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1369 Dr. Paul Springs on Specializing, Adhesive Dentistry & Online Education : Dentistry Uncensored with Howard Farran

1369 Dr. Paul Springs on Specializing, Adhesive Dentistry & Online Education : Dentistry Uncensored with Howard Farran

3/5/2020 10:40:00 AM   |   Comments: 0   |   Views: 47
Paul graduated from Rutgers School of Dental Medicine, in 2019. He went on to a general practice residency at Coler-Goldwater Specialty Hospital, developing proficiency around medical and cognitive special needs, as well as a true appreciation for challenges facing institutional patients and providers. While training at Bellevue Hospital, his pursuit of comprehensive treatment planning and complex prosthetic rehabilitation continued, particularly with planning, placement and restoration of dental implants. Paul counts himself fortunate to be in a prosthodontic specialty residency based in daily mentored clinical practice at Monte Medical Center in the Bronx. Within specialty practice, he loves providing life-changing treatments, discovering new techniques to improve predictability, and innovating materials and methods from other fields to provide patients with outcomes that were previously impossible.

VIDEO - DUwHF #1369 - Paul Springs

AUDIO - DUwHF #1369 - Paul Springs

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Howard: it's just a huge honor today to be in the podcast with Dr. Paul Springs DMD your let me read his bio huh this is gonna be fun today he's a graduate from Rutgers New Jersey School of Dental Medicine they had a name change that's been a very confusing thing for old guys like me he went on to a general practice residency at collar Goldwater specialty hospital developing proficiency around medical and cognitive special needs as well as a true appreciation for challenges facing institutional patients and providers while trading at Bellevue Hospital his pursuit of comprehensive treatment planning and complex prosthetic rehabilitation continued particularly with planning placement and restoration of dental implants as a general dentist he was active in the Queens County Dental Society and the Academy of general dentistry where he developed a commitment to excellence through lifelong advanced education as an attending faculty member of Luther Memorial Hospital School Health Program he was immersed for the first time in day to day problems of Public Health and the solutions possible and one-on-one treatment and education a paradigm Paul counts himself fortunate to be an A prosthodontics specialty residency based and daily mentored clinical practice at Monti Medical Center in Bronx within specialty practice he loves providing life-changing treatments discovering new techniques to improve predictability and innovating materials and methods from other fields to provide patients with outcomes that were previously impossible I really am glad that you specialize because you can't deny the historical trend up from 1900 to 2000 1900 and so health care is not even 1% of GDP there's no specialties at the end of the century it's 14% of GDP now it's 17% the physicians at 58 specialties we just added one now we're up to 10 but you still have these kids coming out and saying I'm gonna master endo and so we're diving in fluoride pediatrics and I'm gonna learn how to place implants really with a sinus lift and Vodun grafting really all that and then restore and then jump over here and do veneers and cosmetic dentistry AACD and 

Dr. Paul Springs:they're gonna learn in this line and would you like to go to that doctor in retrospect I wouldn't for many years I well for several years I wanted to be that doctor and I think you can see it from my bio kind of went here and there kind of wanted to pick and choose I learned something here something there and I was convinced and I think it's unfortunately the fallacy of the digital age that people think oh you don't have to learn it hands-on I'll see it on Facebook I'll do it the next day and you know unfortunately it's human experimentation in many cases but I went there I did that I found out I hit my head against the wall a few times and I realized you're only as good as your mentors and unfortunately you have to learn these things the right way and it's not even about you know being in the right place and doing the right things it's more than anything it's having patients coming in with the expectation that I'm going to get this significant treatment they've already been to the other places they already know you're the most competent person that can do it for what they're willing to spend which is a lot of times when it comes down to and then just taking it from there having the expectation and having someone standing over your shoulder saying there's a landmine to your right step to the left and you know that's

Howard:  what I've tried to do with a lot of my friends I get these text messages that say oh this lady agreed to a full mouth rehab now what you know where do I start where do I finish and where's it gonna go yeah this the funniest guy in my dental school class is very Winsky and when he told me he was gonna become an Adonis I said really I I I didn't know in our discussions that you loved root canals the most he says I don't I just don't want to learn every day I'm subject from A to Z and that was probably the most profound thing I heard in dental school and I didn't even realize what he said for a decade and man God just staying on top of endo I mean they're using microscopes or I was in Israel lecturing and this guy was showing me this this new technique to actually wash out the inside instead of the mechanical filing the general way he was showing me and and thats on endo is one way and I've seen three different versions of that prototype out there and he was showing me a way that just cleans out like a washing machine vacuum thing and and I signed an da I can't say much more than that other than I hate lawyers and but the bottom line is it's everything you've got to stay on top of just a root canal well and how are you gonna do everything but you know on the other hand that's a it's a balance we all have to strike

Dr. Paul Springs: I think one of the greatest things about dentistry is it's a lifelong process even if I was to try to learn everything that's current today it would take the rest of my career to do that but it's ever evolving as we know and there are hundreds of journals and everything else endo is a perfect example there's a lot of studies out there that are showing that people with what we would traditionally call irreversible pulpitis are being treated managed for five years plus with no abscesses maintaining vitality doing adult pole bottom ease and immediate restorations of the teeth you know and endo I think is right before some major paradigm shifts for sure and these are studies that have been around for five years with 5-year follow-up but you don't really hear about them and I think it's largely because everyone's learned what they've learned and though is what it is and no one but the patients unfortunately benefits from doing something simpler as you would say faster cheaper higher-quality unfortunate

Howard:  so out of ten specialties um what made you look at prosthodontics and and there might be some but a quarter of our viewers are still in school um what why did you look at prosthetic even wanted a screaming kid 1000 at the same time I just want to be in a screaming room i I'd be Appy Adonis if though all the kids were in one op screaming at the same time well I'm the youngest in my family so you were the screamer actually it's funny I'm here like

Dr. Paul Springs: I was telling you I'm here visiting my family my parents and my sister are out here and I was talking to my brother I said where do you have to go I said I'm actually gonna be on a podcast he's a comedian he listens to a ton of podcasts of it comedy and music he has a radio show also the Marcus Springs show if anyone's interested in the collected music but he he said you're gonna be on a podcast I said yeah it's a dental podcast you've never heard of it he said oh what's it called wait wait don't hurt me and now I want to meet your brother I would have a very dear brother since I'm

Howard:  so  what would you so the reason the reasons to specialize are just obvious um I mean I there's so many I'm number one look at a DSO here in Arizona is ground zero for DSO is the highest penetration of 18.6% because any dentist that's licensed in any state can move here and do dentistry you don't have to jump through all those regulatory burdens but when we look at specialty data you know the average net income for dentist specialists are 320 general dentists 197 so you make $100,000 a year more I'm Dentist so on their practice to make 244 if your employee 147 so owner operators bring out or more but blood oral surgeons make the most 450 in periodontist 330 endo 307 pediatric dentists three hundred and four thousand but you just make more money if you specialize so then that specialist comes in my office and does a root canal if I bill it I do it they'll give me maybe 650 but if the intern honest does it they'll give him 1200 right that that that's double right so it's so paying a general dentist 25 percent to do the root canal is you actually make more net income paying a specialist 50% because remember we're not talking about percentage we're talking about total profit dollars so I so the DSOs can make more total profit dollars with insurance companies so  um so congratulations on seeing the wisdom and specializing and treat other people like you ought to be treated if I had to have a operation say I had some was wrong my I I wouldn't want to go to a near doctor I'd want to go to just a guy who does eyes you know so but wait why did you pick Pross tone and set a pareo endo pediatric 

Dr. Paul Springs: there's a long answer and there's a short so the short answer is someone I really respect basically pointed out to me the way it could be done that I could be on a paid residency that makes huge difference right because we all have school debt I'm fairly fortunate that mine's pretty low and I had already been paying it down for about five years when I would decide to go into specialty treatment your brother vodcast paid for that but you know what it comes down to more than anything is clinical advantage like you said it's treating others how I would want to be treated there were enough treatments when I was general dentist where I said I think that'll work I think yeah this is pretty much what we talked about in school yeah I think that ought to work but what I learned that the funny thing is I went into the residency thinking it was going to be about improving my skill set and to an extent it was but mostly it was doing more in different forms of things I already knew how to do more than anything it was a change of mindset and you know a lot of it is having the time to have conversations with patients that avoid the problems going forward so many of the misunderstandings and problems we have with patients are because we didn't have a chance to find out what really matters to them and what they're really looking to achieve and whether what they're looking to achieve is even possible or reasonable in my experience specialists have the ability even if they choose not to take it they have the ability to take their time a little more to do to have those conversations and to have the diagnostic knowledge because let's face it that's the hardest part and most important part to know before you go that I'm not going to you know have unintended outcomes that I don't expect here so for me it was all about having you know anyone who tells you they have a crystal ball is a liar and I tell that to patients all the time because they come in for second opinions and consult anyone who tells you they have a crystal ball as a liar but the more you know the antidote to that fear is more knowledge and so that's what it's always been for me 

Howard: Ryan and I actually know a girl that has a crystal and believes it so um so to the kids out there conflict is like let's say I say I was a Chuck Cohen and I was and Rick Cohen the Benko brothers and say I asked them on the show say no what's your favorite laser well they don't want to say anything cuz they might carry five lasers and be friends with all five of them and wined and dined with them all yeah sure but prosthodontist have a lot of channel conflict because i know some process on us who tell me they've always wanted to get into implants but they'd lose all the referrals from the periodontist the oral surgeon and  I was wondering I'm your modern-day prosthodontist oh so when I get out of school the pediatric dentist got all their referrals from general dentist and so they only got the kid who had sort of been scared he's older he's great and it worked out terribly bad and the smart one said I don't want to wait till they're five or six and get the bad one today they transferred from the general dentist to the pediatrician and start putting all their focus on the pediatrician to get this kid for his first appointment and they  don't even want to market to general dentists there's not a pediatrician in Phoenix Arizona that wants to be a you're a list for your screaming seven year olds is not compliant he's already been ruined and scared so so um um prosthodontist they're very confused or like I want to place implants but I don't want to because I don't want to lose my referrals or Pro stone is getting most of referrals from periodontist oral surgeons general dentists are b2c public patients 

Dr. Paul Springs:well I'm sure you've never asked a question that complex to a prosthodontist and not gotten the same answer it depends it's all a matter of practice set up you know and referral patterns within your area I love placing implants that's my favorite part of dentistry planning placing restoring implants start to finish that's what I love that you know if my schedule was all that every day you truly loved it they don't tell me to have an online C course from you for an hour planning to say well we have a title to title called planning placing and restoring implants tour you actually have a better title that you sent me that I just loved it I always say we do three things perio kareo and occlusion doesn't rhyme and you emailed me my favorite listener says how about karaoke REO and lateral Puteri oh yeah it doesn't roll off the tongue with it I do you think it's just me Carrie Oh Perry oh and material yeah I don't even say the P I don't speak Greek even though I'm in the specialty that knows the piece I don't say pterodactyl I don't know although this could go on the long conversation I was a linguistics major so this were you really Wow so I understand so do I have to credit you every time I say I carry Oh Perry oh and lateraled Puteri oh I just said how about Carrie Oh Perry Oh Ontario then again that's gonna confuse people oh it's gotta be I yeah I don't know but that was that was genius

