or third print or as we have 4,300 orthodontists and you know you and I may not be threatened by each other but there are some younger doctors out there or older who if you know Glen says hey anybody got some great marketing ideas some people will say sure but Howard may be sitting there and say to himself in Phoenix you know this guy Glen in Dallas I'd love to help him but I've got three other orthodontists down the block for me and if I tell my best marketing idea they might see it and I'll be screwed so I created a group called earth runners Rd where people sign up they become a member there they have to pass a geographic exclusivity test to make sure that there is nobody else in there according quote area and then they sign a nondisclosure so what goes on in the group stays in the group which really fosters a sense of let me share everything I've got so that nobody who I would perceive as a competitor will be there and I can really help those around me so that's all the printers Rd and I'd say probably 50 to 60% of the people who apply cannot get in because it would be infringement on someone else's Geographic exclusivity but on if so there's no words everything okay so that's the difference between or top earners and/or the preneur Zardi yes sir you guys can general dentists go to ortho for doors are not really they they cannot not not an orthodontic assistant with very few exceptions no consultants no business owners I've really tried to keep it pure because I want everybody there to feel safe and secure and and there are many out there who don't feel comfortable talking orthodontics in front of general Dennis and I I don't blame anybody for how they feel about any subject like that but let's talk about because

Howard:  I  mean if you go to any in the Donnison town and say will you help me with a molar and oh they say yeah you send any to to an oral surgeon say can you help me can you show me how to pull this out they'll say yeah I mean every specialist has no problem sharing everything they know with the general dentists especially in the dental schools and yet I meet kids because there's two dental schools in my backyard there's one in Glendale and there's one in a Mesa and and I have kids who come out they're $400,000 in debt so they ask an orthodontic question they said well you know what if you have those kind of questions you should go to work those school they're like dude I'm in college paying $100,000 a year and I just asked an ortho but if they asked about a chrome steel crown a pediatric dentist would never say all that you gotta pay yeah so it was a where does that come from I I you know I think cuz you were on both sides used to be out used to be general Dennis for the FHD for 20 years so 

Glenn Kreiger: I know words come from I never tackled braces myself it was something I always referred out to my orthodontists because I felt like they could do a better job now when it came Invisalign I did about four or five dozen cases as a GP and for me for the quality I needed I at the time I didn't have the wherewithal to finish a case the way I saw my good orthodontist finish a case and I will go on record and say while there are many general dentists who do good orthodontics I have yet to meet one who can match the ability of a good orthodontist to handle all the complications associated with cases they take on and to consistently give the same result in orthodontics can give now the problem is whenever I say that all my GP friends will come out and go well I have an orthodontist to my neighbor need those horrible results and my answer to them is let's not compare our high-water mark to what you consider to be a bad orthodontist if you see somebody who needs surgery heart surgery I'm going to go to a cardiologist not a general surgeon it doesn't mean that a GP isn't capable of handling simple orthodontic cases or simple Invisalign cases with the right hand holding and I do help my general dentists with basic simple cases as long as the road flows both directions going back to my original point I don't think anybody has anything to be concerned about I think we should be helping general dentists understand and identify all orthodontic issues and occlusion and when it should be treated I think we should help them understand how to treat basic simple the the one tooth crowded in the front kind of cases or a couple of teeth crowded but let's have our general dentists also work that Street the other direction and not take on six month smiles on every single case they're treating not take on every Invisalign case that walks through their door I think we can help each other and if you asked where it comes from it does come from the the orthodontist who you know I I have a patient I referred to a general dentist or a cleaning before orthodontic clearance and he talked her into full mouth veneers she didn't do it and she came back to me and complained and said how dare he tried to talk me out of orthodontics but I do think there's distrust on both sides of that equation and again I'm all in favor of general dentists doing some of every I get endo I did oral surgery but I referred out a ton more endo I referred out a ton more oral surgery and I referred all of my orthodontics to my orthodontist later on because I realized I couldn't do it as well as they could so as long as everybody's got an awareness of what they can and can't do as well as the best one doing it I think we're good and if you're a general dentist who's doing ortho and you're doing it quote-unquote as well as any orthodontist you know show your cases and if that's the case nobody can give you a hard time because again let's go back to photography show our cases right now 

Howard: so I'm gonna ask you another question and are you bracket agnostic or do brackets matter whew yeah let me explain something to the kids and so when you ask a guy who owns or the preneur Zander and has five for 3,800 people on his words on face group what I just asked it was a delicate question is this channel conflict um you know I mean it'd be like asking you in your hometown in front of your entire town do you prefer to work on men or women I mean it's like yeah I answer so what the patient's right that's why I have no I was gonna say

