Office Visit: Dr. Nick McHargue by Kyle Patton, associate editor

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Categories: Practice Management, HR and Accounting;

by Kyle Patton
Photography by Lana Eklund

Dentists spend most of their working hours inside their own practices, so they usually don’t get many opportunities to see what it’s like inside another doctor’s office. Dentaltown’s recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of how they practice.

Every year, Dentaltown asks readers to vote for their favorite products and services in the Townie Choice Awards, then publishes the results in our December issue. (See 2023’s winners here). Out of all the readers who completed their ballots, we draw one at random to win a special prize: $1,000 and the chance to appear in an Office Visit cover profile.

This year’s winner, Dr. Nick McHargue, has been a member of the Dentaltown community since 2002 and has practiced in Missouri for almost 30 years. Between his decades in practice and the lifetime of experience bestowed upon him by his father (also a dentist), McHargue has amassed a breadth of anecdotes and advice. In our exclusive Q&A, he shares the most important lessons he learned, reflects on his father’s influence and provides a candid look into the day-to-day of a true bread-and-butter dentist.

Office Highlights

NAME:
Dr. Nick McHargue

GRADUATED FROM:
University of Missouri Kansas City

PRACTICE NAME:
Nick McHargue DDS,
Columbia, Missouri

PRACTICE SIZE:
1,500 square feet;
5 operatories

TEAM SIZE:
8

How did you find your way into dentistry? I had the easy path into dentistry because there was no path—it was more of a drag strip! Dentistry is the only job I’ve ever known. Even to this day, I can’t imagine doing anything else. (I did dream of being a race car driver, but my mom was wise enough to keep me away.)

Growing up, my dad’s dental office was just like a second home where I had to clean, mow, water the flowers and trees and weed the garden.

After our work was done, my two older sisters and I would often practice/ play polishing each other’s teeth in one of the operatories. As we got older, we progressed from chore work into actual dental work, starting with basic lab work, pouring and mounting models and making baseplates and wax rims to eventually doing full wax setups for dentures and partials. A large population of north Missouri shows size 3P, Shade 62.

As we matured, we went on to chairside assisting, with fingers on the lip retraction, no gloves and no masks. Today, we joke about how our main job back then was to clear the patient of whatever debris was in there—usually Copenhagen or Skoal—before Dad came in.

My senior year, after state wrestling with a beat-up face, I had an interview for the six-year dental program at the University of Missouri-Kansas City in the basement of the dental school with Dr. Bruce Barker. Barker inquired about what had happened, and we proceeded to talk about wrestling for most of the interview. Six wonderful years at UMKC, and I was a dentist just like that.

Tell us about your dad and his influence on your career— and your life in general.

My education in dentistry with my dad was backward. I learned how to bake a really good cake, but didn’t learn all the ingredients until dental school. I knew the way to get things done and to get things to come out well … and then I learned the educational system’s way to do it. Once you know all the ingredients, you can make it great however you choose. That’s why I’m the chef, while my wife is more of a skilled baker (a stickler for rules).

Not only was my dad a dentist, he also was the town mayor for most of my youth. So everywhere we went, somebody knew my dad and, by extension, me. I’m not the social butterfly my dad is, but I have learned social skills. Not good enough to get a date, but enough to keep patients easygoing.

The best thing he taught me was how to treat patients. As a child, my dad took great care of me in the dental chair and was always very soft and gentle. The nitrous probably helped, but he was awesome. (Nitrous for kids is like lidocaine for adults in my office.)

My sisters and I joke about how our dad could read a book about anything and then have the ability to coach or teach it. He coached softball, baseball, the swim team—you name it. If he read about it, he could coach it. My dad worked six days a week between two awesome practices. During my teenage years, I actually took jobs hauling hay for a nickel so I wouldn’t have to go to his second office.

I still stress about work a lot. My wife, an optometrist, often says, “Why are you always so stressed about teeth? You have 32 teeth and you can replace them, unlike your two eyes.” Whenever I get frustrated and can’t fix something and the patient is upset, I just go back to that.

What kind of cases excite you the most?

I commend all the dentists doing FMRs and full-quad Class IIs these days. It’s fun, but a lot of headaches and work. My team and I enjoy the slam-dunk cases that change a person’s personality in one appointment, from diastema fixes and a broken front tooth to simple recontouring of misshaped/ chipped teeth. This is basic, easy stuff—one, maybe two shades at most. A dentin, maybe, but usually just enamel shade. Patients aren’t dentists. They want Hollywood teeth, nice and white and clean. Stop putting stain on Class Is! Please, just stop!