Howard:  so but what was the title you were going for um oh well you said the one that came up organically planning placing and restoring dental implants start to finish um it's kind of restoring dental implants start to finish you you should do that and I am thinking interesting where when because I lived through the implant things so when brand mark first came over here he would only let your oral surgeons and then history pizza Southland Invisalign came out they would only talk to orthodontist you know were always the little guy you know that has to sue her way to the dinner table not only the patient can do clear liners that the patient got to do it before the Gerald that was good and when but the greatest implantology is that I ever met was the Karl Mesh and he started out as a prosthodontist and the only reason he got except he got ancient implants is because he was so frustrated that people were having these implant hater bar snap and blame it on the implant manufacturer and he's looking at this non-working bite and he said he got into implants because that all the people that were in implants did not know how to take a bite and did not know removable and then the biggest lab in dentistry were 50% of all the dentists will send some once a year Jim Gladwell sure and 7% sent him everything they eventually did not chose not to go in to implants because it was being taught to the oral surgeons and their oral surgeons were teaching it and he was getting cases and from the instructors and these implants going five giveaways and Jim said oh my god this is insane so he just redlined it and it wouldn't be until periodontist and general dentists got in that actually started making you know signing this from the crown down they Glide will actually got back into the deal so um so I want to come back to well I will just stay there for a second um I always wonder though when it comes to carry Oh Perry Ontario um it seems like you can really transfer knowledge fast and easy back carries and Perry oh but it seems like the transfer of knowledge of occlusion is it doesn't seem to flow like Carrio imperio way is pitarrio I think all of them you can easily go you know to the surface and you know a fairly superficial level but you know you can understand it doing something about it is different right modifying patients behavior is pretty much what the first to come down to the third one maybe also I mean when it comes to occlusion no one disputes no matter what camp you're in there's a genius quote I want to say it was LD panky all that occlusion is is simultaneous contacts of all the teeth heavier in the back than in the front and the front teeth separate the back teeth that's it you know superficially that's true or as

Dr. Paul Springs: I say when I like I want to piss off my occlusion instructor occlusion it's easy dots in the back lines in the front that's all you got to know but the fact is you know to actually to look at a given situation and say why did this person get how they are how can we put them in a position where they'll hopefully destroy themselves a little more slowly that's that's a long conversation for middle many bottles of tequila but you know when it comes to the idea of actually modifying patient behavior I don't know anybody that can do it you know you see people to stand up on the podium and say oh after I build their bite they never grind their teeth down again really so you're just better than God that's what it is you know enough ego and it will work for me and my hands it doesn't work you know I'm involved in a cool pilot study right now we're a couple of the world's surgeons at Monte they published something was in Jeddah a few years ago as a protocol for Botox and Massa doors and the temporalis again not Greek I don't know to pluralize temporalis but what they're there looking at now is the change in bite force after that and I think something like that even if it's as a means of biofeedback to help people understand that really the pressure they're putting on their teeth is way too much I will often tell talk to patients and say when they have clear signs of bruxism I'll speak to them and say you know how much time do you think the average person spends with their teeth together and they start thinking about it and you see their masters flexing as they're thinking about it and they'll say I don't know half the day I'll say actually the normal person spends 1% of the day and night together with their teeth in contact and you see these looks on their face now am I vain enough to believe it's gonna change their behavior no but I think just like you know we've all had that patient who they felt the difference once you scaled off the Tartar and they said oh now I understand and you know kind of turned their behavior around I do have patients who now say you know everyone's had the experience of someone who says no I don't grind my teeth no and you kind of say well somebody is if it's not you at somebody and then they come back a month or two later and they say you know I realize I am squeezing my teeth together I think I think that awareness and feedback is the first thing that necessary to change people's habits 

Howard: you know um tech scan is a company that started out in dental and MIT and now they got a hundred engineers and they're pressure mapping and all that stuff and that's East Coast and then on the west coast you got a align technology with zones I Tarot and in an InDesign and now they have millions of scans and it's kind of like going forward it's like someday those two people will have to get married won't they I mean I mean back to Carrie Oh Perry Oh lateral to guerre you know Carrie's I take x-ray I can see interproximal Japanese I mean I cannot mine of all have comb cuts but I mean theoretically you could see fairies um you can see bone loss or peri oh but you can't really see occlusion on a radiograph which I'm now hearing by a bunch of people who signed NDA's against say anything that basically line technology thinks they're gonna get some occlusion measurements but if but those people would say man it'd be nice if they also have the tech scan stuff you know but when you go into occlusion the olds who guys like  pinky daus and things like that they were never big tech scan people that was the neuromuscular people I'm you're a prosthodontist you guys take that occlusion more serious than a silent P do you um were you did you ever what are your thoughts on tech scan

Dr. Paul Springs: I wish I knew more about it there was a recent article from the journal prosthodontics that looked at it and they  did find some some clinical value to it for sure I think to me it comes down to again it's a I think a very useful product but you can sell ten thousand of anything to dentists if you promise it's gonna make their job easier and do it for them right that's true of anybody but dentists especially 

Howard: 1,000 the $50,000 YAG laser is a class example they came out as $50,000 sold 1000 then went bankrupt and I've seen so many times a big machine 50 thought you think $50,000 and the same skills that got you to learn the difference between a cosine and a tangent would kick in and you would solve that equation and I'll buy it

Dr. Paul Springs: but yeah you can sell a thousand of anything to a dentist different kind of cosign and that you know yeah is it valuable absolutely do I know enough about it to say yes or no whether I think it's worth the I don't even know what they charge for it but I think taking your time and you know sometimes the oldest ways are the best and it's simple a little bite wax a little articulation paper you can really see what you need to see granted it doesn't give you the timing and that's true if you wanted to you know plan some amazing precision discs elusion it was progressing off of canines and premolars and off into the sunset then maybe that's useful I haven't seen the need for it you know when people have healthy natural canines I rarely see a reason to put them in anything other than canine disclosure personally that's in my limited experience 

Howard: well let's not get personal we're not even drinking so if we said dentistry three diseases what letter grade would you give the current 2020 America 211,000 license dentistry 331 million people what overall letter grade would you give for the treatment of caries versus pareo versus occlusion 

Dr. Paul Springs:well again I think for a given instance of a given Carius process we have the prescription all right you cut it out you fill it up we can do that changing the behavior that's a different question honestly is AG behavior being perio well even even care is right even the diet I mean again there are some people that they just need the information and it's sad to me how many people have how many patients have treated who really did turn it around cuz no one ever told them when you drink sugar you're bathing your teeth and sugar it's in a place you can't reach it you gotta floss you gotta solve these problems you know I tried to distill things down for patients and say all of your problems are solved by floss you know I was the kid who I never had a single cavity my mom's a dietician till I was 19 I've been hanging out with a kid who always had mr. Pibb in the fridge and for three years I was drinking it all day at eleven in approximately jhin's next year you know so it happens and sometimes heavy work is that mr. Pibb you should thank dr. pepper obvious the doctor would have done that what was the mr. an unlicensed dental therapist

Howard:  mr. Pibb is the unlicensed dental therapist dr. peppers the real one eleven interprets interesting history because all those old soda brands all started off as patent medicines right dr. pepper was I think was a based on VIN Mariani this Italian fortified wine with cocaine drink so there you go and the graham cracker was for acid reflux and Justin things and I swear to God if you drink too much if you eat some graham crackers really dr. Graf whether you believe it works or not right back to later great so caries you got a hold you draw them out you fell on let's say it's an a pareo Ian Carey oh you give it a

Dr. Paul Springs: yeah I would give it an A as far as the practitioner solving the problem today right we can do that today again changing the behavior altering the biofilm that's a complex topic that you know there are a lot of experts that have no idea on that as far as pareo I think we get even deeper into the weeds are talking about you know anaerobic pathogens that are not ever seeing the light of day unfortunately a lot of these situations and patient predispositions we just can't modify you know that's  tough and I don't think it's so much a failing of dentistry even though there are a lot of practitioners that find it more convenient to just do the bloody prophy and not really talk about it I think that's partly due to you know influence of the third-party payer system and that sort of thing but I think we can do as far as treating it we can do a pretty good job the average dentist at least knows how to do it even if they don't always I was amazed though there's a study that showed they gave hygienists unlimited time to scale one tooth the pocket on one tooth unlimited time until they were sure that root surface was totally clean there wasn't a single tooth where there was nothing beyond four millimeters so four millimeters is pretty much the mark of how far you can scale without a flap or maybe laser or some other adjunct not knowledgeable enough to know about but so you know not everyone is referring those pockets that can't possibly be cleaned that are you know that are recalcitrant to treatment so 

Howard: I would still give that up probably be do you like that little there's a company in Scott so it makes a little flashlight internal camera that goes sub G for the scaling Oh like periscope yeah that's right here and so I didn't know that I have no experience with it where else would you start a pareo company then Scottsdale I mean it's a city of bleeding gums yeah that's what mostly yeah

Dr. Paul Springs: but again you know we know how to solve it and that's more of a question of patient compliance than anything I would say because how many people have this  

Howard: oh yeah the periodontist flap this side and cleaned it out and it was the worst experience of my life I'm supposed to do this study do it always um I went to UMKC and dr. Charles Cobb was an amazing period ah still is and very outspoken on dental lasers so outspoken he won't even come on this show and talk about because every time he writes an article dental lasers she gets so much flak and emails and he just doesn't even want to deal with it but he solely show us a study of where people got their root playing curettage on the right side and didn't get it done on the left side mhm and didn't change your behavior and three years later there was no change in anything and then he showed us a study the most mind-blowing to two studies he showed me in dental school one totally depressed me one was a study of forty identical twins raised apart since birth and the mean average age getting him back was like 40 or 50 and have like something like I forgot how many it was like have 10 dental parameters nine of them were the same well and I oh my god because you thought getting water fluoridation in the city was a good thing or this or teaching how to brush or floss and that one just said genetics it's all about it you know and then the other one was people told they needed a quadruple bypass and didn't get the surgery but change their behavior quit smoke and drink and exercise and all that stuff versus the ones that got the $300,000 no skin in the game socialized medicine a gift from Bernie didn't change any of their behavior and it did an impact and and the group that didn't get the bypass lived three and a half years longer the ones who change their behavior and didn't get the bypass lived three and a half years longer than the ones who've got the hundred thousand dollars of other people's money confiscated by the IRS or you'll go to jail no skin in the game and it didn't haven't they didn't live longer 

Dr. Paul Springs:  well one of the favorite things to say is that prosthodontics is the specialty of patient management and you know whether it's the way you teach people or the way you sometimes have to confront them that's one thing that I will often confront patients with I will say the stuff we do two days a year means very little it's all about what you do at home every single day and then I just like to be silent and stare at them and wait for them to you know have some glimmer of recognition and sometimes it happens sometimes it doesn't but I think you said it right there I think if I think we that's true of most things we have pretty much of genetic pre-programmed you know path of least resistance that we all go down given not much change but if people and you know whether that's the individual genome the microbiome the transcriptome yada yada yada we can argue about that for four days but I do think that if a person is willing to modify their behavior it can make a difference now the degree to which for example occlusal disease or you know clenching and bruxing is modifiable I haven't seen any good Studies on that 

Howard: and it's not just the gut microbiome but turns out there's a trade-off to our sewage because if you would have gone back to the CDC for 50 years saying well what would extended life expectancy the most they always said clean water sewage in vaccinations accounts for almost all that and now it looks like we're seeing the trade-off of sewage because they're saying the fermentation that when you most animals and humans for the first 50,000 years you're eating and pooping in the same place so that's how you got the bigger fruit so you go out naturally select and you pick the largest berries and you'd eat them but then you prove in the same place the seeds that come through so you are always selective the largest seeds they were growing so that's what we know accounts for why a a Neera corn is a thousand times bigger than naturally our corn tomatoes berries all I said but it turns out there was something more when you were pooping there you're the diseases though you know you the cold the mutates it it's always changing it's a mutating it's a you know a generation every 20 minutes whereas humans every 20 years it's in that deal it's in your food supply the coevolution it's a cool evolution so your gut microbiome is fermenting outside of you and still evolving with the changing deal that you're getting back in your food supply it was a continuous circle but now that that poop is like in our house it just goes down to the basement and Dorian's room right and just just like a shower and uh but um so even worse than I'd imagined as well so so it seems like now that turned out there's a bad side of sewage mmm so there's a lot of variables there but my question is I'm always um I just think it'd just be horrible to be out on the dating scene kissing you know like you you they know because of STDs they would you know wear something a protective thing I think they named a dental insurance company after it a Trojan I'll never run yeah what was your next best idea for that dental company but um well it's like when you tell your patient they need a prophylaxis right where does their mind but what do you do you think Carrie Oh Perry oh do you think there's anything about trade and speed do you think lovers are sharing this disease I think it would be foolish to say no you know it's easy for us you know the whole scientific method for us to reduce variables as much as possible try to try to spotlight one thing and modify it and see what we can get from it and it's very easy to have the same sort of reductionist thinking when you're looking at natural selection for example like the situation you're talking about people marvel at corn and say how do we get this from this weird grass right people forget the the locus of selection where those genes are flowing it's not the individual it's not even the species it's the community it's the you know the predator it's the prey it's the foodstuffs it's everything it's the climate and 

