Aaron Nicholas DDS is a practicing dentist and international speaker with over 30 years of experience. He graduated from University of Maryland Dental School. He is the Founder and CEO of Monday Morning Dentistry, Smile Protection Dental Plan, The Dental Assistant School of Maryland and Nicholas Dental Care. He has authored numerous video courses including. The One Hour Molar Root Canal, Buildup and Crown; Ultimate Anesthesia; Profitable Hygiene Without Bloodshed; and Efficient Extractions for the General Practi-tioner. He is the Developer and Instructor for the One-Hour Molar Root Canal Build-up and Crown hands on course. He is a regular participant in the Dominican Republic Dental Mission Trip and has made the excursion 20 times to help provide dental services to the less fortunate in that country.
VIDEO - DUwHF #1359 - Aaron Nicholas
AUDIO - DUwHF #1359 - Aaron Nicholas
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Howard: it is just a huge honor for me today to be podcast interviewing Dr. Aaron Nicholas DDS a practicing dentist an international speaker with over 30 years of experience he graduated from the University of Maryland dental school in 1987 that's the same year I was so dude I know you're old Aaron just try to live through to the end of the podcast we both graduated a hundred and forty-seven years after the University of Baltimore Maryland opened and that's where he went to dental school he is the founder and CEO of Monday morning dentistry smile protection dental plan the dental assistant school of Maryland and Nikolas dental care he is a frequent guest on dental podcasts including the dental preneur the relentless dentist dentists implants and worms the better dentistry podcast live and Dentistry podcasts Cody and company and dental practice heroes he has authored numerous video courses including the one our molar root canal buildup and crown ultimate anesthesia profitable hygiene without bloodshed and efficient extractions for the general practitioner he's the developer and instructor for the one our molar root canal buildup and crown hands-on course he is a regular participant in the Dominican Republic dental mission trip and has made the excursion 20 times to help provide dental services to the less fortunate in that country I could go on and on and on and I'm so excited to get the man himself on the phone on the podcast but I got to tell you that being a you know I graduated 87 started that my media company in 1994 and it's now 20/20 so that's a if I only knew algebra I can't tell you how many years that was but in all that time the most controversial feature we ever did was by a dentist named Scott Perkins who did an article called the 15 minute root canal and it caused such an outrage I had endodontists in Toronto banning me to ever speak in Toronto you know like like I'm like whatever I mean you know and I'm sure the same buffoon would be for freedom of speech but just not speech he doesn't like but the bottom line is I'm a couple of my friends we thought is this guy for real and the locals that knew him said it's for real so me and Jerome Smith and a bunch of other guys we actually flew down there and it blew my mind because what he showed me was you know you take it in it honest he says oh it takes at least an hour well he would take out the slow speed he'd switch to latch he'd put in a file he'd waste all this time and then he'd go dip dip a couple times and he'd be doing that process whereas Scott had four slow speeds out and before he sat down one was already loaded with a 15 or 20 or 25 it was just all systems and what I realized was it was a review of the first controversial guy he met Omar Reed who I'm going to his funeral at the end of this month on the last Saturday this month at 11:00 is the fact that I'm Omar wrote an article called the 90-second crown prep and they tried to destroy his reputation but no one would ever listen to what he said and what he said is he sat with the timer and he sat behind other people and I watched him and the actual amount of drilling time was a minute and a half it was drill rinse dry look drill rinse dry log well and will you get up from your chair and go into the sterilization room and get that one thing that we use every single time we've ever done a crown prep since no since the beginning of time and in fact Omar really really might as my staff was very upset because I started a deal where if you had to get up and leave the room then I got up and left to you with you but I went to the office manager and said you know how would you like to be getting a bypass surgery and something that's necessary during every bypass is not in the room because you're a bunch of buffoons and they'd say well we only have one I'm like well we didn't get eight I mean we have a topper Tory Southwest Airlines has hundreds of 737 Boeing's they're all identical every operatory is identical and then I go into a watch other dentists and they'll go and do a crown check and or a hygiene check and say oh yeah you just need a little clues only take me ten minutes well hey dude can you do it now oh no because we'd have to switch the room and we're not set up and it's like dude you're in Opera right now yeah but it doesn't have a high speed at a trader well then get a high street in iterator and then they'll say well it might run over in the next patients here we'll have the hygienists go start the next to her next patient in another room and then the high just like well this is my room and I can only work in this room and I have I have a picture of my nine-month old newborn baby rat on the wall and I can't you know it's like oh my god it's just logistics logistics and that's what you are you're in operations and logistics guy
Dr. Aaron Nicholas: that's all those guys you talked about that's my journey I started with Elle Marie and I looked at his stuff with Carl Perkins team Alex his stuff I flew down to Houston took his course and went through all of that then I looked at developing some my own stuff in making templates that go on the deliveries so that they don't have to remember what goes on they just look down there you see a box and it has words in it that's what's missing just go get that and then we put together carts for all our procedures to have lots of little bits and pieces so we have endo carts we actually have two one for the doc one for the assistant and so once you get finished to in the end though you just restock clean up the cart you park it in the in the cart parking lot the next time you just wheeled those two things in you drop down the template you open up the cassette you pull a few things out for disposables you're good to go our setup times like seven minutes so that you know you get somebody comes in they have a toothache they need the root canal you got a 20 or 30 or 40 or 50 minute window you're not wasting time trying to get the room set up you know you can get the room set up while the financial arrangements are getting made and then you can get to work but the I have the same frustrations you do with you know it's we do this procedure every time we need to stay every time and then they have to be calling for it on the radio or go up to go get it it's like come on I mean how many times a month do we do this thing aren't you tired of getting up walking down the hallway
Howard: one of the biggest threads on dental town I wish you would make a post on that it's called has anybody analyzed profitability of procedures with PPO participation it's like eight pages long and I've seen my homies think like this since day one they think the longer they spend the higher the quality and all the research from Regina hurts Langer it's actually the opposite let's take oral surgery an oral surgeon could pull your wisdom teeth what how long do you think at oral surgery would take to pull the average force had four wisdom teeth I'd see thirty minutes max yeah and what would the general dentist time be oh yeah so who's a better quality let's go Miller endo retreat on a maxillary second molar how long were the average ended on a steak that's two visits each visit okay that was a bad example just a standard initial root canal on a on an on a second molar probably they already have later and how long with the general dentists take up to three usually two visits so Regina hurts linger called it the facts focus factoring the first literature she found out was that when it just came to a tape and ectomy I mean it's a straight incision you remove the appendix no I'm sorry it was a hernia sorry but another deal just a straight incision tuck the intestine back and makes them such as the doctors who had it under 8 minutes they had no failures and no second visits emergency by the time you were 16 minutes it was like a 10 percent failure rate and she's like wow these are all old I mean a cross-section of doctors of all ages and schools and the bottom line is if you know what you're doing you do it fast if you know what equipment technology you need it's sitting there so when you are taking a PPO you know when you get when you charge a thousand dollars for a crown it's cash only you numb up the patient and then you walk back to your private office and sip some coffee for 10 minutes and then you walk back in there and you prep and then you say well I'm gonna delegate on the businessman then you have the assistant packed the cord then you leave for another 15 minutes