Howard Speaks By: Howard Farran, DDS, MBA, MAGD, Publisher, DentalTown Magazine

My father told me that God gave you two eyes, so that you could keep one eye on the customer (your patient) and the other eye on cost. When you go to work each day, you should work hard on driving down costs so that your customers can have the freedom to afford the dentistry you provide. If you don’t drive down costs, your patients are denied the freedom to fix up and save their own teeth.

Every time I ever tell a patient they need a root canal to save their tooth from an extraction, the patient tells me that they really want to save their teeth, how much is the root canal going to cost, and will their insurance help pay for it. To deny that dentistry is over priced for at least one third of America is an arrogance undeserving to humanity.

There will always be people in every profession who sell their services at the top of the price spectrum. This is called market segmentation. General Motors starts with a low priced Chevy, a little more money a Pontiac, a little more money an Oldsmobile, then Buick, and if money is no object, a Cadillac. But money is a huge object in America for nearly a hundred million people. In the United States of America, with 281 million people, 1 out of 3 will lose all of their teeth by age 65. Another 1 in 3 will lose more than half of their teeth by age 65 (https://teethwisdom.org/about-oral-health-america/).

During a recent endodontic symposium a speaker said, “These NiTi instruments make endo so fast and easy you may be tempted to lower your fees. Please resist that urge at all cost.” Almost everyone laughed. Now don’t get me wrong, I have a huge sense of humor, but what are your own personal thoughts regarding the plight of the embarrassed woman who has lost all of her teeth? The little girl who goes home and cries herself to sleep the night she lost her first permanent tooth because she couldn’t afford a root canal? The dad who has to pick between a $1000 root canal or taking his kids to Disneyland, in a world where nearly half the fathers don’t raise their own children?

In the year 1900, healthcare was less than 1% of the GDP (Gross Domestic Product). A century later, in the year 2000, it is 14.7% of the GDP. When anyone talks of faster, easier, cheaper, the highest in price endodontists, selling their highest in price technology, start getting very defensive and insecure. This is simply their problem and not yours. Technology gains are the backbone of any growing economy, along with people and capital. Technology in endodontics, like technology in any other profession, should increase productivity, making root canals less costly, lower in price, more abundant, and less scarce.

When is the last time you really thought about scarcity? Scarcity exists because society has unlimited wants and needs, but limited resources. In other words, while we all want a bunch of stuff, like to keep our teeth, we can’t have everything that we want.

Scarcity means:
(1) There is never enough resources to produce everything that everyone wants.
(2) Some people will have to do without some of the stuff that they want or need, such as their teeth.
(3) Doing one thing, producing one root canal, forces society to give up something else.
(4) The same resources cannot be used to produce two different goods at the same time. You have to pick, a root canal or a television, a crown or a weekend getaway.

Dentistry lives in a big, bad world called scarcity on a planet abundant with sugar. Scarcity is what the science of economics is all about. Scarcity is the economic problem.

I feel the high priests of endo are morally and ethically obligated to tell the world’s endodontic purveyors what the tradeoffs are between a high priced, technique sensitive, warm vertical gutta percha compaction, which shrinks 2 - 4% upon cooling, verses a single cone technique such as EZ-Fill. Responding to such techniques with “It just doesn’t have the look” is scientifically insolvent and morally bankrupt. It reminds me of 1964 when Justice Potter Stewart tried to explain pornography as, “I know it when I see it.”

If we followed the research closely we would all be complete schizophrenics since we can find a study to support nearly any theory. I think we all need to merge the “Attitude of Excellence” with the lessons from Henry Ford. There were 76 car companies when Henry Ford started his own. But what was Henry’s contribution to the world, and economics? Making a car affordable to the masses. When you talk about the criteria of a great root canal, tell me and everyone else the criteria of a root canal that is never done. Tell me how much better is your technique when it means millions of teeth will be treated with forceps and sunshine on the root ends!

So in conclusion, watch closely how all the flack and fodder in dentistry is aimed at the very few speakers who actually take insurance and PPOs. Notice closely how most of the Gatling gun ammunition comes from the dental speakers who do not treat the poor, do not take dental insurance, and do not participate with one PPO. Usually they don’t even have a dental office, or if they do, it’s just for show and tell. Watch the same high priced endo “gods” try to make you feel guilty for doing faster, easier, cheaper endo for the middle class and poor. This is what I call “The Dental Irony.”

The majority of us should rise above the boutique practice, mythology, mysticism, and numerology and go back to our real world patients who eat way too much sugar, who floss religiously twice a year on Easter and Hanukkah, and spend most of their money foolishly.