Dr. Paul Springs:I think this the same logic can extend to a lot of things I think our biggest downfall as a society is we get hyper focused on the small things and we can't we generalize the small things to things that aren't appropriate but then we don't try to look at the whole and I think just like you talked about combining this the the datasets of tech scan with Invisalign I think that's that's as close as I get to being a tech future or optimist is saying as these big datasets come together and artificial intelligence can look at it in a way we can't what are we going to learn from it you know I would say it's very similar to you know economists talk about the tragedy of the Commons right everyone has access to a given common resource and so everyone wants to use it and eventually it gets used up and destroyed I think we kind of see the same thing with enamel you know enamel is a limitless resource it keeps coming back and so no one values it just like we don't value air even though it's the most important thing for us we value gold a lot more because just because of rarity and scarcity you know they're finding asteroids out there that have enough gold that are that it's millions of times the value of the world economy and the quintillions you bring that thing down and suddenly there goes our whole basis for value and so many things you know well they captured that they could probably pay off everyone's alimony 

Howard: and that's back to carry oh I think another problem with transferring knowledge of Carrio pareo versus occlusion is that severely worn dentition where we've all seen it a hundred times and you say to Frank did you have a hard time chewing it's like dude I can I could eat a cow I ate myself yeah so so how so it's very confusing when over this case the instructor saying well this guy's his right leg doesn't work and he has erectile dysfunction and depression because he has an interference on this bicuspid over here and I I adjusted the dot in the line and now his right leg works and then your dog likes him again his wife came back knobs and he's eaten a double bacon cheeseburger no problems 

Dr. Paul Springs:and again what's the solution hack some more away right just grind it down more and that's one of the things that upsets me most about modern dentistry is we have excellent adhesive materials we can do miraculous things but for whatever reason the these additive solutions that don't involve grinding down the whole tooth to nothing in order to restore it seemed to come from countries with more socialized medicine they come out of the University of Geneva Hamburg you know for whatever reason our model of service dentistry which I would call piece work basically you know it influences us to do the most predictable simplest thing most predictable today and again I think that's the problem with most of our society is the focus on the right now you look at the difference between someone who's on the street living for heroin and someone who's planning generations and centuries ahead for their heirs the main difference is how what's their timeframe of outlook you know if everyone's focused on the quarterly earnings where does that get us but when I look at that

Howard:  I see a lot of physicians and dentists beating themselves up about the current state of the health care deal but there are 1 million physicians and there are 1 million attorneys and I beg to differ that it is the 1 million attorneys who all the congressmen sent in to Supreme Court you go back to the 1776 it's all more there's not dentists and prosthodontist and physicians in that so they got the whole government in the right hand and then they use that to shake down business and have created the mess they're in and so to me it's just comical that you're gonna vote for some lawyer in Washington to fix all the problems it's like they've been breaking your legs for 250 years and now you go umm if I give you more money will you stop breaking my legs leg is like there I've met the enemy and it's all the regulation and they  focus on all the taxes and all the things like that but just thinking about health care how much health care would be less broken without all this stuff you talk about use of backlight in minimally invasive dentistry we met oh this is

Dr. Paul Springs: this is something that I enjoy a lot you know I actually the idea came to me because I was listening to a podcast where they're talking about these Chinese tests that they that were from 6,000 years ago that other texts had referenced but they didn't have any actual copies of it except for one or two that were all faded and so they looked at it under different wavelengths and they found that one of the one of the pigments they's used had a particular type of copper in it that would fluoresce under a given type of light and I said in dentistry everything everything aesthetic is transparent and it's all the same color so you know how many times have we cemented something the patient complains of sensitivity and you take a scaler to it oh my god there was a big fan of composite along the you know composite resin along with the margin of that night how did I miss it you know so I started thinking to myself maybe there are other wavelengths that we could see these things under so I started playing around with it doing a benchtop thing and yeah she backlight off of you know Amazon for 10 bucks you can see a lot of differences in I didn't know somebody you were doing the the bench laptop thing yeah so you know I and so I started thinking resins and then you know there's a lot of hand waving and lots of articles and ink spilled over how do you find a screw access for example in a cement retained implant crown so I did a little research and you know most of the different porcelain manufacturers will make a high fluorescence glaze so you can just put a little dot of a high fluorescence something-or-other or if you prefer to have if you have a you know a patient who's a bartender and has to have a good smile under black light then maybe just leave a little dot of it off of wherever the screw is and this way if you ever have to access the screw you know right where to drill so things like that thing like I said cleaning up resin cement trying to again if someone has to have fluoresce of fluorescent smile because they're always under black light you can look at the different manufacturers they all have they all publish different fluorescence values and you can kind of figure out how to make it make it match for the patient so there are lots of cool applications for it another thing that I love is again I'm very very into adhesive dentistry not cutting away any more enamel than they have to make something work if you but sometimes you have very thin enamel on a surface and you can't quite tell them I dentin in my own enamel maybe until you have already put phosphoric acid on it maybe not even then but if you hit it with a black light you can see that enamel and dentin they fluoresce differently and so you can know exactly where the margin of your enamel is and you know you can have a little sell one for dentistry for this well that's another NDA I need you okay no I mean it's I don't have any expectation of 

Howard; getting rich off of it again it's something you can get off Amazon for you should try to get rich because that girl you're dating you don't know how what the true cost of that is and Ryan did you set up a separate savings account for your little wife though yeah you know what I shouldn't have moved in New York the imp alimony or it's do they have it's the what's one where if you live together yeah do they have coming on your I'm not sure get up once I looked at a big time in Arizona I had a friend I don't want to say his name oh my gosh love him to death he's no longer with us anyway he lived in Georgia and he lectured all around the world is always gone and he one day Beth loved his life they decided they were gonna get married buy a house to verse 8 she got him for common law really I mean a gazillion dollars I mean it was it's such a criminal outrage well it's different in different states to hell over there you know and then bitterly common law and that's why I feel sorry for the I get so many questions and from other countries and that is the common error they think of the United States is like a country right and they don't realize that Medicare is federal law about health care and Medicaid is state law and there's 50 states and they're all different it's different on marriage and States and dentistry and like  where your license in New York what would what states can you practice in just New York know what other state can you practice in what's the only state that passed a law that if you're licensed intransitive for any state for any state Arizona that's why we are number one in DSOs 18.6% of Dennison Arizona work for a DSO whereas on the distribution five states aren't even at one percent and we're de team saying cuz the DSOs are expanding here because like they'll be in Florida and they need a process right but your New York and you're like yeah I don't want to jump to all these hoops for Dallas it's not worth and some states are better at keeping people out than others and they go oh hell good Arizona today well Miami's has a loose tooth so maybe I'll bring her to your office later on you can and I hope you do you set your mother there I did yes and thank you so much for that but yeah I think um well it's it's just again it is what I said earlier 1 million attorneys all these all these costs right that the Millennials don't understand that the only secret to lower prices is lower cost the only secret to lower taxes less regulation so when they see the high cost of health care they just think that 8 billion humans couldn't figure out what Adam Smith said in 1776 day that week we got all that wrong none of that mattered throw that out it's just fundamentally broken and we should get a lawyer especially a politician to help fix it and they just don't realize they're the ones that completely messed it all up from A to Z and I mean and but anyway enough of that oh I mean I don't I'm not sure

Dr. Paul Springs: I would take us back to you know 1800 before there was regulation on you know meat processing and real medications you know like I said dr. pepper being sold as a medication so you you you promote cope without cocaine

Howard:  I could be drinking coke with cocaine if it wasn't for people like you Ryan Ryan show this guy to the door you're my bouncer today but um yeah everything should be a nice equalent I believe that I believe I am so optimistic and so excited about life because I gotta quit repeating to everybody but you know Neil Armstrong landed on the moon in 69 with a computer weaker than this and that was the first time sapien ever landed on the moon and I believe that when Steve Jobs stuck the internet in the phone mm I was the first time sapiens arrived on earth and could see the same hand that the that the people in the top could see for 5000 years and I think instead of a six to one convergent I just measure might kill rates you know they kill six your own family kills one I mean families kill their own you know you catch your Ryan's gonna have to deal with this someday when he comes home as and his wife is with his three other brothers and you know so families kill one percent well you know the most common way of killing family members is killing the elderly in your family so just keep an eye on them yeah Ryan as soon as I don't recognize you I want you to push my wheelchair into the bullets hey Dad you need a bath hey if I don't know who you are I know what you spitting anytime taken me but I think I'm I think that this is this is again this was the birth of the individual 2007 and I have seen from 2007 to 2020 the glorious rise of the individual and I think it's gonna reach an equilibrium one to one but I only measure and kill then when it started it was these guys kill six for you killing one of your own and I think the equilibrium should be one-to-one so if they bring that you know you got three million people in prison a lot of them were smoking pot of course we've never had a president that smoked pot or and you know all this crazy madness stuff and what and I understand where it all came from because for five thousand years all the people were illiterate and couldn't read or write and now they've all got a supercomputer in their hand and I just have more faith in the individual so but institutions matter you know it all depends on who's right but when you make a rule when you say when you make a rule you as long as you realize that if this rule goes south you pull me over I didn't pay a parking ticket well you just kid the police from the right to kidnap me transport me to a cage and you're in New York it wasn't there a city in New York like a thousand people are in jail just because they couldn't pay like a $50 fine or a $50 fee so they'll end up sitting in a cage for weeks everyone's for 50 bucks in 

Dr. Paul Springs:some places those police have a right to kill you depending on the color of your skin so right yeah pretty ugly situation in fact I told you about that blacklight poster I originally wanted to title the poster black lights matter but I was afraid I'd have nine-year-old prosthodontist throwing articulator well you 

Howard: I love your post I love you I love your post I and you um you posted a couple times that multiple convictions of racially motivated violent hate crimes um is that the red yeah apologies to Tuhoe go I spammed spammed the page a little bit but but but I I think what I what I love is free speech and if we're gonna have it because I grew up in this Catholic school like um you know my dad passed away he was Howard D gene for Eenie me Howard Eugene Fran the second very confusing so everyone called my dad Jean and me a mistake and you know I'm still waiting for that sex talk for my dad and now I have five grandchildren I still haven't got this this talk general generational refresher and he could tell you the most horrific joke but if you set a sex joke I mean he'd like wreck the card and get out of my car it's like what you just said and now a sex joke is bad so um I  just I think I'm that all bad stuff comes from the heart and when little kids ask a question and I see her that my grandkids all the time where they'll ask a question and their mother will say don't  ask that it's like she's three she just had a question and her to her grandpa she should feel safe and why would her mother be putting downward pressures on a three can you imagine you just arrived on earth you're three and here's the guy that breaks all the rules gives you all the candy whatever the hell you want there's no kale in grandpa's house and and then a mother says you can't ask grandpa that question that that's lastly I love I love it when people talk about the controversial stuff because everybody talks about the things we don't need to talk about but but I'm gonna go back I want to hold your feet to the fire on that adhesive dentistry because you say the state of education surrounding adhesive dentistry and why we teach our students do the wrong things every time what do you mean by that that's a strong statement 