and then the whole thing ends up taking hour and a half but when you actually sit down and numb them up with septa cane set a timer for 4 minutes while that's soaking in you to shade you fill out the lab scrip and then at four minutes ding you packed the zero cord then you packed the one cord then you pull out a 57 bird take out your contacts take out the old restoration then you prep the ground you get it all done and then right there you make the temporary because with the assistant you can make the temporary in three or four minutes but when you make the temporary you can check can I see the marginal in temporary well if you can't see it on the temporary how the hell you can see an impression and then what about your clues all you know when you when you get a reduction coping back from the lab that means you took the impression before you made the temporary so don't ever do that again so you make the temporary and you drill through the temporary you're like I don't have enough reduction so then you do your plunger cause for more reduction and then you make the second temporary it's all fine and then you take the impression and or scan or whatever and you're done in half an hour but the dentists across the street says oh you know that guy over there you know he only schedules 45 minutes for a crown he's a hack I take an hour and a half to do a crown because I'm quality you're not quality dude you're freaking slow and don't nobody wants a slow dentist
Dr. Aaron Nicholas: yeah so what mindset what have all the dentists on her two million dentists on earth what percent of them believe in their heart the longer time they spend and the slower they go the higher the quality will be I think about you know somebody does something fast the very next thing is well what's the quality like what's the quality like and the truth of the matter is you know even like with extracting teeth you know if you're really go in there and take a tooth out and you have to remove bone well you can sit in there and tug on that tooth for an hour let everything get all dried out finally remove the bone that you need to remove get everything finished up that patients gonna be in pain me when did come morning okay but if you went in there when I have to remove the bone you take the bone out real quick you take the roots out and then you close everything up that patient generally isn't in a lot of pain because you haven't been just fiddling around for an hour and it happened and making everything it works absolutely
Howard: but I wish you would make a post on that thread because I think that I'll say Aaron will you post on this thread because I think I think that it's obvious that it's all operations logistics whereas the most people think that it's all about having some great idea they always say things like oh I wish I would have thought of that well he'll look at McDonald's do their on the intersection of first and main they have a drive-thru for 60% of their customers they sell a hamburger frantic coke I see the lot across the street is a bankrupt gas station once you go by that and compete with McDonald's mmm I wished I thought of that well it's just all operations and logistics it's not the idea it's the logistics I even see that I have anyway I go on where Dentist will get an idea and they'll spend the first two years and all their seed capital getting patents and patents and patent lawyers and protections and while they're doing all that some other guy will go make a prototype sell it to his buddy across the street and have three iterations of this thing and then as sells it to Ultra debt before the other guy gets a patent attorney back
Dr. Aaron Nicholas: I mean execution is king you know if you're if you've got an idea great get out there because by executing the first version you actually learn more to make the second version better I started teaching that a hands-on course for that one hour crowd I had it all figured out I went through in the very first part of the hands-on course I realized that everybody was doing their access openings wrong I'm like what I told him I showed him I showed him pictures and so I just called everybody back I said hey guys do you want to talk about what I said this day and then I did it myself and all of a sudden everybody's doing great access openings now they have a nice straight line access into the root canal system and life's getting better before you know and that happened to be over it over and over because I learned what I was saying while it was very clear to me wasn't clear to them because they're running it through the filter of what they usually do and so you have to go through and break the old habits to get into some newer habits are gonna serve you better
Howard: well let's make this a selfish narcissistic interview just for my own world you know this is what I was when I was get ready talk to you today I want to ask you an age-old question that I'm confused that so when we were back in dental school remember I'm just as old as you but I don't have an AOL comm email okay what's that but you know when we were in dental school there's a lot of people that thought the failed root canal came from the bottom that bacteria came out of the bloodstream and got in between that get apart and started living there and then later that was proved wrong that indeed all the bacteria was ground down sleek so you see a failed root canal and it's failing and I see these endodontists and they drill an access hole and go through there and they redo the whole root canal but you didn't solve the first problem how what was getting down there and then you're talking about access I always when I do a mole a root canal I always take off the crown and I always prepare for the final restoration first and that makes the access just mind-blowing ly easy and then I see these on these dentists doing a retreat root canal through a crown and through like a BB sized hole yeah and it's like well why don't you redo the crown they go oh it's a new crown it's only like six months old yeah but though I bills a hundred bucks you know I mean who cares I'd rather I'd rather put on a new crown I imagine if you took your car in to get its radiator repaired but they had to draw a hole through the hood and then they repaired it with a weld dog well you know we didn't want to buy a new hood so for me it's the same question is if root canal has failed would you redo the root canal through the old crown or would you assume the Crown's leaking as a source of bacteria and take off the crown I take the crown both because it makes it easier to do the root canal and because you can't see everything under the crown so you it may be leaking someplace you're not seeing and so you make your little hole and you do your retreat and your root canal is great but there's this little chunk of decay under the distal lingual margin that you couldn't see or get to and all of a sudden that's gonna decay away the rest of what's underneath there and then there you are two three four years later trying to explain the patient while the crown fell off of the tooth not restorable anymore so I would much rather replace the crown yeah and when and has this ever happened to
Howard: you in 32 years it happened to me but maybe I'm a hack but you prepare the tooth for the final restoration and realize that it's not even restorable you know that m OD amalgam the cracks and and by time you get all ready for your final restoration like you know what this this tooth is extracted in an implant does that ever happen to you yeah yeah and and by the way that you kids out there after remember that when we got out of school everyone who had placed 30,000 implants in their life only did it on a pan oh and they didn't have a CBC GI I had my diplomat in the International Congress or a plant ology before I even knew anybody who had a 3d imaging machine I didn't even know anybody that had one it was all 2d in fact I'm so old we thought the coolest thing on radiography was how they put the R on the one side and they all on the other I mean I I thought that was that was a cbt of my time so so when you're so would system well let's finish root canals on before I was gonna go and some other things but I'm how what would you say to someone he says dude you're a hack you can't do it molar route
Dr. Aaron Nicholas: get out in an hour first off I'd show them completed root canals they've been done in an hour and say can you tell me how long these different root canals took which most people will have to say to know secondly I'd say let's you know come and watch thirdly I'd say let's talk about the process and how long should really take you to do these things you know and a lot of it depends on when I'm teaching the course a lot of times I'll tell people you need everything in the room and you need it out and that means out on the counter that means you don't have to go into a drawer you don't have to open up anything it's there and it's ready to go a lot like Perkins for cordless motors with the proper file in each one you know it's the same kind of thing it's like it's gotta be up and ready to go you can't be be going to get it and
