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Howard Speaks: The Sweetest Taboo by Howard Farran, DDS, MBA, MAGD

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by Howard Farran, DDS, MBA, Publisher, Dentaltown Magazine

One of my favorite songs in college was "The Sweetest Taboo" by Sade. It's interesting to look at what was taboo in those years versus what's taboo now. Back then, if you drank whiskey and got in fights and car wrecks, that was okay, but if you smoked pot you went to jail. And now, 30 years later, states are legalizing marijuana. Gay marriage was very taboo when I was in college and now that's legal in several states. Taboos change, and there's a taboo in dentistry that needs to change. The taboo is that too many general dentists in the United States are scared to do implants.

Consider that in South Korea there are 20,000 dentists, and 15,000 of them place an implant every month. Here in the United States, we have 120,000 general dentists—and 95 percent of them have never placed an implant.

It's funny how Americans tend to think we're the best at everything. One thing that Americans are definitely first in: confidence. We're first in other ways too, such as having the strongest military and the best movie industry. One list we're sure not on top of: implant bravery. Anybody who has the skill set to extract a tooth has the same skill set you need to place an implant, but most American dentists avoid implants anyway.

Implants work. They're better than natural teeth in many ways, and general dentists shouldn't be afraid of them.

Working relentlessly on the teeth of a patient with bad habits is like building a wooden house in the middle of a field and waiting for termites and the elements to tear it all down. We tell the patient to brush and floss and use Listerine and a tongue scraper, and then no matter what, in six-and-a-half to 10 years, the termites come back and eat the entire barn and we blame it on the patient. With implants, we have a chance to build an aluminum barn. That way, if the patients don't brush and don't floss and don't do anything we ask them to, the termites come back but they can't eat that aluminum barn.

And yet we keep filing teeth down or saying, "Well, the tooth has a big filling in it, so we'll fit him for a crown." We do bridges and they're an absolute atrocity that end up in the garbage years later, and it's all for no reason. Yet in Brazil, India and China, where they don't even have dental insurance, most dentists place implants and they think it's easier than the alternatives.

In the United States, oral surgeons and periodontists place almost all implants. They're great at placing implants; no doubt about it. However, some of them are too quick to recommend expensive, overly complicated treatment. There is a time and place for that type of procedure, but sometimes simpler options are better. It's a red flag for your oral surgeon if every time you send Grandma over there for an implant consultation, he only has one treatment plan and it's usually $50,000. In a country of 330 million people, how many patients do you know who have $50,000 to spend for their dental health? There are 31 million Americans who don't have one tooth in their head and I'm willing to bet that very few of them have that kind of money.

Take into consideration Germany, where oral surgeons do the big cases and general dentists do the less-advanced implant procedures. Since Grandma (or, in Germany, "Oma") can't afford the $50,000 treatment, the dentist says, "Well, we can take some mini implants and place four in the lower jaw, and six in the upper jaw, and for [the equivalent of] $750 and one appointment, now those dentures will have six ball-and-socket locators to snap onto on the upper and four ball and sockets to snap onto on the lower." Oma hears that and she's happy!

Sure, there are oral surgeons and periodontists in Germany, but they are used for extreme cases. The general dentist places all the single implants, which is about 96 percent of the business. Thousands of dentists around the globe take this approach.

You can extract a tooth, and if you can't it's time to hang up your dental license and go sell shoes.

If you went to college for eight years and tell everyone at a cocktail party that you're a doctor, but you can't pull a single tooth because you're not into blood and all that stuff, it's time to quit. I mean, really, go into something else, because when Grandma walks in there, it shouldn't take more than a one-hour appointment to sit there and screw four mini implants into the lower jaw and six into the upper jaw … she's already got an existing denture. All you have to do is figure out where those metal frames are, put a mark on the first bicuspid, make a little indentation, then fill the indentation back up. It's a very simple procedure. It's $5,000. It's one appointment.

I see this whole industry popping up regarding surgically guided implants. About 96 out of 100 implants are placed one at a time, just like crowns. Let's say a person is missing a tooth. There's a tooth in front of this missing tooth and a tooth behind it, and you're telling me you can't numb that up, lay a flap, look down at the bone, split the difference, drill a hole and place an implant? You don't need hundreds of thousands of dollars of specialized equipment and surgical guides to get this done. There's an easier, more cost-effective way.

If you're going to place an implant, you need to know how to lay a flap. It's like peeling a banana. And then you need to see the bone. And then you need to drill a hole. What is the profession coming to when a dentist can't drill a hole in a missing area without a surgical guide? You can learn by using a guide, sure, but that's like putting training wheels on your bicycle and then never taking them off. Surgical guides and implants can be a controversial topic, that's for sure! Some people swear by surgical guides, and yet I can give you the names of 50 oral surgeons and periodontists who have never used a surgical guide for a single tooth implant. Don't make a mountain out of a molehill.

The whole bottom line here is fear. The fear is that you've never done it before. People get on the Dentaltown message boards and complain that Grandma is coming in for a sore spot and they don't want to do a denture reline because she'll have to come in five more times. She's not comfortable, and the reason she's not comfortable is because you didn't place four mini implants on the lower and six implants on the upper and you gave her a bad reline, and she's miserable. And you didn't even make money on this because you can't screw a mini implant into a jawbone.

I am telling you, every dentist in the United States could be placing 500 implants a year in a combination of probably half minis for fully edentulous, half for a single missing tooth. If American general dentists did implants at the rate of the South Koreans, the American implant industry would grow exponentially and we would go from the golden age of dentistry where everything was done in porcelain and white fillings, to the titanium age of dentistry, where we fix these teeth once and when the bugs came back to eat them, they can't. We'd go from being dental engineers to dental biologists, finally learning how to make a barn in the middle of a field that the termites can't eat.

You're a dentist. You can do this.
Howard Live
Howard Farran, DDS, MBA, is an international speaker who has written dozens of published articles. To schedule Howard to speak to your next national, state or local dental meeting, e-mail rebecca@farranmedia.com
2015
17
JULY		 Fort Lauderdale, Florida
Southeast Institute for Advanced Dental Learning
tom@mccawley.com
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