Dr. Paul Springs:well granted you know some people some of your viewers might consider me old now because almost 10 years ago seven years ago well that's your that's that's your 10 what was that book David and Goliath wasn't blank yeah I'm glad well 10,000 are anyway so so yeah so you know I was trained to cut GD black preps you know whether they were needed or not I was basically taught that that anything other than amalgam in the posterior was heresy at best and malpractice you know at worst but you know not to mention when I you know I like most people my age I have some group texts with people who were friends from dental school and I you know if I just get on there and vents about people cutting down these teeth completely for full coverage crowns when it's totally unnecessary you know we have adhesive resins now you know they say oh well we didn't learn about and about it in dental school so is it predictable is it something I can do when patients not going to come back and break it basically it comes down to temporization you know it's more convenient to have a temporary that has mechanical retention so that's what everybody does and again the value of being able to have a conversation with your patient and explain to them this there's a chance something might come loose on in the temporary phase but we can fix that you know you give us a call we'll let you know when you can pop right in and pop right out and we'll get it taken care of but in exchange you spend the next 80 years of your life because most people my age are slated to live a hundred years you're gonna spend the next 80 years of your life holding on to that half of the tooth structure that otherwise we'd cut away there's studies in the pm days where they show 70 percent of the tooth gone for a crown is that really what we want to routinely do or for that to be our model well then I talk to people who have been doing it their whole career and of course the problem is cognitive dissonance or I'm sorry confirmation bias right they can't they can't consider the possibility that they've been doing this their whole career and they're harming people so they say well it's more predictable if it breaks then we'll do an endo and a post if it breaks and we'll take it we'll put in an implant cure there titanium deficiency you know unfortunately there are better ways but people aren't learning it I hope to god that people are learning in dental school now you know you look at people like  David Clark who has done a lot of work to revamp how people are doing preparations for direct adhesive dentistry and it just makes sense but people get stuck in this and they don't want to consider anything else so they tar it with the brush of unpredictable or whatever the case may be 

Howard: and then the insurance there's a lot of that word they won't pay for an onlay or any I have seven gold restoration or mouth all with zinc phosphate cement and I am i delta wouldn't have approved for any of those because are the armed laser inlays

Dr. Paul Springs:because one thing that's very valuable that someone taught me that made a huge difference for me is if it touches every surface of the tooth by the ad a definition there's a crown so if I do a tabletop occlusive veneer but I'm over the line angle on every side that meets the 88 definition but look at look at Delta Dental of Arizona and if you want to after this podcast we can all get in a car and I'd love to drive you over there and show you their parking lot it's all sixty thousand dollar cars and say

Howard:  okay well the meeting average car new car we're talking a new card forget the fact that seventy percent of car sold the United States are used cars and 70 percent of houses sold are used houses only one of three homes sold is new or Simek cars at the top of the market might be 12 to 19 million cars a year but it's still the old car but we'll just say that everybody just only got new cars you can't apply that $30,000 car and benefit and then pay thirty thousand more for a nicer car so like if it's a gold crown with gold prices fluctuating they're all gone to zirconium but if I said well you can upgrade that town of gold but you're gonna have to give me a hundred dollar co-payment or something like that Delta will shut that down they're always shutting down at the top right and it doesn't matter if it's Delta the police department the Department of Justice it doesn't matter who it is at the top the number one thing they always want to do is not be transparent and take away your choice and so if you just say well we're gonna find out what you're doing we now have a super key barrier my name is Neil Howard the Duck Armstrong and I'm standing on earth now when I can see your hand so the transparency is gonna what's gonna cut their legs out but the next thing is why it's so parochial to sit there and think that well I don't know what's best for me I can't make this decision back  to that regulation thing which I understand where it all comes from but I mean it's 2020 if they if coca-cola sell you Center says this is one gram of cocaine my first thought would be do they have like the extra coke that has like 10 grams of cocaine America invented crack and you might be thinking I want coke light I want coke with now any cocaine it was Malcolm Gladwell's the book was outliers so you have and there's been a lot of research on this and of course the press only picks up the one time he was wrong and it was with learning how to play the violin and so now I don't even like that instrument more Malcolm but so you've done your 10,000 hours so you're at the the the the peak the prime you also talk about something I'm online education the incredible potential and terrible downfalls I just want to say that um for dental town online see that we started dentaltown in 98 and every and they this was home of Phoenix online University of Phoenix right online and my god when I saw that I just thought to myself hell I don't want to go I don't want to I was always flying around because when I came here there was no dental schools so I I'm I'm not just proud that I got my fadd Miami GI I'm glad I got my MA GD my only bragging rights is I got a done before Arizona had a dental school because you know how much that actually probably cost me I mean days missed from my work oh my the the way from the officers at $10,000 they hit and then you're flying all I mean to get my fellowship of the mission suit I'd apply to Pittsburgh seven times for three days and but what made it all worth it is I'm Kiss played there one night so I think I got eyes in this course with the same guy is 7 three-day weekends I think is on weekend fifth or something kisses playing in those and I went down there at the lunch break and got scalping tickets and we went back to that was so damn fun to see them singing that but anyway um but what would what is your what the incredible potential and terrible downfalls about online education well can you work them all into the course that you're gonna make some day I wanted to call back can we name your course the incredible terrible downfalls of online C click here for more myself 

Dr. Paul Springs:I've always said the best lectures I've ever seen have been the failure lectures and no one has the guts to do more may be known as the forethought to document their failures a

Howard: :my favorite business book guy in the world was I'm you know Jim Collins hero built to last he wrote good to great he wrote but this best was the only one that was out how the mighty fall right and it was the shortest book because how they how they do great things is an entropy ax him Cambrian explosion about possibilities when methought how they variations how they how you fall and die is pretty succinct but that that was a good one and the best one I always forget his name he was a process that spends last years at Green Laboratory in Arkansas and I think the answer to your question is um he only did it because he was a highest self-esteem implantology in the world well you said prosthodontist yeah he would just sit there and say look I'm not gonna III know I don't have low self-esteem I'm not gonna come up here and carry the same five great cases all around the world for twenty thirty years like these other people because I'm gonna show you the worst mistakes I ever made and every one of those mistakes you just said they're done I'm never doing that again right yeah I think so you should you should follow in his footsteps and just totally photo document every failure and have the balls to go up there and say here's my mistake no I'll blame him on the dentist before me well and the dentist no it's not what it was the last fault anyway what is wrong with these labs well no they can't margin to a blow what were you gonna say about online education 

Dr. Paul Springs:so you know I hope I don't sound negative on online education because I'm the biggest believer in it of anybody but I think the problem is more cultural than anything I think we can get such a good picture of something and we can get such a good explanation of it narration of it unfortunately too often it's from someone who really is giving you the tip of the iceberg and wants to sell you the ice cubes and then you know what you miss is all the mistakes that are going to give you heartache for the rest you know next ten years of your life so I think it's partly that and it's partly the kind of postmates suffocation of our culture that knowing what postmates so it's the app where you know you have food delivered to you right you know that's called postmates that one flew over my head so postmates is a New York app that delivers food must be I don't know where it's based I'm sure because it's the home of not wanting to talk to anyone else I have that I have said just here to acknowledging people when I make eye contact weird but you know people don't want to go out they don't want to meet someone they don't want to learn hands-on and so often you know obviously what we do is all about the hands-on again the cerebral stuff is important because you have to understand risk factors modify them and know what to expect but you gotta know how to do it at the end of the day and unfortunately I think when I say online education I'm not talking about like dental town I'm talking about more like Facebook you know when you have these you have people again posting cherry-picked cases someone who's been one whole day on a single crown and they're they're showing you how to supposedly build a better mousetrap well it may have an application but if they're selling it to make their name on it then what the message they're going to put out wittingly or unwittingly is this is the best way and it's the one that works in every situation and it's the only thing that works but unfortunately people that don't have the experience to have been burnt by that a few times are gonna do it and they're gonna going to harm the patients you know when you compare that to you know what you guys have done a dental town where you have comprehensive curricula from people who know and are interested to teach you the whole thing because again they have the self esteem honestly they don't need the money or to build their lecture and career it makes a huge difference so it's just like anything else just a matter of consider the source the first

Howard:  the first red flag on online CE is the comments have been disabled it's like gee and then the second thing I would say about it and they say I'm not I I really might my baby I can't stand people they go to graveyards and screams the dead people I mean you're you're here because of them so um almost all humans lived in the last 50,000 years they're starting to push that back and I noticed uh soso but Beasley it's been a hundred billion so a hundred billion ninety nine percent of all humans lived in the last fifty thousand years and and and you know what present they gave us our presence the greatest present you'll ever get is the awareness of your existence on earth and you got it from the hundred billion people that died before so I don't like to go back there and start yelling at them for everything they did wrong because we're not perfect either but the this seems like in the modern history of 5,000 years again the problem has been the top conspires down on the individual and they do it without transparency so back to the speaking the thing I know is when they submit photos to publication we have software and we say well that's been documented that's it's been altered you give us a real photo so that's  a huge problem but the other problem is lack of transparency that this guy just gave a whole lecture and you don't know that he works for this company and then you go and then people say they don't realize that should that you go to this meeting you just come back from the Chicago dinner one hour I wish you do and of course on when those people go rent all those booths they'll say okay I run all those booths where I get four speakers right and so they don't really because if you look at those deals look at the biggest names and speaking and then why are the names that are they never post on downtown they don't have online see you never you never hear these guys right but they're at every flippin meeting all the time I just think they should have to wear the NASCAR suit and just stand up there and say hey you see you and and I have no problem with that because I know the owners of most these companies and most of these people it's a huge misunderstanding to think that like the owner of alternate dan Fisher is just some schmuck trying to sell you a bunch of crap that he doesn't believe it I mean I mean it's his personal identity its entire life I've ran into that guy I've ran into that guy in a dozen different countries and and Decemeber yet he was the first guy that showed me Perry at home and we were in Cologne Germany as like 20 years ago the guy was so excited I had a hard time listening to his explanation because I was just thinking okay you're too excited about it you're holding a period tone this isn't some lost artifact from it from anything from a temple and uh you know I mean you just knew that if you took away his dental degree and his dental company and gave him that asteroid fill with gold he'd be he died sad right I mean you just took away so life well that's totally cool but just be honest just say I work for Dan and I'm speaking for Dan Fisher and just just be honest but when they can't be honest there's usually you know it is just a huge red flag Oh so who want to believe that people are doing things for the right reasons and the majority of the time they are but we're not good at spotting fakers and we're not good at spotting Liars unfortunately and when I got to 300,000 followers on Facebook I quit I'm no longer and there I have nothing to do with it and it's for two reasons number one that when you post only six percent of your people see it because they're just shoving you ad so you think that you have a hundred people following you and they all saw this I have three hundred thousand on Facebook and indeed they don't see it but what I don't like about those types of social media platforms is that if I say you can fix all gum disease with green tea because you know you can and then if I disagree you unfriend me so so that's that balkanization where you know you're sorry and that's why they hate dental town which continues to grow all the way through we were four years before Facebook and I have added a thousand new users every month since Facebook sergeant she doesn't four and the reason it's actually the momentum is coming back is because these people in the bubble they've never they don't really suppose and you can see it also I used to call it the Saddam Hussein syndrome the Saddam Hussein's name you going to a dental office every say yes doctor yes doctor and they just they just agree with whatever the doctor says and that is a dysfunctional deal for the owner/operator for everyone because yeah because you think these people have been by your side for 10 years or helping you but they're afraid of you and they hate you and they hate you and they're telling you what they think you want to hear because you know what Saddam Hussein if they said it well well we've a Kuwait I mean you're the general can we keep out America or what are you gonna say oh hell yeah because if you said actually it'll think about a hundred hours and we'll be decimated he would have shot you Stalin actually died in severe pain for last week because he was moaning but every doctor they came in and couldn't do anything he killed Wow so what that turned out to be is the last week he was just all moaning and crying and everybody cleared out of the house and just like let him go down because are you gonna risk your life for  Stalin so um another thing you say and by the way you are so cerebral the perverse incentives created by our current payer models and the tragedy of the Commons that they create and that was what you were saying with the insurance absolutely Delta all wants to upgrade to the nicer car but when they give you a hundred dollars towards the filling you're not allowed to upgrade it to a gold inlay a gold onlay or anything because the good people of Delta think that you're an illiterate person that can't read or write and doesn't have a smartphone and they need to make that decision for you well and so 