Howard: shout out to Scott Perkins man love that guy I mean that that that's a Dennis I swear to God I mean I just love him because he's he's always a scientist first you know Galileo said science is not a democracy I don't care if a thousand people vote and they say the earth the Sun goes around that the earth I'm sorry but him and Copernicus said it it's not a democracy their earth goes around the Sun in Scott Berkun z-- well you can just tell it the way his walnut brain works it's very Newtonian that when you're telling him something he's trying to see it mathematically and he's gonna decide if it makes sense and he agrees or if he it's disconnected and doesn't work mathematically and he's on to the next thing I just just love the way his mind works you know
Dr. Aaron Nicholas: a lot too is that if you're not doing things that are gonna create problems for you then you can go through the process a lot faster you know so you're you're packing a couple of quarts before you're really prepping that too and one of the things you're avoiding is bleeding that you're then gonna have to deal with in order to get through the procedure so if you start with root canal therapy and you do your occlusal reduction you prep for your crown you take away the decay and the old restoration you've just removed a bunch of tooth structure that otherwise you're gonna work around for 30 40 50 60 minutes and then turn around and cut it off anyway so why not get everything out of the way get yourself as clearer path as you can and then go from there and sometimes like I'm doing one of these and I'm like I'm prepping the tooth I'm taking a lot of time to get everything prepped and just right and I have to keep reminding myself this is gonna make my life easier and now when I start my root canal everything goes super smooth because everything is very straightforward
Howard: and I want to tell the kids something very very very important and when it's really important I always repeat myself and that's why I just keep doing it but you're a dentist and there's 10 specialties and one of them is public health and I know when you come out of school you part ways and half of you or apical barbarians blood and gods Pulte do molar endo all that stuff and the other half want to be these fanciful tooth fairies doing bleaching bonding Invisalign and the elective stuff and that's great but if you got $400,000 in student loans an oral and maxillofacial surgeon averages four hundred and forty eight thousand net a year periodontist three thirty endo 3:07 pediatric dentist three or four and once you slip into ortho and down you're out of the 300 orthodontist or 289 prosthodontist 2:19 and general Dennis or 187 so what I'm telling you is that when someone has an emergency is it usually because well I have a fancy dinner date on Friday and my teeth are a little dark and I see you're wearing a pink shirt so you're either very secure in your sexuality but it's not really you know know that what is an emergency in a dental office man my two Skilling me I can't eat ice cream I can't drink coal I didn't sleep last night I'm I'm eating I'd be profane in an aspirin and I don't have to have a treatment plan presentation case presentation for you I don't I don't need to be wearing a suit and tie I'm a fireman in your house is on fire you'll take me whether I took a bath or not and you don't have to sell that stuff they're begging to get in and then what do you say oh well we don't do that the real doctors down the street and we're gonna send you there and he can't get you in for four days and they never forget that I I was on fire I went to your office and you couldn't even throw your coffee at me and you sent me away and and when I look at these DSO guys you know like Starbucks another Howard Schultz you know he opens up a bunch of Starbucks every year and the next year he'll closed a bunch of them down and open up a bunch of new ones and these dsos they open up a practice and if it's not doing seven root canals a month after 90 days they know something is seriously wrong and if it's at under seven root canals a month at the end of one year they go to the greater fool theory which no matter how absurd lehigh the stock is you can sell it because someone's dumber than you you know you may be dumb but there's eight billion people out there and and I know at least one of them is dumber than me and someone will buy this dental office so they'll list the dental office and sell it and try to get to some better demographics but if you're walking out of dental school four hundred thousand dollars in debt and you say you don't want to do molar endo and extract teeth I hope you marry well
Dr. Aaron Nicholas: listen you go out you have your marketing plan you want to do social media you're gonna do mailers flyers you're going to go out and and go to the town parade or whatever and had your table there you're gonna meet a bunch of people so people now know you then they have a problem they come in to see you and it's like oh you know if someone has that pain it's either a molar root canal cuz they're never the easy ones upfront or it's a tooth it's decayed that needs to be extracted and I don't mean decayed a little bit like the K down in the bone where you got a pull out root tips and stuff and it's gonna be one of those two things so if you can't handle those you know the triage service for your endodontist or your oral surgeon and then once the emergencies over it's done but if you can do that in office if you can take care of them you can look them in the eye ago dude like I'm so sorry that you're having this problem I'm glad you got your squared away today but let's get you back in so we're not just putting out fires for you let's get you and get a good cleaning and let's figure out what else is going on so you don't have to live through this again and you have a relationship and they'll actually start to come back whereas if you send me down the oral surgeon go hey when you get finished over there come on back they don't come back I mean that's that's the guy that took care of them down there not you and
Howard: also the biggest error everyone makes all day long is projecting their personal bias on to the decision at hand and so you're a dentists and you want to do bleaching bonding Invisalign well you're not the thirty thousand people of Parsons Kansas you don't know what they want and they came knocking on your door because they got a toothache and want this tooth pulled and you already decided that you're not gonna do that right well where the hell did that come from because you didn't you say well I'm a Dentist I paid for my school I'm pretty sure most of these schools were paid for the majority by the public like I went to University of Missouri Kansas City dental school tuition didn't even pick up 20 percent of the cost the state of Missouri and the state of Kansas and and New Mexico and Hawaii Hawaii paid seven percent New Mexico pays seven percent that's why they each give seven seats Kansas gets thirty seats and then Missouri gets the rest and and the reason the state government paid for those schools is because they need access I can't believe you're interrupting me during a podcast Laurie at least come say hi no you got to say hi Darren you got to say hi there he's wearing a pink shirt come on look how fancy you look this is my this is my this is no Kyle do not edit this out this is my partner in crime for 20 years I could not have done it without you Lori and I'll tell you the real story soon as she shuts the door and leaves and but um so the bottom line is that the government you know Churchill said at the end of World War two we're not gonna rebuild England with a bunch of sick people who are uneducated so let's start building some schools and hospitals and get a workforce that can read and write and it's not coughing and sneezing and dying and so the government did that because they need access to public health and the best access to public health is delivered by free enterprise where an owner/operator owns the thing as skin in his own game and you show up on his door and say hey I have a toothache you can fix that they don't go to the hospital and say I broke my leg in the hospital says oh we don't do links we just do arms and ears sorry so so man up be a real doctor and if you can't pull the tooth and do a root canal you need to go to Cole's and buy some big-boy pants ok so your websites and by the way it's extra money Monday morning and you are the Monday morning dentistry com doctor so if you go to Monday morning dentistry com the first thing I went to is your online courses and you have a one hour molar root canal build-up and crown course and of course it's 697 so I'm going to here dentist with $400,000 of student loan say 97 well how much is your first root canal gonna cost yeah so just the whole 697 oh so you won't go learn ortho from raclette even though his course cost less than your first Invisalign case I mean come on so it tastes it takes money make money so so tell us about your journey what made you make a one hour molar root canal bill upon crown course for 697 at Monday morning dentistry com
