Scott Perkins' Time Paradox -- Increasing quality while reducing time and effort By: Scott Perkins, DDS

Time is Life! Lack of time is often punishing and capable of compromising our quality if we are not cautious. It suppresses our ability to create income; fabricates stress and robs our loved ones of accessibility in our lives. In the final analysis, life is only composed, sculpted and eventually measured by the time we have accumulated here on this earth.

I maintain a thriving practice in Houston, TX, but I am primarily recognized within the dental community for three things–exposing the managed care connection to the Reader’s Digest article a few years ago that baselessly defamed dentists, my research and development in the area of clinical efficiencies, and for my claim that the primary etiology of tooth wear is acid induced.

Throughout the years though, I have been honored to hear distinguished elders of dentistry testify that my ideas have literally rejuvenated their love for dentistry. And nothing makes me happier than when I hear about a young dentist who has acquired more quality and additional time to enjoy their life by using some of my time effective methods. It redoubles my efforts in the pursuit of ferreting out the wasted time that plagues dentistry.

I have experienced an intense amount of hostility coming from some of the dental profession but also have been revered by others. It’s a really strange feeling. I’m really surprised by both.

Dentistry has been truly good to me over the years, but rarely have I ever felt so enriched as I do now because a good number of my peers have honored me with their respect, testimonials, friendship and goodwill. It is a new and unique feeling that I will never take for granted.

I have been honored to hear distinguished elders of dentistry testify that my ideas have literally rejuvenated their love for dentistry. And nothing makes me happier than when I hear about a young dentist who has acquired more quality and additional time to enjoy their life by using some of my time effective methods. It redoubles my efforts in the pursuit of ferreting out the wasted time that plagues dentistry.

First came the Gunrack...
Having my impression guns tossed in drawers became very cumbersome and inefficient for me. To address this inefficiency, I invented a device called the GunRack, engineered to hold numerous impression guns straight in a row and color-coded to stay in order.

After using the GunRack a year, I began to think how helpful it would be for other dentists. I called DentalTown Magazine, a new publication that was definitely on the ‘cutting edge’ of dentistry. After speaking with Associate Publisher, Judith Farran, about my invention, she suggested I write an article on my procedures in performing a truly efficient crown prep. After agreeing to write the article, I began to analyze every step of the procedure to find out what true ‘efficiency’ is in a dental office.

I started to write down every step of a crown procedure, assigning times to each segment. When I added up all the set times together with the estimated prep time, BU, cord packing and anesthesia time, I was amazed at the result. Unless my math was wrong, a crown prep could be completed in 15 minutes!

Excited, I approached my assistant and said, “Theoretically it’s possible to perform a crown procedure in 15 minutes!” She rolled her eyes at me as if to say I’d gone completely bonkers. She did agree to cooperate and work with me to see if my hypothesis was correct. I’ll never forget the second procedure we timed. When I finished, she stopped the timer and it read, 15 minutes total! We just stood there looking at each other in disbelief. WOW! It was a very strange feeling. A few months later, we achieved the same time for a molar endo.

The January 2001 issue of DentalTown Magazine featured my first article on efficiencies, “The 15-Minute Crown Procedure”. The now notorious cover featured me in cowboy attire holding two impression guns and wearing an ‘impression’ cartridge belt. The headline–“The Amazing 15-minute Crown Procedure–this isn’t what they taught you in school”–turned out to be a hot topic of discussion and very controversial.

Just as an aside, I’ve been asked many times about where I got the ‘impression cartridge belt’ I was wearing in that cover photo. I am proud to say, three of my six children are boys. My boys love duct tape. My two oldest boys, Michael and Riley, have made duct tape wallets; shoes and just about anything else one could imagine being made out of duct tape. Mike even made a pair of shorts from duct tape. To this day, they still carry duct tape wallets, although now they like to use clear packaging tape. It was the boys who made my impression material cartridge belt for me.

After the article debut, I was flooded with emails and phone calls from all over the country. I’d never experienced anything like that before. The telephones at my office were ringing off the wall. The message boards on DentalTown.com exploded with a riveting point/counterpoint discussion. There was simply no way I could handle all of the comments, questions and requests for more information that poured into my office.

Anticipating doubters (I would have been one myself) I decided to make a video showing my step-by-step procedure. I made the video to prove the entire procedure could be completed in 15 minutes. I analyzed endo shortly after and made a another video performing a 15-minute molar endo.

Time in a Crown Procedure Consider the three ungainly piles of dental materials smothering three teeth. You are actually viewing the essence of where the majority of time is spent during a crown procedure. Namely, mixing a base and catalyst together and waiting for it to set. This process must occur six times. Each time the dentist and assistant must wait. Set time is not quality sensitive (unless you disturb the materials pre-maturely). Most of the time that composes a crown procedure is the time it takes to mix two materials together and let them set.   Time in an Endo Procedure Endo is a completely different animal. The endo procedure is a process of attempts, roadblocks, changes in protocol, and multiple repetitive movements. In addition, endo requires a lot of “feel”. It was the “feel” aspect that perplexed me at first until it finally occurred to me that there was a way “feel” could be developed in an accelerated way. It was time for me to apply efficiency principles to learning itself.