Dr. Paul Springs:they make the decision for you so it forces the dentist into an uncomfortable situation whether they have to make the decision for the patient the patient never understood their options which is technically malpractice right so then when anything goes wrong the dentist is on the hook both personally because we all take the stuff personally but also professionally and financially it's again it's just as you said it's another case of of the top trying to dictate to the bottom and unfortunately having the money to do it and I don't know what the solution is but you know one of your heroes Marko Bucher would you Chitra I'm not sure how it's no one can say his name I don't think he can say his own name how do we save Marco 

Howard: I need to get that guy what is it rain well actually actually you know who is your mother Ryan not only does she speak fluent French but I could never believe that any time we went to another country before before we left she could get by on the street in that language I mean just see I can't I'm typing in on dentistry uncensored and I can't even find oh I'll go with Marco you know 

Dr. Paul Springs:he and the ABA ABA was a Health Policy Center they had a great article a few years ago that I was shocked at how little attention it got but it was basically saying we have to do something to change these reimbursement methods and you know I don't know I think it's john cleese we used to say that there should be a an enamel preservation fee that we should be charged or that we should receive I think that makes a heck of a lot of sense because as it is we're predisposed to do what we do and what we do nine times out of 10 is destroying something you know unfortunately and in 

Howard: that amazing I've typed in a DEA economist don't find them okay there it is I sorry Marco if anybody says bu j i see i see i think he's born and raised in them that that's the smartest guy in dentistry that's the smartest economist um he was I'm from Toronto he was at the World Health the United Nations when the ABA got him my first thought was how the hell did you get that guy and they did they got him and what I loved that and because you know a real economist the real ones they don't have a dog in the game I mean they're just there to tell you actually what you just said was completely right or completely wrong based on here's all this data I mean you become an economist when you don't have enough personality you become an accountant and my god and he's actually is pretty cool I mean you talk to that guy you think well that's a normal guy I'd like to have a beer with but you know if you did he wouldn't be he would just be this like incredibly boring guy probably drink iced tea the whole time but a much as sack smartest guy in dentistry loved his deals and some of it are I still want to hear more well I'll come back to that bigger check but yeah that they created that the incentives are just because Delta the insurance doesn't make sense because the only reason to start is because again the government so the whole deal about health care debate it all started none of those they say well you know 20 the 20 richest countries have socialized medicine well they didn't before world war ii this all happened after war ii and it all happened when Churchill said you know to rebuild this country it's not gonna help if everybody's illiterate and sick so let's build public schools and public hospitals come from the heart great deal but in America it was because during war - they put a wage limit on places so it was on the strongest union of the time and a member unions are to hope the working man get more money right yeah and the bottom half don't have any use where's the biggest Union oh the Pilots Association they make 200,000 it's always the richest the baseball players know what the most powerful is the baseball yes yes so the richest people who make so much money can afford to pay union dues so the whole Union deal says were for the working man the working man can afford a damn union it's only the richest professions and the American Dental Association is a trade union so is the AMA but you're right it's baseball and all that kind of stuff but anyway um so they put price wage out there so the the the Longshoremen's Club you couldn't ship anything or out of this country and the reason America had the biggest post-world war to gain the it was the largest economic transfer a wealth of all time in fact finding oil in the Middle East was only half that well transfer because everything was made in Germany in Europe and they were leveled how Japan had two nuclear bombs I mean it Japan and Tokyo didn't declare the reconstruction over from war to till nineteen eighty which was the yard in high school so from World War two to nineteen eighty if you want to buy a toaster refrigerator car we were the only shop in town the end out of the Longshoremen's club yet you had to ship it in or out there are no railroads going from here to China and so basically but I did see on Gilligan's Island where he made the  cement the cement shoes did you see that where he could actually walk on the bottom all the way to freedom but there's something  happened I forgot why but it didn't work out it was the professor and but anyway and yes the answer to that question is Marianne and they  have the old ones know what I'm talking about and uh but anyway um so they go to that deal and so the trade Shore Union said uh well you can't give us a pay raise so we're gonna shake you down for some because that's what unions do they use force and coercion against the individual owner just like the police department does against the individual guy who's sleeping in his car in front of my today's don't know what I've seen that a couple of times they go out there and I walk out is there a problem yeah this guy's sleeping his car okay well you know it's my freakin parking lot right and he's like well it's  a potent officer I own this land it's a human sleeping in his car you make $60,000 a year and get free why are you disturbing a sleeping man sleeping you don't have anything better to do that's our God to arrest and kidnap people you know and move them to a cage and all this so I got and but anyway so they said well we're gonna shake you down for a free dental right I'm like why didn't you shake me down for free housing why don't you get free but thing about that why cuz they don't want to live in a government dorm that's true so why don't you shake him down for a free car oh no it'd be government translation well it wiII be a city boss who then I guess we don't want you messing with our house well what free government food we'll have a cafeteria oh hell no I'm going to McDonald's need a bacon cheeseburger even though I have an insulin pump in my car you know that so they went after something they don't even understand like dental right well no I don't I don't want you messing my house my food my cars my clothes my shoes they wouldn't let socialize anything come over unless they had no idea what it was and what scares me about socialized medicine the most is I only know dentistry I don't know shit about nothing else and when I go to all the countries of these socialized deals and I look at their schemes in London and Paris and England there it's so wrong and it's only wrong because the government made it no one understands it the people lately look at health care only 1% of Americans spent the night in a hospital last year and most of them were for babies so the reason everybody loves their socialized medicine is because we it's a 99% chance you didn't use the last year well hell I you know I love eating kale you know why cuz I didn't eat any last year did I no if I did I would absolutely love it I just think it's never gonna happen so I think most things the truth is somewhere in the middle right

Dr. Paul Springs: what those programs do very well is prevention again like you I don't know anything but dentistry but I know that in Scotland where what they do very cheaply they have all children especially in low-income communities they force them to brush their teeth twice a day at school and it makes incredible differences in their cost of providing dentistry going forward if you know prevention is oftentimes a no-brainer it's the but at the same time it's the really hard work of sitting down and talking to people in helping them understand or of making new habits where bad habits were there before it takes a lot to force someone to change I never flossed a day in my life till I went to dental school and but I actually saw the results like you're saying people have good feelings about things they don't understand

Howard:  so this came out today what did you think of that scientists have created a special toothpaste I could reduce heart attacks and strokes I'll wait for the five year follow-up but until that

Dr. Paul Springs: I'll be cautiously optimistic I'm curious what they're saying but you know come on if here this is showing off of that finger thing it'll be the old school and you're just afraid of the mouse right you're afraid to touch it I was afraid I'd get bit let's see well you know unfortunately OC reactive proteins it looks like it's an anti-inflammatory it seems very interesting they're bound to be unintended consequences but I definitely prefer this to you know on three centuries the only approach we've had is kill all the bugs scorched earth everything must die and you know now we learn that if you use chlorhexidine it makes your blood pressure go up because you don't have you basically kill bacteria that creates what are the nitrates in your blood so something that actually goes after the inflammation which tends to be the real source of the problem that's very exciting I hope I hope it works out beyond the whatever level of tests they're on now

Howard: here I'm sorry if we're going overtime no I am in no hurry I told on vacation okay well I my goal is to ruin your vacation this next thing that you talk about a lot and a big fan of your post but the young have the hardest time managing patients the young the patient is a dog the dentist the tail and my god the four or five dumbest worst things I ever did I actually told the patient why I would never do that and then they talked me into doing it yeah and what was the editor Ryan of the AMA Tukey newspaper know the owner of the paper and I'm like dude I couldn't pull that wisdom too you put a gun to my head and he said well just you're gonna do it you'll be fine and sure enough took an hour and a half I was 24 but we got it done but they talked you into things so we would tell young kids about after your 10,000 outlier hours about patient management

Dr. Paul Springs: today's hero is tomorrow's asshole and that's always the case I was was not expecting yeah today's hero is tomorrow's asshole I can't remember who I stole that from someone smarter than me for sure but or you know the line I started using and you asked why procced the short answer is I never want to do a tilt distally tilted second molar end oh yeah but you know what I started telling people is I would love to help you I know you're in a lot of pain but if I do this root canal neither one of us is gonna sleep tonight and they usually appreciate what I'm trying to say you know every it's I don't care who it is like you mentioned in my bio I'm in a residency where our mentors they also see patients and so it's great because it's a small group and we all get to say listen this is how I screwed up today and this is what I would do better next time and my program director is one of the smartest people I've ever met and what he always says is every mistake you will make clinically is because your heart is in the right place and you're trying to do someone a favor so you try to rush it because they're leaving town or you know maybe they don't need to be they don't need more anesthesia because I'm worried about whatever now they're in pain and you can't do what you need to do and you have an outcome that's permanent if you wanted it to be you know a short-term issue it's always your heart is in the right place and you're trying to do the right thing for them by their unintended consequences every time and as much as I hate to admit it that's why you got to make these things and

Howard:  I made a big mistake that last week I had a patient come in and she wanted she her gums are receding and she said I wanted to stop so I put a tourniquet around her neck and I know they won't recede anymore but now they're like well now she's dead and I might she want her gum recession to stop I'd stopped it 100% cure but going back to the perverse incentive you you talked about the current pay models the insurance companies things like that but what about the perverse incentives the dental student trying to pay back a hundred thousand dollars a year student loans to a dental school that should have one eye on the student and one eye on cost and instead they have one eye on the student and one eye on a brand new dental office with pay raises for everyone and  I noticed the faculty you know there anytime you try to talk to the faculty these Dallas Coast oh he's in Italy at a TMJ conference oh no he's in France at a gum disease I was like you know we got a course on dental town for eighteen bucks on that gum disease are you sure you need to fly to France really but they  seem to live the high life just like the nonprofit people at Delta you know how lucky you are to be the head of a nonprofit named Delta Dental I mean you are a rock star we're a nonprofit named New York University so you got all these nonprofits that are ran by like the Rolling Stones and Pink Floyd and the kiss I mean they're just you know they just live a life of whatever but do you but in your heart and your your I'm closer to are you a millennial or you a millennial what percent of Millennials who graduated four hundred thousand dollars in student loans might have a perverse incentive to do a crown instead of an mo D composite 

Dr. Paul Springs:every single one and you know some days they're gonna win the fight sometimes some days they're not and you know it depends on their  circumstances it depends on what kind of office they're in it depends on who they're their mentors or it depends on how much experience they've had to see how things are gonna go wrong before they do but it's  a sad fact if you have to make that not every year or every month then you're gonna do what you have to do I consider myself extremely lucky that you know I had in-state tuition when I to a state school and what what no where were we born race I was actually was born in Denver grew up in Kansas City area 