Dr. Aaron Nicholas: so I same here you did and I open the practice right away and by the end of the year too I was going bankrupt and happened to hire a consultant which you know it's just like and even find one you know they existed because back then there's no there's no podcast and you know I just happened it was a side conversation with a periodontist hired them they said hey you need to come and do some CE courses and I'm like I just got a dental school I know everything there is to know about dentistry because I just got a dental school why don't I need to go see courses and they said well it'd be good for you might learn something and it's free I was like okay that wasn't right those are three really good reasons you are actually one of the first people I've heard speak oh my gosh so sorry that happened you're a survivor so anyway I went to a lot of courses and some of them were a complete flop and some of them were like I could just go back on Monday and start putting stuff into place so I had a lot of people help me I kind of wanted to give back ahead someone asked me if I wanted to do helps me younger guys and I said sure and so I started doing some speaking for him and then I started putting together these courses as I was talking to younger guys who were having problems with some of these areas in the Praxis so that's how the courses got done and Monday morning Dentistbecause I didn't want to waste anyone's time and I wanted them to be able to go to course or buy a course and watch it and Monday morning be able to go back and Institute things that would make their lives easier more profitable and kind of move them along a better path so that's that's why Monday morning dentistry and that's why the courses and there's still some stuff in development of course okay
Howard: well I know my homies well and I know him well and thanks for always shooting me an email Howard at dental town comm I really love hearing who I'm talking to and I love the comments in the youtube channel but I know what they're thinking and the first thing they're thinking is well what's better your online course or your hands-on course
Dr. Aaron Nicholas: if you have the ability to get to the hands-on course I would do that release if I go to the hands-on course do I get the online video course we don't usually do that I can work out some kind of a deal though if they say how we said you would
Howard: would you do it do you know what you know why I like that because you know the research you know we've been doing online TV for a lot of years and and the best feedback we get on it recently I never even thought of it they say I don't have to take notes I don't have to write anything down it's a one-hour course if shows a chart and I want to see that chart again I can just go back open up that course go to the chart print it out whatever but you know when they're sitting there and they don't have that video they're just gonna be taking notes and then you got to walk around with a fire extinguisher and put out fires and their pencil you know but III think it's a it's a way you can just realize they just try to learn it just try to see what he's saying you can always go back and watch the video later but that would be my that'd be my recognition but you might but you recommend the hands-on course and one day a day that's a one day it's a one day I used to give them the printout of the PowerPoint presentation and then I have a laminated sheet that has the there's two things I think are super important for them to have and it would be useful to have in the operatory so actually laminate that sheet and hand that out of the course that they have that to take home and have it for a reference in the course or in the auditory when they're there working okay I think another question are gonna have is on your website you say that one our course the next ones April 10th April 10th to
Dr. Aaron Nicholas: my office here and your office is in Burtonsville Maryland halfway between Baltimore
Dr. Aaron Nicholas: Washington d.c Baltimore used to have a football team I was so dumb I was betting I lost money with my son's father-in-law that I I thought Baltimore's gonna go all the way I I picked them in the Superbowl deal and which but anyway so it's April 10th in Baltimore or halfway between Baltimore from 8:00 to 5:00
Howard: but the price on it says it's between two hundred ninety seven and eighteen hundred ninety seven dollars to ninety seven is if you want to bring a staff member like an assistant that sort of thing 1897 is for the dot and for people that are counties that are listening to your podcasts and put in a code County 20 and and get a discount off that County 20 yeah and what's the 24 year yeah 2020 um so as they put county 20 when they what happens discount not to be rude but you need to clean up that 297 / 1897 because I know I'm not the sharpest tool in the shed but I couldn't figure it out and if I couldn't figure out there's at least one guy there's just one guy number so it says participants will learn or expand their knowledge of how to perform predictable painless anesthesia for canal therapy what my goal is is to get you to share all your beans so there's no reason either go to your course or see you ever again but so how are you gonna teach him to perform predictable painless anesthesia I know what you're gonna do you're gonna say I'm gonna leave right now and the hygienist is gonna come in and uh meal right in Arizona oh my god and now they started enough to program so oh my gosh I just love it when you go to those states with f2 programs these doctors they're operatory you know when they're doing their major work for they got a couple hygienist going and a couple left us so they'll go in there in the morning and the hygienist will go numb the two F cos and then they'll do and then they'll go in there and do the prep and then they leave and they they'll put on the matrix or rubberdam the holding thing I mean it's just it's just amazing but anyway um so what are you gonna teach him on a perform predictable painless anesthesia is it gonna be septic a Medicaid it's for sure gonna be septic a because there's so much misinformation about septic came out there that
Dr. Aaron Nicholas: I've run through all of the research of that and there's nothing wrong septic ain't even for ie blocks that's it's still fine we talked about you know timing and we talked about using a PDL and using some of the adjuncts with that just a number of different things and then really just you know knowing your knowing your anatomy and and knowing don't give the injection the way that you learned in dental school there's other things that you can do to make that work out better you know so and
Howard:I just want to say that uh Stanley malla med was on episode nine seventy one and I'm just on you two alone it got twenty five hundred views and he's the the consultant on all the lawsuits and the nothing dangerous about sceptic Ain but the myth just person keeps going and going and going and it comes down to people just believe what they want to believe even though there's no data for they want to believe but if you think sceptic Ain causes all this stuff you're wrong it's the needle poking the lingual nerve when you're given the injection anyway yeah well interesting when they started looking at those studies they found that
Dr. Aaron Nicholas: all those incidents of paresthesia using septa cane were in North America and not over in Europe even though they've been used in a Europe for years and years before ever came over here so yeah so why was that that the that the is the injection technique is the problem it's not the anesthetic
Howard: so how do you advise them to do a painless NSA you you recommend that they became
Dr. Aaron Nicholas: switch step came what else you use something that doesn't have a base of constrictor in it first because as soon as you had epinephrine you decrease your pH which is gonna make it burn so lets you something that's more that's more kind of tissues and then stop using hurricane and start using a compounded topical that's gonna give me a lot stronger and it's going to work a lot faster it'll work a lot better and you put those three things together and you're most the way to a painless injection I have patients that come through all the time and like I'll send the oral surgeon for something and they'll come back and go you know he's a nice guy did a great job but you know he it really hurts when he gives me a needle and
Howard: I was like okay so I've made up like care packages for my specialist like took it to their offices and tried to be really nice about it and I think they ran through it and stopped you snooze what happened but I never heard that they no one ever said oh that was a great idea they just made I think they used it up and they were done I don't appear that interested in doing that you know the one thing I noticed with all my journey getting out is that um if I start feeling stressful or tense or whatever first I didn't know what was going on then I realize I'm picking that up from the patient yeah so you know when the pain we know they start moving or intense in your memories ensign and I still see the young kids you know when they're young because when they get done given the injection though they'll put the needle down on the tray and then they stand up there to leave the room and as they're leaving the room they exhale holding their breath the whole time so everyone just needs to relax because if you're stressing out on the shot he's picking that up from you and if you're feeling stress and you don't know why you're picking up from him so a lot of its just in the delivery the persona and eat a lot of it's like you were doing when you were discussing that like you and your shoulders up and your and your head was kind of scooch down in your art and I've caught myself doing that give it an injection my shoulders up around my ears that's like you know looks like put the shoulders down let's relax three you know you can beam injection and make that change and you can see that that actually translates your patient okay so next is identify why a single visit root canal therapy Billiton crown is preferable to multiple visits