Glenn Kreiger:  I have no problem answering the question the reason you went up is because if you get twenty orthodontist into a room and say you know there was a movement on for many years that one specific bracket which will remain nameless was could move too fast or more effectively and better and would ameliorate the need for certain modalities otherwise the Dayman bracket yeah exactly remember we talked about dogma and how we change in our careers when I first came out of school of my six cases that are board-certified that I had to show two of them are damon bracket cases four of them are not damon bracket cases now there is that camp out there that believes bracket plays no role and I know people using $0.17 brackets and then there's the other side where people who will say oh I'm a Damon or I'm a a Henry Schein SL x3d I'm a self ligating person and I'll spend $20 per bracket now at the end of the day I've seen remarkable orthodontists finish cases with any bracket type and any bracket prescription in my hands there are certain brackets that work better than others there are cases many of them that I like self ligating brackets more because they allow crowding to unwind easier early in treatment but there's often a price to be paid for certain brackets later on whether it's monetary or in finishing so at the end of the day as my instructors used to say the tooth doesn't know what bracket it has on it right but I do believe there are applications where certain brackets will assist in certain ways and that's my diplomatic way of saying that I can finish a case with any bracket on it but if I see a really crowded lower set of teeth and I want to expand a little bit I'd rather have a self ligating bracket and I do use both self ligating introduced like getting in my practice for that reason

Howard:  can I tell you what I don't like about general dentists doing orthodontics it's to me to me you know I I'm a dentist but I am my MBA and I you know in 32 years I've done a thousand cases of everything but the bottom line is when you go to an orthodontist office how long is that patient in the back when they're coming in for how long yeah I mean you tell when a routine adjustment yeah 20 minutes okay there yeah so then you go in and you say okay what's your toss-up red 50% how long does this get in there 15 20 minutes okay now you're a general dentist and you're doing it what's your overhead 65% how long's a kid scheduled for a routine bracket change one hour hello it's a little

Glenn Kreiger:  I see that to every young hello it is the worst so you asked a question about had a fourth and honest and general Dennis feel the other question is as a general dentist who's now an orthodontist I would tell any general dentist out there who wants to get ortho heavy but it's you're out of your mind because the most profitable procedure you can do a north in general dentistry is either extractions or endo right if you can do an endo in extractions all day long and do them well you'll make way more money are you set up for payment plans what is dent ryx or practice works they're not set up to accept 24-month payment plans and what are you gonna you're gonna go from doing crown and grades all some of the next we're gonna tie a patient in it's not good business sense for a general dentist to be doing ortho and for that matter or Invisalign is not a moneymaker for general dentists you're out of your mind if you think doing Invisalign is going to be your ticket the money I learned I love you

Howard:  I love your clarity of genius I mean your D just said endo and oral sir I think thinking about a molar root cow a thousand bucks one visit what do you have into it about four or five gutta-percha cones and fifty cents worth of sealer yeah you know 

Glenn Kreiger: you're probably charging 1500 nowadays right and then then you look at oral surgery which is my number one fun thing I mean I

Howard:  I'd rather pull for wisdom teeth I used to love it oh my god because it's instant gratification you either got it out or you're and you know yeah you get it done and what do you have into it four or five six car pills anesthetic and you reuse your pliers until and then you go to an ortho case and now I'm married to you every month for the next two years for what yeah here yeah and I this was turn one degree can you fix this for me and was waiting in the next room I kid you not last week this guy who was telling me he's mad at my orthodontist said I have the most adorable orthodontist he's from Canada he's the nicest guy I don't know how do you not like a Canadian I mean they just apologized for everything and he's gone back there through overnight and he's telling that this is this guy's like 77 and I want to say them dude you have a liver spot on your head the size of a quarter you need a therapist I mean I mean if you're 77 and have a liver spot and you're still talking about it and he wants to go to a new orthodontist and I I wanted to say to him I didn't but I should have said I think you need to see a psychiatrist because you look like you fell out of a car you look like you're dead and you're fixated on this little flipping tooth but last thing though about Oral Surgeons when I see the books of an oral surgeon who does no implantology at all just an accident just that guy's got thirty five thirty six percent overhead Wow and then when they're doing implants it jumps up to fifty to sixty so you know sometimes just doing a root canal and pulling a tooth those are the big moneymakers and I had the founder of Heartland and the operations director leader Pat Bauer of Heartland and though the first tell you if you're not doing endo if you're not getting people out of pain by pulling their tooth or doing a root canal seven times a month that they have no interest in your office they wouldn't buy you they would merger they think they think you should go into the greater fool theory and see if you someone will buy it from you and go somewhere else cuz that's bread and butter dentistry hey I you got a friend out here who's been on the show David Frost no the orthodontist do it Frost's too for us is the inner donít know the ended honest the Frost brothers yeah the Frost brother Stewart frost is my friend in Phoenix great orthodontist wizard Oz and his brother which Frost is he I don't know I've met him once I apologize I don't know his name off the top my head he lives right across from his brother yeah and my gosh yeah Stephen Frost is the endodontist and Stewart frost orthodontists and Stewert Frost is my favorite orthodontist in the whole world you know why why you tell you about his story in San Diego no oh man he went down to San Diego and he was out there on the beach with his family and he heard some commotion and he ran oh there's some way some lady lost her son but he's the only guy didn't he's looking around where was he last seen worse and he realized okay he fell in a sinkhole and he starts diggin found her damn son gave us into the sand yeah buried in the sand and nobody knew and somehow he figured it out I think he and his brother might have been there anything he's nephew they read the paper for digging this kid out of the sand I know because he didn't panic he didn't pay why his mom was screaming he was trying to figure out where was this kid seen last and what a what a amazing if you ever find a great orthodontist on beat that story and but hey next time you're in town so tell the orthodontist what you doing in town here you started a orthodontic Education Center we Stewart in in Phoenix 