Howard: so where it was the Chiefs winning the Super Bowl the greatest thing that ever happened in your life surpassed honestly I don't have time for support I'll never forget when the Broncos hired when the Colts let go and I ran into one of my best friends whose art speak surgeon and his neck x-rays were going around the internet talk about a HIPAA violation so you can actually see and my orthopedic friends are like I don't know what these guys are talking about but this man will never play football yeah and then he goes and then when he and then when he was playing against the young perfect athlete from the North Carolina I mean this is a quarterback tour I've seen what was his name work I've seen him tackle I've seen him react 'old and flipped over fell over forward with a I'm still running on his feet and I'm seeing him and then I'm seeing the neck x-ray that I actually saw in the Safeway grocery store with an orthopedic surgeon thinking okay this guy is dead and the old dead guy won and I still don't understand what happened I think he he must be half Irish went drinking at halftime that's the only thing that's a thing I can figure out that he did I'm and then the last thing that you talk about that I'm a big fan of you say dental sedation why the common models predisposed dangerous practices I mean my gosh Joan Rivers I just went in for a little thing off her larynx and died from in office still and I see I'm you know full disclosure I've four years some of these dental malpractice people have they send me there they're either monthly or urine settlements because since I own a media company you know they they would prefer that you didn't do kill people who are if there's anybody that wants you not to kill someone it's your dental malpractice deal but my god any time it's a million dollar plus claim they only had one thing in common there wasn't there was IV sedation involved and I couldn't imagine what it would be like personally to kill a patient especially there was a kid now you killed somebody that's as old as me I mean come on the average life so I see in 1900 was only 41 I'm 57 he was on overtime but man when it's he's already got the ballot to put me yeah but the bottom line is that is this must be awful to Killah for you but I I have never and then the other thing I always call bullshit on is when your tribe does something that no other drive does so in air in America you can't walk into any hospital and do the IV sedation and do the bypass oh but you can't if you're in dentistry and then you then the next red flag I do is try to say okay there's 220 countries what does all the other countries think about this issue then of course you indeed go to like United Kingdom says indeed we do not want the dental profession doing the IV so so everybody's come to the deal that you know you can die from this so you should probably just pay attention that in fact when people say to me they go well you know is it is it dangerous to get my wisdom tooth out I said hell no I said yeah the only thing that'll kill you is the IV sedation big and I'm like well I toughen up man up man up I mean do it on nitrous um I know friends that are dentists who when they had to have a surgery and they could do a spinal block they they they did that they did under local because they they get it so so what's your thoughts on dental sedation well 

Dr. Paul Springs:you know the risk of sounding like a broken record it's the same things we keep talking about it's lack of transparency and it's the few few conspiring against the many I'm very very enthusiastic that with the our new specialty of dental anesthesiology you know I was more excited about that than I would be if there were an implantology specialty and I you know like I said in my heart I'm an implantologist but hopefully you know this will this period is falling behind us but historically it's been as you said oral surgeons that are doing the procedure at the same time they're doing the sedation for many years there were there were very good financial incentives for oral surgeons to want to control the way sedation is done even down to this major there was major vote maybe two three years ago there was a change that the the ABA started recommending additional training and basically the equivalent of IV training to do oral sedation you'll rarely hear me complain about additional training but you know what many people more expert in the field than I am interpreted this as is a power grab to try to create a larger barrier to entry of course the people who suffer are gonna be the people in rural areas so if someone who has who their business model depends on sedating people they go away to now mandatory training when they've been doing oral sedation for a million years with no problems and now it's illegal for them to give valium and nitrous at the same time because it's multi drug which it puts in a different category they go away to IV training and they're taught that it's the newest and the best and the only predictable way well now they've just fallen from the frying pan into the fire the only people I know about who are really talking about this or the  doc sedation people and Stephen Rassner is amazing amazing general dentist amazing practitioner and great guy in podcast host in South New Jersey he talks about a combination of a benzodiazepine short-acting short half-life along with a couple different types of antihistamine and it just ends and nitrous it just makes sense you don't go too deep with any one thing so you're not pumping someone full of fentanyl and you know again the tail wagging the dog it's doing what's necessary to get the job done I did you know did a few implants for my mother and it's been some years ago now but you know she was already on an antihistamine she was using as a sleep aid and I gave I suggested she take one other antihistamine and I gave her a short-acting Bend benzodiazepine and I asked you know of course she was cooperative the whole time she could answer questions we were chatting and laughing on the way over to the procedure and then she took a nap after that and I asked her the other night I said mom when I did those implants for you granted it's been a few years ago what do you remember of it and she said not much if I had to guess I'd say the whole thing took about five minutes well that was worth doing implants on my mother I took three hours to do it you know so there's no reason to shoot a gnat with an elephant gun but unfortunately the institutions and the individuals who can't have a an ability to profit from it tend to push things in that direction so you know you see the  propofol and the  fentanyl that's used as a first line when everyone I talked to went through the same training and is an oral surgeon when I like you always say I get a couple of drinks and I'm the first thing they say is no I like to keep it light I like to start with a little versed and see what's needed and take it from there and I'm doing right now some  sedation training with someone way more knowledgeable than myself and when he has the opportunity that's what he likes to do - you know if it's gotta be IV start  them with a little versed and and only ramp it up as needed that's the whole benefit of doing IV is you can titrate it so why go straight to the big guns well because that's your business model you got 40 people coming in for wisdom teeth today you got to get them under get it done and get them out so what if they're zombies for an hour that's the model unfortunately

Howard:  um it's funny you said dr. Steven Rassner um do you know he was on the guests of the show love that guy to death just an amazing man but do you know what I was thinking whenever I think of dr. Reznor guess who he you you're I'm trying to you're 

Dr. Paul Springs:35 


Howard: so do you remember how old were you 1986 two years old okay well you should may not remember you should know I'm culture probably yes there's a 1940 he was in the dental school with dr. snow in fact you know how you're assigned at upperclassmen and then what so when he went to clinic his upperclassmen guy was dr. snow the guy who got sentenced to 42 years in prison for the largest Philadelphia cocaine case and so when I was in dental school the big show was um Miami Vice or something like that as uh it was a guy from Wichita with blond hair and yeah Dawn John's he was from East High in Wichita and and another guy in anyway anyway it was that it was the biggest show and that was when cocaine started becoming you know a big deal kind of like medical marijuana is now so everybody had to start uh trying that with horrible consequences in this guy was just selling the crap of it to all the dentists and faculty and the neighbors but it turned out he noticed there was a van parked out in front of his car and he was so out of his frickin mind that he told one of his drug dealers to find out who it was they came back they said it's an undercover and then so he put a bounty on to have the the guy executed she's shot right in his van turns out the guy who was negotiating the hit with was that guy in the van spurned her and so anyway so he goes 42 years which is kind of insane because I'm it's just what a tragedy never the crime it's the cover-up well it's the it's the guy who has to serve the 42 year term isn't the same guy who did the hit the guy did the hit was snorting you know an ounce of cocaine a day it was completely out of his mind but the sober middle student is gonna have to sit in a cage for 42 years and so anyway so that's always charged me but sorry but but Steven Rassner but you know but Steve Reznor sums up why you should get your magdf AG whatever because in my 32 years the only thing I could correlate between what did this guy have a happy career and was happy and it seemed like he was having fun and reach all those expectations or was this guy just miserable burned out and fried the the most thing I can correlate it to is number of hours of C E and I joined the AG because I noticed that and back in the 87 that every that every time you went to a course it was the same guy he's over and over they were all and they were all upbeat on dentistry and you know they were all they all loved it whereas your drinking buddies might have just thought it all sucked and it was like a downer party and I wanted to surround myself people that dragged me up and so then they said that to get your fagd had to have this many hours and implants and this many hours in ortho and I called the guy said well I'm not gonna do implants North oh I need more yeah but he wouldn't let me so you know you're young dumb and you're all pissed off and no dental school and I had this big requirement for implantology and I found this one class that would do the whole thing and it was the University of Pittsburgh this guy I never heard of Carl mesh seven three-day weekends so I go in that class sit down guess who I sat next to for seven three day weekend's Reznor and my god I thought I fell in love with Carl but I fell in love with Steve Rassner who is another MAGD and when he told me the story I couldn't believe and believe that this story because I was you know I was West Coast and this is a Philadelphia Story pretty much all drugs and everything's East Coast is and I mean I'm here in the West I mean have we done anything wrong have we done anything wrong in the West so my gosh one I had um I just can't stop with you I'm dental tourism and organized dentistry is place in it 

Dr. Paul Springs:yeah well again you know this is something that unfortunately organized dentistry I don't think has really looked at no but this is something I took a deep dive on there's a lot more literature on the medical side of medical tourism than there is dental and it feels like an intractable problem people can't afford what they need and so it's a lot cheaper and easier to you know especially here molar City is right across the border  Mexico have you been down there I've never been what I owe it's very cool you gotta go I've seen you tube videos a good friend of mine I found out about it from a friend he he's an Air Force vet his father's an Air Force vet and you know he had excellent dental coverage until basically you know he left the service and so on he's driving his father to Mexico getting some implants by a guy they can't really communicate with he doesn't really know what's going on you know I correct me if I'm wrong but I think Mexico doesn't actually have any sort of National Registry of dentists you know so really you you kind of have no recourse you're not from there you're going away I certainly have patients who have gone to you know weirdo Varda and had full mouth rehabs done that turned out to be epic disasters way beyond anything you can imagine a patient who went to Costa Rica gotten all on four turned into a some on two when she lost half of her mandible you know it's just people there there are so many reasons it's such a bad idea but it works well or well enough in 80% of cases maybe and what I found out with in the medical field is it's something that really has been embraced in a way because the biggest best teaching hospitals you could name Mayo and you know Duke University School of Medicine and others that I'm having trouble remembering right now or I wouldn't not only fifty percent sure and wouldn't want to say it if it's wrong they've created partnerships with hospitals and up in lower-income countries where they've created a situation where practitioners in other countries can get training where practitioners from here that want to go on vacation can get training and where it's administered or there's a partnership or at least training from these major teaching institutions and it's sort of a rising tide that lifts all boats it's a you know a triple win situation where as what we have now it's kind of a zero-sum game and the loser is always the patient and so I think as a as a profession we have to acknowledge this because you know the claim has always been problems of access to care you know there's always access to care the problem is you know the patients aren't always where the practitioners are so if we can make this a triple inhale there's a company that there are companies that use large self-insured employers they should have said that they work with large self-insured employers to transfer their patients for say hip replacement to a hospital in Mexico or Costa Rica they might even fly in a you know aborted us surgeon to do the surgery there and they have twice as much support in a foreign hospital as they do here many action you're gonna make me are you trying to get me have me have a heart attack or a stroke