Howard: I mean to me that that's obvious I mean it's like same-day dentistry everybody every time same day dentistry and the guys wearing the nascar suit selling the machine they tell you oh you'll do this an hour and then we're on dental town and in the trenches you know it's more like two hours to two and a half to three and I don't want to go sit in the doctors room for three flippin hours
Dr. Aaron Nicholas: I don't want to come back for how would you like to you know when I get my first bypass I don't want to hear well you need a quadruple bypass but we're just gonna do one valve a month for the next four months because that's all your insurance you know you just want to go in there and be done I mean at this point to me this should be like general information but I still run across Doc's all the time a lot of our young Doc's where they think it's better to do to visit stuff you know let heal in between let it settle you know all that and the same thing for hey we do the root canal and then we wait to do the crown because we want to make sure the root canal takes and that sort of thing I was I was talking to young doc and he kept saying that and I said so what percentage for your root canals work he said well you know like the usual like your bail see like 95 96 97 % like so why don't you just cut the crown minute because if you're if your treatment is 97% successful then you should pretty much be counting on it being successful time so just go ahead and do the crown at the same time well what if it doesn't work that's three percent of the time what's your lab bill okay and then start looking all the extra money that you're spending by breaking it up into multiple visits and having that patient occupy that chair for an extra hour when you could just take an extra ten minutes and get it all knocked out right there you know
Howard: my favorite thread on dental town right now is what are the zombie ideas and dentistry that have been thoroughly refuted by a mountain of empirical evidence but nonetheless refuses to die being continually really held beliefs and I noticed I'd noticed one thing it's all old farts posting on this stuff and I'm telling you it's just the way humans are ideas zombie ideas die slowly so look at look at Galileo his birthday his 456 birthday was Saturday so you should Elise on wish him a happy birthday and tell everybody to buy loops or maybe a microscope but I'm Galileo spent the last seven years of his life in prison because the Catholic Church did not want to hear that the earth went around the Sun instead of the Sun going around Rome so zombie ideas die slowly
Howard yeah I mean even like putting posts in teeth I keep getting questions about well do you profuse posts like no post don't work the only time I use post is if I got a patient that's so old that we don't want to take the tooth out so we'll put a post in there and hope it'll ill server for another year or two I mean we're talk about something in their 90's that's great okay so how would you describe the zombie idea of sceptic Ain the something that that you should not use sceptic aim because it causes parasya yeah
Dr. Aaron Nicholas: yeah I mean of course I put up like four four slides of nothing but research or articles coming right off of PubMed that says it's okay to use sceptic eight you know and you just use keep running through those over and over and yeah I'll still get those questions about well you know what about paresthesia with a and IA block I'm like it's just there's no science that says that's the case
Howard: yeah so uh my gosh so um on the multiple visits versus a single one there are times where you need to do a multiple visit do you think so or do you think it's more logistics the only time I ever do multiple visits is
Dr. Aaron Nicholas: yeah if I'm if I'm running at a time for some reason and then for me that usually means I'm doing a retreat that ended up being really tough and the one hour Moeller Birkenau is not about retreats it's about you know the first time if I have a patient it's like super swollen I'm still know that I need to make a second visit but I'm still a little a little edgy about that second visit at that point look at your cost what do you do the one visit and impress for a crown and then you got to go back in and revisit it then that's costing you money I agree I don't I don't do one visits on swollen or tissue and which is the only time use antibiotics yeah so um understand how rearranging the order of the procedure can increase efficiency and lead to a better clinical outcome is that what I was saying numb prepare for final restoration then do endo right because a lot of times guys they're just not sure they can get it all done and what they'll do is they'll say well I'll take off that top two millimeters and then I'll do the endo a nail prep for the crown it's like actually it makes more sense logistically and makes more sense medically it makes more sense in every way to prep that crown first then do the root canal and then finish it up it just works works so much better and I want to say I want to say one thing about the post because I know you never supposed to talk about religion sex politics or violence but I only know dentistry and
Howard: so I've only seen what socialized medicine like if the NIH does for the UK dentist but back to that post comment you made the great people of Japan France and England have decided that your Bernie Sanders free socialized health care will only pay $100 from o-ring endo so the first thing they have to do if they're gonna do molar endo is they get paid another fee for a post so they stick a posting on every canal so you see a post doesn't do anything it actually does it generates income from your socialized medicine you believe that a government agency knows more about how to make a health care decision than a owner-operated surgeon working on you treating you as he would treat themselves and it actually does have a very good clinical result post are the best at fracturing a root I don't know anything that fractures are better than a post so you get money and you fracture the tooth what could be wrong with that Bernie right so um so then so I don't want to spend all the time on a root canal stuff because um I know you do other stuff so the next view online courses and by the way this is not a commercial he didn't give me any money I mean he should have he should have I mean I'm surprised the Dairy Queen man isn't delivering a chocolate malt right now or hey will you go check and see if the Dunkin Donuts guy is out there but uh so another one you have is is um I'm gonna have to argue with this one all day long profitable hygiene and I I'm gonna have to argue with you because I've been a dentist for 32 years I've been in a thousand dental offices and when that dentist comes out and I say hey how long's that high jettisons but in there doing cleanings for you ten years I said was just at a cleaning examiner bite wings did you make five dollars and 18 cents after taxes or did you lose 12 bucks and he says I don't know in fact this morning I was talking to Nathan sparks of open dental about that very question that since open dental doesn't sync with QuickBooks Pro you know these dentists don't know their numbers so when you're seeing profitable hygienists I assume that you're all just hallucinating this is a Netflix movie you just you're just all wishing it's profitable is it named is the hygienist named Ursula or Muriel that's all I would've know because I know this is a completely fiction movie
Dr. Aaron Nicholas: well the other thing too is the bloodshed is it bloodshed on the patient's part where's the blood shed on the hygienist part which was kind of it was supposed to be sort of a joke about it not having to beat hygienists to get profitable hygiene but in any case now so it's it's really about how to run an accelerated hygiene program and do it nice and smooth so that everybody's happy and your hygienist isn't going crazy and she's not feeling overworked and she gets in and does the things that she needs to do you can do your other things like you know fluoride and sealants and you know taking impressions for night guards and whitening and you can make all that work and make the hygiene department profitable but you can't do it if they're just gonna like scrape and take x-rays occasionally you know you have to kind of be under gaines
Howard: okay so my my quarter my viewers and that are sending me emails at Howard at dental town comm tell me that there's still a quarter still in dental school so they don't have no idea what accelerated hygiene program means okay so let's see let's teach the children
Dr. Aaron Nicholas: what that means what that means is if you if you look at the hygiene procedure and you look at who you know the general idea business is you get the least the lowest paid person to do the work that they can do and then the highest-paid person do the work that only they can do so a hygienic only hygienist can scale a root plane only hygienist can clean teeth you can't do rubber cup row peas in my state with unless you're a hygienist so only they can do that