The majority of time in a crown procedure is expended in non-quality critical mix and set times

Mary Jane, my wife and I home-schooled three of our children for two years. I thought back to how children learn. I thought of Saxon math and Kumon math, two very effective mathematics-teaching systems. I structured my endo learning technique after these very successful models. I used myself as the test student. After awhile, presto! I could “feel” endo. I can now negotiate past most ledged canals. If you want to see proof positive, ledge an extracted tooth and mail it to me. I will send it back to you with a file out the apex most of the time (I need the practice). I call my new learning process “Rapid Experience Acquisition”. I believe it is the most efficient learning technology that exists in dentistry today and I am willing to prove it.

Jason Tanoory, the second person to use the Rapid Experience Acquisition, is still in the learning process. Go to DentalTown.com, find Jason and ask him how his endo is going these days. Incidentally, I chose Jason because he was the biggest tire kicker I have ever seen on DentalTown. This kid is relentless! I have discovered many ways to simplify the endo procedure. I currently market three of my inventions for endo: an organizer, PaperPoint and Accessory Point MiniRaks. In addition, I market SpeedPaks™ for Endo, pre-packaged disposable single use supplies for performing a molar endo. These were developed the first time I analyzed endo.

Spend a portion of the captured surplus time here on a quality critical step

As a result of a renewed interest in endo, I have invented nine more products for facilitating quality and efficiency in endo. I am in the process of seeking patent rights for two of these inventions, while the others are still awaiting prototype development. These newly invented products were thought out with efficiency and quality in mind. Endo will be easier, quicker, and safer due to these. Each idea is very “simple”—yet extremely powerful. The PaperPoint MiniRaks brings an array of assorted paper points vertically aligned, easy to grasp and with the proper orientation. They are also ISO coded, and are used with a logical strategy that allows any canal to be dried with just three points and without the danger of causing hemorrhage.

It was not difficult for me to notice the areas in the endo procedure where these simple, yet profound gains would bring drastic gains in efficiency. Any industrial engineer would be able to come up with similar changes.

I have developed and mastered new filing sequences, altered hand files to fit in certain engines, found a way to locate fourth canals without an expensive stereo-microscope, modified the way I use NaOCl, switched to a resin fill technique and incorporated a new, and more efficient apex locater in my endo technique. I have made the diagnosis itself more efficient as well as the job of processing emergency patients at a moment’s notice. A critically important factor in efficiency is organization. Organizing one's thoughts is essential if the intention is to make good use of time. I use a program called MindMapper (MindMapper.com) to achieve this. It allows me to have random thoughts and still keep them in order. I use MindMapper almost every day. Visit the website at mindmapper.com for more information. Gaining experience in Endo is like learning to type— repetition is the key to mastery and then keeping one’s skills sharp with consistent practice. Many general dentists hunt and peck for their entire career. It doesn’t have to be that way.

This canal system included a ribbon shape S-curve canal with fin anatomy and a horizontal accessory canal that joined the palatal and mesial buccal root

I believe it is possible for dentistry to become almost completely painless, for treatment times to be reduced by half or more, for dentists to go home at the end of the day feeling fresh instead of tattered and the quality of dentistry can be raised to a level much higher than today. The market for dentistry will expand to the less affluent with no drop in income for dental professionals. More than anything else, SimpleDental; the company that has been formed to sell my ideas, inventions and selections; is about gaining time in your life. Together with my devoted wife and staff, we would enjoy the opportunity to teach you how to get more time and satisfaction from your profession. What you do with that time is up to you. Most have used some of it to make more money, some to ease their stress and the rest to improve their quality. It is a natural instinct for a dentist to pursue all three. I hear it over and over again from across the country and it is always music to my ears.

The mesial canals of this first molar are connected by a fissure down to the apices. Studying VPS impressions of canal systems of extracted teeth help develop the understanding that leads to a better procedure

		Twenty-three years ago, I was lucky enough to convince a girl to marry me who is not only beautiful, feminine, charming and brilliant, she is also indefatigable, tougher than nails and has worked like a Trojan to run the business side of SimpleDental, which is no small task. Mary Jane is a great wife, mother and now business partner
		Pictured left to right: Sarah, Michael, Riley, Jane, Charlie and Charlotte. All the children have helped us with our business. I’m very proud of them

To order videotapes from the Extreme Efficiencies series, or the GunRack, please call SimpleDental at: 800-454-5161 in Canada 713-658-1708. Detailed information on all my efficiency products are provided in the advertisements within this issue and on my website at www.simpledental.com.