Howard:  are you are you trying to get my artery because because I lived here the I've lived here since 1987 so we're a border country with Mexico you remember the story of the Alamo right that's where the United States stole 40% of Mexico with with again bueno yeah they they're all proud of the story in Texas I know I'm I for my grandkids live in be Bill and it's like it's like a favorite hometown story you know going down there and with guns a-blazing and stealing 40% of a country so my practice right here you know exactly where I am across to you from Guadalupe which is not had a dentist for the whole time I've been here they have five thousand people living there that are illegal and 15 thousand that are illegal and every ten years you know they can't afford a filling they can't afford the dentistry so some very nice man who went to dental school in Mexico comes up in Guadalupe and he opens up a dental office and here comes the trustee government and they kidnap him and put him in a cage and they you know they always said because what was he doing he was he was he didn't have his paperwork in order that's like a communist thingy where are your papers give me your papers I need to see your papers are they're not in order forget all the details just why I mean I it's the same thing that the house I bought a million dollar home from this lady it was so sad well what's  wrong why I brain cancer and there's a pharmaceutical company in America and they made this deal but it's not fda-approved for me and I told him well I just want to try it well they're doing a study I didn't get on the list but they sell it to every other country so I found a doctor in Sweden so I'm gonna sell my house and move to and then and there I can buy the u.s. drug made without again so so I understand the need for regulation so you say well you know we just can't sell anything well why don't you just say this drug is not FDA approved I have a smartphone I can Google Britney Spears and all the things that you need to do white why can I just say well it's not FDA approved but my hematologist oncologist say dude you're gonna die and they boat told me that the best random chance is to take this drug not FDA approved your side effects so I so I've only got a year to live that that's my decision but you always show up with a gun late Lady Liberty it's like oh she's so honorable okay so she's written laws by lawyers and Congress taking bribes from businessman and if you don't do it she pulls out a nine-millimeter and kidnaps and put you in a cage and you call her Lady Liberty she's a frightening for it was kind of like the way I'm well I don't want to mix other things with it but the bottom line is I'm so the good man at the Arizona State Board of Dental Examiners who I know who are elders in their church and they're and you know they're all these great men who will hold the holy book and send out a policeman to kidnap you and put you in a cage because you were doing free dinner or low cost $20 dentistry on a poor man because well we we're so we have to protect you and you can't fight you can't start a dental school unless we approve it and you can't be a dentist and when we license you and we'll you're not being you're not being my consultant like when I if I went to you as a professional as a process and I'd say here's $100 for example you will you tell me what you think you know I should do but that's not how the government is the government psyche here's what we recommend and if you don't do it I'll kidnap you and put you in a cage and by the way to pay for this service I need to take you know a third of your money I just love it when they talk about the income inequality it's like the people complaining about it have no problem taking a 30-year money but they sure get mad when some billionaire has you know fifty billion which if you look at all the billionaires in the past they all I mean the guy who us still left his money to build a library and Carnegie in every County the Rockefeller is still as funding all this stuff Bill Gates and Warren Buffett have already put all their money and a trust and are doing more money but but but the guys who take a third of your money always point to those guys who actually built you an iPhone and actually built you a library actually you know they it's just it's so messed up but but I have faith that I really think the smartphone is gonna wake up these dumbasses who who believe their whole like why I can't make a decision isn't there an agency for that I mean help me from myself I'm born a victim is like it's like in Arizona they they're trying to pick out a book the Department of Education in the book for a first grader and they have to consult with Washington DC you know they have nobody in Arizona can decide what book the first grader should read maybe we should just close that institution yeah I mean and then the kid if when he's reading that book he's thinking about I mean when I read in my grandkids they're not thinking about the book they're thinking about frogs and fishing and you're reading him a book and they point out in Texas daddy good pods a deer and now we went from reading about looking at the deer walking by you know but anyway it's just it's crazy you know I have

Dr. Paul Springs: I have some again last few years I've been in an institution that is kind of in some ways a public service because we do low-cost dentistry for people that really need it and I have definitely seen some people who have had some pretty awful treatment done by unlicensed practitioners now I'm not saying that there's no room for expanding access in that respect but unfortunately prohibition never works is the problem you know what we need is to shed a little more light on the situation and give people the opportunity to a understand what an unlicensed practitioner is be you know just like the doesn't didn't want to have hygienists now we don't want to have anyone who's not a dentist - you know it doesn't have the holy touch I want to know what Howard: you're sorry you're very cerebral and I don't know where does that come from did you you don't you don't talk about whenever you talk about sin it's not like you can tell that you've always thought about all this shit for a long time where does that come from

Dr. Paul Springs: I don't know I guess I was raised to question the things that I was told you know and to apply critical thinking and I guess I'm just always intrigued to understand how how's it work you know to dig deeper that's the other answer - why did I want to go into prosthodontics I had questions I wanted to answer that I had no basis of answering you know so come on you're not getting out of here I'm gonna bar that door till you tell me dental therapist why there's no controversy for me whatsoever I think it's silly you know what we need is and you know whether it's national or local it doesn't matter to me every everyone should be working at the top of their license that's the simple thing that's all it takes hygienists have things that they can certainly do in some states they can give locals I'm stealing all your votes hygienists can get all my blood all my quotes are stolen so go for it Nationals should always work at the top of the license absolutely it's the only thing that makes sense why would you want to have you know I used to argue with my former employer why would you want to have a dentist doing all of your hygiene it doesn't make sense you just simply economically the things that I'm focused on in terms of specialization of services just like you say that I should one person try to do it all it's crazy so I think you know I have friends that work with expanded function assistants for example who placed their restorations after they prepare you talk about an access to care boon that's it right there you can charge a quarter of the cost if you not a quarter you can charge a fraction of the cost if the dentist only has to remove the tissue and then check the final restoration and by specialization that dentists get better at preparing because they do it four times as much and the restorative students do far more restorations so they get to the point where they're far better than the average and at this it's the only thing that makes sense if you ask me well again you run into perceptual issues right suddenly patients want to know why is someone other than the dentist treating me and a special you know what I wrestled with going into prosthodontics is unfortunately that tends to be high level treatment for very rich people so you know they are they're paying the best and just like those longshoremen who don't know anything about dentistry if all they know is this guy has a degree and she doesn't even if I tell them she's gonna do a better job than I will they might they might think that reflects badly on me and go on to the next guy you know so unfortunately institutions and market pressures matter I think is what we concluded here 

Howard; Ryan so you know he used to live across the street from us right there right across Piedmont that's how what to key yeah and then you grew up in Kansas where where did it win and where did you live in Kansas 

Dr. Paul Springs:in Overland Park from 88 to 2002 damn oh my god that is amazing so when I said where does all this come from you should have said cuz I lived in Kansas and Arizona are all the cerebro's alike or I didn't come from Rutgers like Kansas in Arizona or Rutgers taught me was how to take a bad situation with a non-compliant patient and a broken chair and make it all work I was a very valuable education because it taught me a lot of troubleshooting a lot of problem solving

Howard:  well I am my gosh I am big fan of yours

Dr. Paul Springs: I think you're just crushed knowing is mutual you know I think personally for my career you and the things you've done have made a tremendous difference and only look at the patients I've touched and have benefited from it and all the people and all their patients that have benefited from you and this country alone never mind the free education you're giving out worldwide I'm very happy to be here and you know excited to kind of you as a friend nah man on that we got it we got a stop on that no that's that we should start the two-man mutual admiration Club will be the only two members and will just meet together and admire each other well and there's no majority for what impress the other someone told me someone from Russia patient of mine told me a good joke recently she said there's an old Soviet joke in capitalism one man oppresses another in communism it's the reverse it's still one man oppressing another yeah but again I 

Howard: to leave on it on a positive note you know cuz when you're my age you look at your five grandchildren then you realize that okay my grandparents are old and you know my dad didn't agree but so you realize you know that um I'm sure you understand this time thing where you know you can actually run out of time and die and I am so bullish because when I flip back every hundred years yeah when you go back a hundred years it's I mean but it just always gets better and the games that people played technology you know energy was measured originally in horsepower right I mean really horses when they come out the combustion engine they still transferred it to a horsepower and I think this natural intelligence is done pretty good because ninety eight and a half percent of all the species are extinct we're alive we're not extinct when you look at hardly any species made it to living a hundred years there's only like a dozen we check that one off with a turtle and tortoise and all these other things to reach the billion club is very rare shit there's eight billion of us right now and this to think that we went from the big legs moving us around and horsepower to then making tools using our arms and now the most productive thing is just our opposing thumb and so we've got this natural intelligence with this there's no such thing as artificial intelligence and I don't that's good I think that's thousands of years away but just we have augmented intelligence and our opposing thumb is doing more work than our biceps and quadriceps and glutes ever did and I just think it's going to be our finest damn century and the we problem is and that right now the majority of the world has more faith in the collective institutions the top than they do the man in the mirror and I'm just like why don't they tell everybody I don't even know you and I have more faith in you than you do you don't need a Department of Education you don't need Barry Sanders helping you pay for something you got to figure out how did everybody screw it all up well they regulated the shit out of it because you couldn't read or write when's the last time you couldn't read or write on your iPhone when I was born in 62 at 72 my mom went to a garage sale and found her encyclopedias and they were made in 52 so me and my five sisters we were so excited about this information I mean we literally read the books like it was a you know we had already read that Mary what was it the Mary Drew series or Nancy Drew series and then what was the boy party boys hardy boys how do you know this you're too young pop culture here you're an amazing you're too young to know what this is and we read the twenty six seven books of the encyclopedias just like they were the Hardy Boys the Nancy Drew and now the average I don't care if you live in Kansas can't man do or a canoe you got Google you got Wikipedia you got 55 75 million pages of updated encyclopedia nobody's gonna stop the individual the only problem is I just wonder if I'll live long enough to see the average individual have more faith in themselves than in some other religious institution business institution government incision and the fact that they could not know how the government's abuse them for five thousand years it's even in business look what businesses Apple things that you're their best customer right so when they come out with a new iPhone what do they do they make your last charger not work so so now the the biggest business van customer is like oh do you like me am i or am I your favorite company get a screw you over so it's like the minute they sense trunk they used to be like you had to earn your trust and then sociopaths the minute they sense oh my god are you trusting me I'm Mark Zuckerberg of Facebook wall I'm gonna penalize you for posting a video that was copyrighted as I sell your information to Russia and the Chinese and the  Communists and  people it's like my god I'm old school so like on dental town for 20 years I'm so old school that for 20 years us five programmers have had at one year to do list on things that you like what asked us to do well we're so stupid you said you wanted this so stupid me that's what we do and then you go on Facebook so our Instagram do the links work oh no we per we  hired people to make sure they can link well it's a it's a five kilometer 5k walk for oral cancer they have to click here for information we don't give a shit about your 5k we're trying to sell you another ad so all the top people they screw their own customers over more than you they actually hire people to make shit to screw over the people giving them the most money and I'm like okay so you know what about the government that religion did they do anything I mean look at the Catholic Church and  the Peter Phil scam I mean it's not just United States I've lectured I've lectured in Ireland where this dentist about blew a gasket because they had a guy that was just one of the worst and when the authorities were gonna close in on him they moved into Rome and guess what Rome did with children they put him in charge of a all-boy orphanage in Tanzania victims that couldn't say one Dennis do something off when they take your license wait no they should make him do dentistry without an assistant in the prison twelve hours a day seven days a week and that would probably scare more density the right but yeah I don't like to be negative and negative I'm not negative I see jobs blew my mind and yeah he was a horrible dad yeah he was a horrible father I'm sorry when I you know when you're doing a root canal I don't care about your religion sexuality and your skills as a father I I just hope you could do the demonstrate but I am so bullish I think this is gonna be your finest century and any and I think it's guys like you on dental town because you even go to the controversial stuff like you I don't know if you want me to bring this up or not but you uh you talked about him what was that um I was annoyed 

Dr. Paul Springs: ADH shows as their keynote speaker when you think dentistry you think marky-mark right so they chose Mark Wahlberg as their keynote speaker the only thing I can see that he's accomplished in his life and I shouldn't say that that's overstating it he has done some charity work since but mostly what he's done in what he's known for is making a lot of money and making some really dumb movies but they chose him as the keynote speaker and what they chose to highlight was his charity work I thought it was very upsetting that my ad a dues and they now tell me the ad a dues are separate they don't go toward paying for the keynote speakers but we all know money is all fungible they're paying this guy to when he's really contributing nothing to the conversation but unfortunately he does bring in people who don't care about you know things like little things like dentistry they're bringing him and despite the fact that he has a track record of multiple convictions for racially motivated attacks on people you know not like we think but where he was screaming made racial slurs as he smashed an old man's head with a stick or you know threw rocks at children and that sort of thing and he was a young man and I understand that and he you know I hope that's not the same person he is now but I think we could work a little harder and find someone who makes a little more sense or celebrate someone who does not have a past that's quite that reprehensible maybe that's just me