Howard: let me just stop you there it's funny how Americans can afford a house and a car but they always wonder why health care so expensive so the government that passes all this regulation that makes everything high cost then they want to go back to that guy to help pay for the systems like it'd be like Bernie Sanders walks up to you takes a baseball bat breaks your leg and then says you deserve a free wheelchair hey how about you just don't break my leg to begin with but anyway
Dr. Aaron Nicholas: no politics go on an assistant can like seat the patient review the medical history find out what their chief complaint is take their x-rays take impressions apply fluoride so what you do is you get the lowest paid person that can do it to do that job so the way this works out is every patients in the office for an hour they spend a half an hour with the hygienist who does all the stuff that she's gonna do and then the other time is spent with an assistant who's gonna do all those other things and then that way the hygienist sees our hygienist see we work in a seven hour straight day at lunch hour hi Jess we'll see about thirteen patients a day so guess what if you have two patients decide not to show up she still saw eleven patients that day and you've still got a profitable situation going as opposed to you know we have a seven hour day we have seven patients two of them bail and so now she sees five patients in the course of a day you know and you're not gonna get as much as much done and so then the usual thing as well you know I want to spend more time with the patients I want to make sure they don't feel like you know I'm rushing them through and say well how much time are you really spending with them when you're cleaning rooms and setting and setting up rooms when you're shooting x-rays and you know and trying to get them not to talk so you can get the x-ray taken and when you're doing all those other things shoving the fluoride in and with the I can't talk then either so I mean really they have as much time or more time than they do on a straight one hour per patient schedule
Howard: I don't have how much how often do you get your hair cut and what do you pay for that week's cut it yourself yeah you go to the barber shop and they take that the race and they say what you know which one do you do a two or three and you go three they slap it on there they cut the sides then they clip the top a little bit you're done you do your own hair it's four years Dr. Aaron Nicholas: now yeah I do my own hair –
Howard: I do I do I get in the shower and I brush then I floss and then I a save but are you married yes how much how does she how often does she go get her hair cut and are you guys bankrupt do you need do you have any send me a case of ramen noodles but anyway my point was being this my point was being this um the insurance PP o fee fight instead of spending your whole life fighting this why don't you look at the economic reality we have 200 years of economic theory from Adam Smith to today and the person who wins isn't the one who does the patent he has the lowest cost in airline Southwest Airlines has 27% Costco price Club Sam's IKEA furniture so when these fees come down the dentist's all want to fight it and say no I want the fees to go back up but when the fees come down you get more market share and right now a cleaning examined bite wing you can't do it for what the average girl goes and pays for her what I'm seeing in the real world is that the the girls are paying 80 60 or less and the dentist's are charging 100 120 140 and so if you know they'll go pay for their hair nails and teeth though they'll do that but you've made it expensive and Anna who's made it expensive only the government think if the government did not exist we would not even be having this conversation but the government's main expenses so you have to use game theory so with accelerated hygiene you can get this down to where it couldn't cost any more I mean I still think it's absurd that in all national healthcare schemes if you just make the patient pay for fight per second you know they always brag that oh I had a bypass it didn't cost me a nickel well who an economic said that's a good idea quite the contrary everybody in economics says that's a horrible idea no one price shop no one in Toronto looked into the fact that maybe if they drove over to Edmonton instead of a 5% co-payment on 75,000 they would have done a 5% co-payment on 50000 so no and now you don't get anybody so when the doctors are billing procedures they didn't do well now the humans not even looking at the bill to see the fraud because why is he looking at a bill he didn't get a bill oh so you don't want the person that got the surgery done to see the bill to see if the surgeon even build the craft for all what if you had a bypass they billed for a pancreatic cancer I mean couldn't you say I think there's something wrong so everybody wants you to look at the fee and if as you lower the you increase market share so so do you take PPOs
Dr. Aaron Nicholas: we don't anymore I used to when I was early in practice okay we'll talk about that so why so everything I just said was was wrong but do you so explain explain why so when I first got in practice I was doing bankrupt you've heard that part of the story and so I signed up for all the HMOs and PPOs that could get my hands on and what I found was as the HMO patients came through I found a lot of decay around restorations that need to be replaced and with because of his capitation plan I had to replace all the amalgams that's how long ago this was no charge so you know I would have these patients come in with literally their entire mouth needed to be redone just all the fillings need to be redone because they had so much decay and I would ask the patient well what did the doctor before me say is they oh they were gonna wash it and see what was going on that's like okay and so I kind of did my thing and I promised myself that if I got to a point where I didn't want to see the patient walk in the door I would I would stop so one day I was I had two patients one was a deep service patient and one was at HMO patient and both of them needed a crown and the one the crown was like a couple hundred bucks and the other crown was like 900 bucks and both of them looked at me and whistled image that's a lot of money and I decided that I could listen to the whistling a lot better at nine hundred bucks then I could two hundred bucks and so I kind of decided you know I need to phase myself out of the HMO market and move more toward the PPO market so I did that and then we were doing PPOs and then one year MetLife decided that they weren't going to pay for periodic exams anymore because I was in there anyway I guess is what's the way they figured it doing the cleaning and so they weren't gonna pay for those anymore in a bet when I went okay MetLife is gone and so I just dropped net like just they really made me mad I just dropped it and what I found was that most of those patients stayed anyway and either shifted to one of my other PPO or just hate me fee-for-service and then I was like maybe we're on to something here and then I just I kind of just kept doing that each year the worst one I would drop and I made sure that my in office you know marketing was good I made we were really taking care of patients and that's the way I worked through basically dropping all the PPOs a number of years later I signed out with Delta because they had a fee schedule that was not to ownerís I'm like okay so if I do this I realize this is your top of the lion plan but if I get on this one then I need to not have to go on the other ones and they said absolutely no problem I'm like okay and that worked for about a year and then the following year they sent me a thing said well if you're gonna do this you have to do that and at that point I dropped them and we were kind of done but we played this game back and forth over and over over the years
Howard: well I don't want to go off onto insurance and on high insurance because again especially to our international viewers I cannot you know I can't stand the term United States of America because you can't compare persons Kansas to Manhattan you can't compare Miami to Alaska you can't compare San Francisco - you know persons Kansas I mean it's it's a huge country and you know I always hear almost debate where people say well this country doesn't yeah yeah that country has less people than California you know when you're talking about the United States it's a third populous country so does this work and they're you know it's China India United States and Indonesia well United States about the same size Indonesia you know so would this work in Indonesia and they say well no okay so you know that Indonesia and Denmark are different you know that Canada has less people than California so um so it's a big regional country that's uh it's very very hard to understand it unless you go all around it so um so profitable hygiene was accelerated that's the the key they're efficient extractions I'm sorry if you can't pull a tooth you shouldn't be called a doctor right I mean that'd be like dental kindergarten grammar school you're five years old the first class here's your teacher sister Mary Aloysius she's been a dentist for thirty years and the first thing she's gonna teach you is to pull the loose wiggly tooth for the Tooth Fairy I mean and the minute you walk away from that procedure you are disconnected from reality