Glenn Kreiger: yeah we haven't even launched it yet so this is a I guess the first official statement of it but we're we've come together to develop a brick-and-mortar facility that were in the process of developing that we're gonna run out of Stewart's education center to begin with in Phoenix and then develop it from there after we see the interest it's called the Center for orthodontic mastery it's going to bring together consultants orthodontic lecturers and and basically a place where orthodontist can go to get orthodontics specific c/e that will be good state allowable CE so to speak that'll fulfill requirements but from everything from airway bracket placement finishing occlusion marquees you know the expansion airway and sleep disordered breathing management leadership culture all the things that we all struggle with because there really is nothing like that out there there are centers you can go to if you are an orthodontist but there really is no place where an orthodontist can go and get a course specifically designed by orthodontist and for orthodontist and you know the website is ortho mastery calm that's your website it's being built as we speak so you know like I said this is the first place where we have actually announced it online and so you know we have we have basically a placeholder website with stewart's really good looking face on it right now in this blue jacket but you know keep your eyes open because it's gonna launch in about four weeks our courses are going to be starting in 2020 we're gonna announce it at the Orca preneur summit I'm gonna let Stuart really talk about it a bit there a little bit work winds that we know where's the or the preneur summit so the orth winter summit is uh Dallas Omni this September 12th before - what's what's the website for information is just to go to or interpreters calm no you go 200 Arthur preneur calm is my blog but o P 2019 dot-com it's our 2019 I can we sold out all the doctor spots about a month ago we sold out the team track about three to four months ago and we have about 850 people who will be there on this one 2020 is yet to be announced but I promise I'll make it available to you to tell your folks as soon as we announce it and about we'll announce it in about two weeks we're 2020 will be well

Howard:  I hope you make a post on ortho town I like I would post that it's on there but I'm not allowed to go to on ortho town because I'm not at worth honest I get it I get it no no but I'm so ortho op2 o 19 comm ob summit sorry op2 somehow my gosh I you're making me think I was crazy sorry 

Glenn Kreiger: Howard I was staring at the plastic surgery so tightly I mean I'm by the beauty there for a second I couldn't couldn't focus so it's it's it's okey summit 2019 MMI T t1 t1 t.o.p summit 2019 o peace summit 2019 dot-com and now let's see if he's on to something there it is well 

Howard: it's not just another meeting it's an experience or two preneur summit September 12th to the 14th 2019 sold-out at the Omni Dallas and Dallas Texas so uh so it's sold out sold out we sold out the team track like I said three to four months ago sold out the doctor track about a month ago I've had to actually see you know you run a business like like that and it never feels good when you have to turn someone away but we physically cannot put one more person into that room we're not allowed to so 2020 will tell people when it registers so they can sign up for early what city's gonna be in 2020 not sure yeah I promise today I know I'll tell you so what do you think was the what do you think was what why did it sell out in just second just a second year to seven hundred registered attendees what is what is the magic about this that made it sell out

Glenn Kreiger: I tried to create an experience where people get great education come together and and feel like they're part of a community and their take we take care of them like a five star event all food all drink open bars gourmet food keynote speakers and I always throw a few really good surprises in there to wake people up there in the day and so from the time I get there until the time they leave they are part of a tribe they are part of like-minded orthodontist who want to have great practices great culture the great leaders and do great outcomes and be profitable because after all this is ortho printers we are unknown on euro P summit 2019 the Facebook link doesn't work but I would I would connect the Facebook link to your other or to premiers why it stopped working I've got to go looking at I appreciate the heads-up yeah it's not working but I to hook it to your Facebook page group yeah well man I'll tell you why so who is your so yeah Dave Paquette we've had him on the show and Thomas Shipley we've got him on the show yep they already the Henry Schein is our platinum sponsor so the day before from about two till five o'clock we have the we have Dave Burkett and Thomas Shipley speaking on behalf of Henry Schein as a pre cocktail party lecture and then we have we have those guys speaking they're wonderful I love them to death are you going on record today saying that they Paquette is the most handsome orthodontist in the world if by proxy that applies to being that you guys do be brothers sure he's the best looking man I know

Howard:  you know we did a.m. we did a podcast and we're both bald and everybody's porn blocker blocked our podcasts they just assumed they just assumed it was x-rated and it if 

Glenn Kreiger: you know Dave well he is instrumental in my having become an orthodontist because I knew him before I went back to ortho school and he did everything he could to guide me and again to the younger orthodontist out there who one day will be successful and will be a bigger names in their industry never ever ever forget the impact you can have on those around you and always give back and always have time for people who come to you and ask you for your opinion and your advice because Dave Paquette is the reason I'm in orthodontics today all right on that note we are gonna go and to tell you it when

Howard: it was just an honor to have you on the show today thank you so much for coming on the program and talking to my homies today my pet honor was all mine really I really appreciate it thank you for having me all right buddy have a great day thank you you too 

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