Howard:  and can I ask you about another racially question Shantay Parker is the first black woman to be class president of Marquette University's School of Dentistry and it's 125 year history and someone posted why is this news really well hi were you born under you've missed the story on that well I 

Dr. Paul Springs:I'm gonna be an optimist like you and choose to hope that they meant oh hello choose to hope that they meant oh why is this news can't we get past this nonsense already not why is this news who cares but it's part scenery and so you want to get past the wires well I hope that by that what they meant was why is this news hopefully as a society we've evolved to the point where this should be commonplace as opposed to why is this news because this is because the past struggle doesn't matter I hope

Howard:  yeah and I would say I was um very sensitive to sexism growing up you couldn't miss it because I could to see a man everybody knows who you are but um my mom who's all of my life and I just took to dinner the other night and she would put me in jeans and iron patches on the outside and I could swim it was so I lived right on the Arkansas River and by the way who are these people that live down by Texas you call their state Arkansas it's Arkansas and it's not the Arkansas River either moron it's the Arkansas River that goes through our Kansas there's no Arkansas and but anyway the iechyd it was literally I mean I couldn't quite throw a rock in the river from my house but I could get damn in their clothes I could swim and fish that thing 24/7 my sisters were putting dresses they couldn't get within 10 feet of the edge and they just soiled their dress they'd get in trouble and I was sitting out there seriously at ten years old wondering what is my wanker thing gonna do if I if I can't swim am I supposed to hold on to it is an inflation device I mean and and mice and they had to be they couldn't you know they were just so regulated and I could go home with my friend mark board on or Dave horn brick or whatever and spend the night and you know the next day you just tell your mom oh I didn't come home last night you know it was like it was like no deal but if my sisters would have trade that oh they would have been shot so  when people say that that girls and guys have been treated differently it's like well yeah I think that's pretty obvious did you ever consider maybe they just didn't care if you wash down the river and in hurt in an herd management cuz when I grabbed hand is a lot of people that was their degree what was that degree called in a herd management I'm they were what was it was like the big animal husbandry good job Ryan you're another cerebral guy you can see why they in animal husbandry you only need one male bull and their herd and for economics you want all females so of course you send the little baby boys off to the to be turned into hamburgers because they can't make it baby so in an herd management you're absolutely right you could have sent me down the river but anyway well it's like so one less Hill on Shante Parker just amazed her guys she's the first black woman to be class president Marquette University she's just an adorable amazing person but when someone says wisest news what was your exact answer

Dr. Paul Springs: I hope what they're saying is why is this news why is this not commonplace as opposed to or you know at least proportion of the population how about as opposed to saying why is this news who cares I hope 

Howard:   the in racial issues in dentistry do you see them observe them what are your thoughts on those sure I mean you come from a predominantly Irish so that mean you take Jameson straight or you mix it with Dr Pepper you know

Dr. Paul Springs: I wanted to bring some red breast over here what's red breast oh it's Irish whiskey ha well he brought the cigar so different vice tobacco's but um no of course you see you know people tend to associate tend to associate with people that look like them obviously my parents are different weird but you know for example there's a there's a practice that I'm looking at buying wonderful practice current dentists is amazing dentists he's a prosthodontist hands of gold that intimidates me a little bit but what intimidates me more than anything a lot of his patients are you know members of his synagogue and they drive past a lot of prosthodontist to get to him and I'm wondering how long in the transit transition do I need in order to maintain that goodwill because I don't even fault people for it you know if they have closer links to someone else for one reason or another whatever matters to them they may not give you the chance so it happens just like you know I've had black patients saying I want to see it the white doctor you know I've had female patients saying they insist on seeing a male doctor you know people as you often say are endlessly complex I've had so many younger doctors who are have started a new practice or are going to be starting a new practice and they'll ask me about it and there'll be you're  talking about a you know racial conception as far as what people think there's all kinds of other  factors in there and sometimes they'll look at an area to practice in or to buy a practice or whatever and they just don't even see these factors right and they want to overlook them and nobody knows better than Howard he teaches this you know before you make a move you know business move you better study what the heck you're going what you're getting yourself into and making sure it's going to be a fit so I love the fact what you're saying there because so you know so many of us dentists we're not businesspeople we drill on teeth and we think hey we're good and you know so we should be able to step in this practice and it's good all you know it's all gonna be roses and last times it's not so but kudos to you for thinking

Howard:  well wait I lectured in Israel last month and there's a huge number of black African Jews or Sephardic Jews what are they a Missouri but anyway guys in Israel there's so many African Jews you change the names of Sephardic dentistry please but yes people are tribal and then it's funny because in animals we just say you just say they're tribal but I always I always have red flag words whenever humans describe what they do and I say okay that does that's great but show me this in one other animal there's one and a half million species of animals life so surely you can connect this behavior to a monkey orangutan a mouse an ant like oh no it's  only our behavior okay then it doesn't exist but I am that yeah animals are incredibly tribal and they're just they always haven't I mean I've seen videos where the male lion dies and the female just tries to join the one on the other end and the girl's killer and you know you're just there it's very very difficult but um hey thanks a lot for coming by you have you cross anionic questions with the ring that up something 

Dr. Paul Springs:I recently started is a website oh there's a lot of my friends they're always sending me these text messages I can't believe this lady agreed to a full mouth rehab or I'm doing it all on six I've never done it before where do I start 

Dr. Paul Springs:so I started a website called procced consult calm again where the we are the specialty that wants to speak Greek we no one knows what a prosthodontist is in fact there's a great great article called you're a prosthodontist you're a what that's where somebody interviewed people in the stream what is that word government so prosthodontist prosto run thief Rostow means replacement teeth artificial yeah and Oh Dante Greek to know what's prostitute so artificial what's to love so one makes artificial love one makes artificial tooth so 

Howard:  so so when everybody says business Melanie says that we how many NDA's have you signed in your lifetime I mean non-disclosure agreements but whenever they always hold my hand I say is it faster is it easier is it a higher quality or as at lower cost is it smaller like the original the first combustion engine steam engine was so big you'd only pump water out of flooded coal mines as it got smaller it got on the ships and replaces shipping when the ships got here and needed canal building you know so it's got to be smaller I'm I see that when I was in Israel um several laser companies are showing me their hottest new and upcoming laser dude why is it the size of a refrigerator you know I mean I mean see that thing right there that refrigerator I mean what's with this eye what do you call that kind of a dorm fridge it's like it's like and then you and then the open of the back cuz you're seeing them making it all this hall of space and they would say - exactly wrong they say well I think if it's bigger it justifies more the price gravitas it's like no it's actually you know it'd be really cool it's like I'm like Dan Fischer's is do laser light curing thing or whatever his new laser thing it looks like your size of the pen have you seen that one but it's like yeah I want if I can if laser I'd love to have a size of a pen not a refrigerator but the other thing that I'd like to add to you and your generation he's a millennial he's over anytime we talk he's in his mind saying okay boomer but in is just to focus it everybody crushing it from 2007 to 2020 its unadulterated focus on the individual and everyone else's things with their brakes on they pitch an idea and they start saying well you know the legal and the legal and the ABA and the Association dude they they had the game for 5,000 years can you just block them out of your mind for one second everybody that that has a hot idea in the last 10 years it's making Bank didn't give a shit about the government the business class the legal class the religious class and so when you do that process on so a long time I want to be your biggest fan I want to help you do whatever you can I mean it's the least I could do for a Sephardic Jew from New York City is um just total vision on the individual no holds barred this person is afraid of losing a body part I mean imagine when you pull out your q-tip if there's any dirt on it imagine if you pull out the q-tip and your whole ear came off your body coming off your tooth on out so this individuals and it's gonna be prosperous spell it 

Dr. Paul Springs:P ro s th P ro s th consult consult dot-com 

Howard:  I expect when I go there that it says you may not enter because I I have no respect for any place so that's at me as a marital that's just you yeah I mean that's why I won't join a country club but they'll take me shit who won't they take and my god a mate get in a play so so when you do procced consult calm yes please all breaks off the individual and if you ever are that little birdie saying well what will the ATA say well the lawyers say what will the State Board of who gives a shit say well we'll well you can get sued HIPPA OSHA will just kill your company tonight right everyone that's crushing it since 2007 realized that this was the birth of the individual in the next century the last five millennium that was the top that was the top that was from Rome the church the government the legal the the a da the biggest yeah converging on the individual and the next century is gonna be the individual saying hey wait a minute wait a minute no and they're gonna have an equilibrium there's a mathematical space for each side i mean it's it's you know it's a scale but it's gonna it is going back to equilibrium so they're gonna hang on desperately like look at them look at them the wind deal you know we grew up in Kansas you lived in Kansas remember every farm had it a little windmill well you notice all the windmill research is for windmills that have 30 feet blades why are they doing that because they're trying to hang on to their utility and the last thing they want you is to replace that little fan they watered the cows to now watering the house with electricity so that is your utility company passing laws I mean Warren Buffett even part of a company just passed off they're doing everything to keep individual solar from you because I need to keep my big utility company paying me all this wages when you talk about income inequality well the the two-party binary star Democrat Republican from Abraham Lincoln to today set up all this bullshit and I and I understand why they did it because all of us were illiterate and couldn't read or write and believed anything we learned in the one school you know whatever whatever our elders told us we believed I mean my mom even told me a lot I said my mom actually told me it was a falling star those were just stars falling I mean she told me so much the the the tales behind the airplane well they had too much gas in their tank so they have to let out gas to lower their way to land I'm like this feel like wow shit he should manager feel better you know mom well actually the school the college she went to is she actually went to farmers University of central Kansas and that's not one of the good ones did you catch a joke I did not farmers universities there's ASU you have a farmers university of central Kansas it's not pretty on the degree it's I look at the word firetruck more closely and but anyway um my brother went to the University of Hawaii and he says so so you will hit a home run if you are any business that can black out 5,000 years in the rearview mirror and just say there's one guy there and stop making excuses well Hilda he'll need me to make the decision for this and well I don't want him to do that or he can't read that or it can't be transparent it's got to be okay it's gotta be yeah right no I know what you're gonna do because you've done it for 5,000 years and all the new billionaires they've got a new business strategy in mind and they are just going balls to the wall to the individual so you can tell things to all people and that's that's the customer but it's also the people standing over you and brandishing a big stick but you know religion figured out my um my sister my two older sisters are nuns and the the oldest one sister Annabelle Way is fluent in several languages and she's read all the original original works she doesn't read your st. James version of your Bible I mean she she reads the text she Arabic Hebrew Greek all those things like that and she said that you know like Christianity I mean the the the actual scientific stuff is about twenty Scrolls right and and you can the same thing with the oldest realism which is Hinduism and you can read the originals and she said they don't have a single person place thing name and all the great works from the Koran to the Bible to Hinduism except for the Golden Rule treat other people like you want to be treated and she said it reads like plagiarism I mean it's just like it's an in fact it's so creepy lease tolling that some people in the religious world think it was a that's proof of divine intervention but that's the thing about that individual it's so easy to aim at him because you're that individual you're that guy there is you and it's me and it's your mom and your sister and it's your brother it's everybody you've ever loved is that individual and my gosh if you just aim at him like on dental town when you tell me on a feature you don't want that I have empathy Mike oh I see why you don't want that so I'm gonna do that we're look at look at Instagram everybody says well how come my links don't work because we're an asshole and we just want to hate Tim Tim Cook was the worst he was the first openly gay CEO and whenever I typed the F word he autocorrected it to doc I mean it's just a little thing like so I'm so sorry you being gay and I'm cool with that my brother's gays that my best friend in life I love him a lot more than Ryan and and but why is he telling me that he's controlling my texts they just can't they can't stop controlling others they just and it's an animal and I would rather Kansas guy like okay hey no thanks for all you've done for Dentaltown thanks for stopping by and I just I'm your biggest fan 

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