Dr. Aaron Nicholas: I had to extreme III think that you need to learn how I think you need to be able to pull teeth I think you need to be able to take care of like I said earlier the emergencies to walk into your practice and and take care of those people which means you need to know how to pull the tooth and and not one that has a nice crown on it and it's weekly and it's pretty dolly involved but one where it's decayed into the bone the guy speaking healthy and you got to be able to figure out how to get that thing out of there and the same thing with doing else you know if they walk in and it hurts it's gonna be more work nine times out of ten it's gonna be more you know they need to be able to do that but I had an associate years ago patient broke number nine he prepped eleven and an eighth or a bridge and then he sent the patient to the old surgeon to have number nine extracted and I and I was I was working there the same day and I was like hey I never saw you take the tooth out whatever happen by that case he's like oh it's a really tough extraction I sent to the oil surgeon and I was like please please please ask me next time that's about a five-minute extraction you know he just but but no one had ever taught him how to do that you know so for him that was almost an impossibility for you and I we look at ink oh five minutes maybe you know and it's better than anything
Howard: I mean my favorite joy in life to this day is still pulling for wisdom teeth and you know I go and I numb and then I set a timer for you know eight minutes and then for impacted wisdom in 'its for root canals crowns but the pressure you know you got hot coal movement pressure pain you know I set the time for eight minutes on that and then when I go in there I hit the start deal because I'm curious what my time is and 99 percent of all those four teeth come out in under five minutes for almost 30 years and every time I have a temporary assistant a lot of times they temper Oral Surgeons they always say holy moly man I you're twice as fast so oral surgeon and what I like about it is it's instant gratification I mean as soon as you the juice out you scored you won the game you go home everything else is delayed gratification I mean I can't think of anything more fun and you have the tools of course I have a slow-speed setup I have a 57 surgical a 2-inch flap heals the same a long time is a one-inch flap I mean I mean you every movement is with intent and you do every movement to cover the worst case scenario you know you're not gonna go back and smudge some more and rinse and look just and with elevators I just need to feel I mean Stevie Wonder could pull 99% of the wisdom teeth I pull because you're back there and you're getting in that little elevator in there and as soon as you get a purchase point you're not looking at anything you're feeling it out about anyway so so is do they just not do it because of fear or they do it because their ego or one time they couldn't get it out so they panicked and that happened to me a dozen times and my we knew the protocol we would put the pace in the car we would drive him to dr. dawn gases office if it was during Baker's hours and if it was after hours we'd send it across street to Bob Sundberg and and and we had to do that until I learned how to pull out the route with the crown so so big deal so so you screw up 10 times you know it hasn't happened to me in several decades
Dr. Aaron Nicholas: I think it's a matter of you know you get so much time in dental school to teach young guys and girls how to do stuff you know and so you know you teach elevation you teach putting the four-step on there you teach the different motions etc etc but what happens when there's nothing to grab on to I don't really feel like they get taught very well how to take out a route that maybe decayed below the alveolar crest so I go to that the Dominican mission trip and that's one of the things we do all day long is take students who are rising seniors and show them how to take those teeth out because those people that have those broken down teeth for years and years and years and they're now finally coming in to get them out and it's not a matter of there's not a whole lot of teeth with a crown on them down there you know you just you just learn how to get those roots out in it usually by day two you know we're talking rising seniors they maybe have taken a tooth out by day - they can handle 75% of what we're seeing come through there on their own and in another day or two they're even better than that so it's not terribly complicated it's just a matter of you've got to go through it a few times
Howard: okay I've split all this time on Monday morning dentistry comm you the that is your website dental is it dental - Marilyn com what do you call that little thing in the middle is that - yeah so dental Maryland comm that's your patient website right that's my homies dental care it'll take you there so you also have this smile protection dental plan
Dr. Aaron Nicholas: so that was a we started in-house dental plan and I talked my my specialists into extending the same courtesy to my patients that I did and then I was gonna take that see if I couldn't market it to businesses and somewhere along the way the guy in the insurance industry that I was talking with kind of back out and then I got busy doing some other things with associates and so it's still my in-office dental plan and we're actually looking at maybe trying to revive that and see if we can take that somewhere I mean I don't know about you but like I've been I'm gonna practice 30 years there's lots of ideas to come around you know you take a swipe at him early on and they don't quite work out the way you want to and you come back to them and I think that's gonna be one of those one of those deals
Howard: yeah so what and when we're looking at business books who's my the favorite guy for any anyone in practice management is gonna be Jim Collins and he started with good degrade great by choice how the mighty fell but Jim we started off built to last I don't recommend that book anymore because I was written I read that in the 80s and that's just too old in fact I'm gonna take that off my list but uh but Jim Collins says that what he just said scientifically is he has an idea so you know faster easier higher quality lower cost smaller less money just a myth that with a BB gun and see if you hit it and if you don't hit it then think about it and change it up but you gotta hit it with a BB gun if you know with a BB gun then you can put some more time and money into it and load up a 22 rifle and see if you can shoot it and hit it with the 22 rifle and then if that works then you say hey it's time to get leveraged and take some savings or other people's money and build a cannon ball and blast that target but what the young do is they have an idea and they think they walk on water and they've never stuck their tongue an electric socket so they load up a cannon ball and they shoot they miss they're out of money they're out of gunpowder they put all their metal in one ball and they're bankrupt and speaking of bankrupt that's another thing too young kids do I see it all the time I started to this kid I had lunch with him on yesterday and he doesn't even have a line of credit so he's in a financial problem he's been practicing for 20 years I said well what what's your LOC your line of credit so when you look at the bankruptcies each year forty to sixty thousand businesses and the number one causes is they run out of cash so during a contraction and I'm getting a little nervous because I lived through we got a nice cone ad that was the worst eighty seven black Monday that I mean we graduated in dental school and and what was our reward in October black my black Thursday stock market shrunk a quarter than we did in y2k we didn't Lehman's but my god when if something falls through the floor and it's always short it's only it's usually a year or two max I'm if it falls to the floor and something happens you don't have to start laying off staff and selling stuff you already established a line of credit so when times are good they loan money to anybody and give you lines of credit and then when it's bad they don't give money to anybody so you need your LOC before you need it and in fact I just had my year in financial mean this is February 17th so we just did ours last week and I said why is the LOC at 500,000 and well we don't need it well you don't know we don't need it but it see if he can get it to a million you never know I mean I mean just ask JSON but you need you need that before it happened so we'll take smiled smile protection dental plan do you think the homies would like looking at that side or should I just take it off completely I'd take it off it's not much there okay I will take that off completely but you still have more sites to come well no that was a smile production plan Monday morning dental Maryland that's your that's your office so so what is um god I can't believe that was a that was a fast hour we talked about profitable hygiene with accelerated hygiene and I'm gonna call that profitable accelerated I gene efficient extractions anesthesia techniques surgical extractions for the general beat-beat GP my gosh what else uh what else should we talk about while I have you on the show
Dr. Aaron Nicholas: we ended up starting a dental assistant school oh that's right that's the one I was thinking of the dental assistant school of Maryland yeah so we we we bought one of those those programs and put in place it took me it took me four years to get state of Maryland to approve the thing which was ridiculous but then we started having for years get stated me on to approve it
Howard: okay so all you all you big socialists what did he just say you have this heard that's been living for 50,000 years and a hundred billion humans have gone in before there even was a government and then when I'm lecturing in the Caribbean I'm like well what are you doing well I'm trying to buy that debt that building there I put a dental office well what's going on well I mean I'm in Jamaica and it takes four to six months before the government replies to it and then their lawyer will reply it it may be another four to six now so so you're gonna build a dental office but it's gonna take a couple of years to open because of the government and then and then and in the same conversation that guy thinks the government's gonna save them I mean what when do they realize that the government is the problem it's not the solution I mean if you're trying to get off drugs you shouldn't go move in with your dealer I mean you know so so the bottom line is I'm too cute or year for years I mean it's just oh my god anyway um so so then so now you have the Maryland assistant the Maryland dental assistant school it's called MDA s online so is this a virtual school it will be soon
Dr. Aaron Nicholas: so we the way that the program works is they come twice to the office three hours each time for lectures and hands-on and what we're finding is that they're having a tough time making it to the office so what we're hoping to do is to put the last part online and then have them come to the office once a week to get them through that process and then get them to school but so the didactic you could take anywhere is gonna be on line and then where they need to be there the hands-on is well that's up
Howard: well that's a nice smooth invention how's that going so far it's been
Dr. Aaron Nicholas: going pretty well the biggest problem is quite frankly the students have trouble they have trouble paying for it so we've had to like make payment plans and that sort of thing lots of them are in life situations that aren't really supporting they're trying to get to do this sort of thing and then it's like they're you know they broke up with the boyfriend and they moved out and they can't support themselves and now they have to they're trying to work a job support themselves go to school do the the studying they need to do and they're working a couple three jobs just to try to try to hold heart and soul together just those kinds of things having trouble studying
Howard: you know they won't set aside the time to study and so they they come and take take quizzes and they're not doing so good and so we're we're doing a lot of life coaching quite frankly in the course of getting them through the school but the flip side of that is that right now in my state it is really tough to find dental assistants and I say the last for dental assistants we have came out of our Dental Assisting school so I'm pretty happy about that that situation okay um so back so you also had another say the cd-i group I have no idea what that is it was the cd-i group focus on dentistry we'll take care of the rest 40 years of experience and dental plant administration we provide discount membership plans was that the group you used to make you're the one we were talking about the smile plan no dental plan is completely within our office we didn't use any group at all to do that thank you ourselves we developed it ourselves heard that CDI the CDI group okay so that wasn't your plan so that was my error so I'm so you got the smile production dental plan we're gonna take that off Monday morning dentistry dental Maryland and this is a new dental hygiene school was school we are MDAs online and how's that how's that working out for you so far so far pretty well I mean like I said we've had some challenges along the way but you know it's we started we do what we thought was the right thing to do and then as we've encountered problems we've adjusted and shifted and hence the trying to put that guide active online so they only have to come in the door once a week instead of twice a week we're hoping that will help get some people through and solve some problems for them if they can do it the didactic on their own time their own convenience I think that would be helpful so you uh so MDAs according to the Bureau of Labor Statistics there should be more than 74,000 new openings for dental assistants up to the year 2022 the dental profession is currently facing a shortage of trained assistants well the trend I see is they're starting to just like Arizona they passed that expanded the FDA so well yours get them to after we don't have in my state but do you see after coming down the pike I would love to see after coming down the pike
Dr. Aaron Nicholas: I don't I don't see it right now you don't see right now they're just getting just dental assistance at all we have people call the school regularly and say anybody like a warm body anybody in class you don't care we just need some people I had I had to convinced the the committee for the advisement of secondary education that we actually needed more dental assistants in our state because they had done a survey in 2009 and asked dentists if they needed more assistance in the overall they basically said no and I said well dude it in 2009 you're just a year past 2008 when the stock market fell and most guys are just trying to hang on to the the people they had not have to lay anybody off but that's the survey they were going by so then I had to serve a dentist in my area and then literally everybody said yes except one guy and then I went through and talked to the committee I said look if I'm off by 90% you guys we still are not turning out enough dental assistants in this state and we're not trying out enough by hundreds and so they and the one guy looked at me and said well I feel better you too dear to him a job coming out of the school but okay I was livid I was just like you gotta be kidding me like there's not nearly enough assistance around here yeah and I'm I mean who would want to tell someone their career was limited suctioning spit and all with the Dental Assisting school how do you weigh in with the saliva techniques of this what's the one what's the one you bite down on you put in your mouth do you like that I like it okay I much prefer to have a assistant there helping with the procedure helping them maintain the field I know a lot of guys like that especially they don't have an assistant like they're the associates or sometimes they have assistants sometimes they don't sometimes they don't get the good assistant you know that kind of thing also like the doctor gate the thing that you put in there and it kind of spreads the cheeks and everything that's like that pretty well also you said a fair amount of time when we're doing surgery
Howard: well hey my gosh that was a an amazing amazing hour with you I'm just just making sure I didn't forget anything I think you covered everything you know you're really good at making online courses a great marketing thing for you to do is make an online C course for dental town because then they'll get to see you they'll get to know you it sound like speaking all these people want to get out and start becoming speakers they don't realize you can scale your brand name a thousand times faster digitally I mean you're never gonna say because I remember when I started lecturing and you know the first four or five years if you had 100 people in the room you thought you're you're on fire and now now if you do a podcast and it went to less than a thousand people just on YouTube you like you like might not have uploaded it you don't I mean so so yeah I'd love to have a course or you everyone do an article you could do an article on your online one hour root canal that would be a cool thing to an article and then that would drive into your website sounds good yeah and I'd like you to do a kind of quick because I know how old you are you're as old as me if you don't do it by Tuesday will there even be another Monday and tell us one more time how do they would stir for that hands-on course in April that's the end or one yeah and there's a button on it says hands-on courses the website just got redone so the your your comment about the 295 295 is is pertinent for me the only other one is on the ad credit you say for FA G DM credit and ma GT credit so that's just a typo but love love what you're doing really I'm a huge fan of everything you're doing and it was just a Monday morning demonstrate dentistry MMD what was that the most famous NFL deal back in the day was the Monday Morning Quarterback remember that you did you were you a big fan of the Monday Morning Quarterback I was there yeah but hey gosh thank you so much for coming on the show today it was young honor to podcast you and I hope to see on the message boards a dental town calm all right sounds good I appreciate it all right all right have a great day buddy