Before

After

How has your approach to dentistry changed over the years?

I know what works for me and what will last for my guarantee. A lot fewer Hail Mary passes and putting up with pains and problems. I have been around long enough to have seen my own failures, so I know what’s worth doing and what I should say no to.

I like to see long-term success in all of my work, except anterior Class IVs. (People just do stupid stuff and they’re going to break it, just like they broke the original.) I’m much more patient and conservative with treatment and patient needs. If the patient is having pain or swelling, I address it immediately. If the patient has intermediate decay, I make sure they’re on board with what it takes to take care of things so the restorations will last.

My practice now is like a fine mechanic: basic maintenance, occasional repairs, fillings and every so often maybe a root canal treatment and a crown. Unfortunately, through the years, I’ve learned that some people are not meant to have teeth. In those cases, I’m happy to provide dentures or partials. If implants are needed, I have two classmates who practice locally who are some of the best oral surgeons in the world.

What are some old-school approaches you still hold to?

I still remember coming out of school and saying, “I know more than my dad.” Nope. We have better gadgets, but someone please show me anything done 50-plus years ago, and then a cast crown.

One of those life lessons: After quite a few years working, I’m not placing any Class V or distal Class II anything on second molars, and forget me trying to restore a third molar! I’ll do it, but you must be someone special. (I extracted my dad’s second molar. Amazingly, he’s doing just fine.) I will pack amalgam in them, crown them, extract them or send you to someone fresh out of dental school or corporate (with free bleaching) to place composite.

One of the biggest lost arts is a good stainless steel crown (SSC)—one of the easiest methods of restoring a tooth. Pediatric dentists will preach about it all day long, but today nobody wants to do that for adults. To this day, I still see the occasional SSC properly fitted and sealed (I mean crimped and fitted) that has lasted 30–40 years. I would call that a complete success.

My dad quit practicing a few years ago. His practice was three hours away but I regularly have consults from his patients who come down to see me because if they have a SSC crown, they’ve been told by another dentist that it needs replacing. I tell them to save their money and go out while they’re here in Columbia. Something that was done right and functions for 20-plus years doesn’t need to be redone.

Crown and bridge, root canals and extractions make up a lot of your day-to-day. What’s your biggest tip for each of these procedures?

KISS, aka “Keep it simple, stupid!” Working with my dad, things were basic, easy and well-done. A filling took a condenser, a carver and an explorer. In dental school, suddenly I had 20 various hand instruments that some random instructor might want. (I think I still have that instrument pack from dental school, still unopened, somewhere back in the lab.)

I was happy to see a dental student post on Dentaltown a while ago, but they mentioned using a hatchet in pedo. I was like, “What the heck?” My kid used a hatchet at deer camp for firewood. Why would a dental student be using a hatchet in pedo? Unless you’re Dr. Lane Ochi or Dr. Jason Smithson, put that stuff away and learn to use a condenser for both packing and shaping. Explorer to finetune; take the band off and finish up with your finishing bur of choice.

Always go with a shade lighter for your composite restorations. Especially front teeth. Patients will always be happy with lighter.

For extractions, go to Dr. Tommy Murph’s threads on Dentaltown’s message boards and start reading. Murph’s principles are sound … just do it with a little more finesse and caring. My forceps are either 50-plus years old or less than $5 from auctions. It’s not the hammer; it’s the carpenter. Root canals are the one thing I truly had to learn on my own. My dad was great with roto reamers but initially, I had a few more separations than I was comfortable with.

I started using nickel-titanium files and those, in combination with my SybronEndo HP, made it much more pleasing. I was still having occasional separation, so I tried EdgeEndo X7 because of the price difference and I haven’t looked back. One hand file to length, apex locator, Edge’s X7, done and soak.

You’ve been in practice for almost 27 years. What advice do you have for the new generation of docs?

Do your research, and lots of practice and repetitions. Go to town on those typodont teeth. Build up your finesse and especially speed. Volunteer at health clinics, charities, whatever you need to get experience doing fillings and extractions. Call local docs and oral surgeons and get a bunch of extracted teeth on which you can do endo access and root canal treatment with rotary files.

Study hard on the financial aspects of life. Read The Millionaire Next Door: The Surprising Secrets of America’s Wealthy and The Intelligent Investor, and do Dr. Howard Farran’s Your 30-Day Dental MBA program. Most importantly, live under your means until you’re truly established, but still get away and enjoy things—take walks, meet up with friends and have a drink.

What’s your approach to marketing?

Location, location, location. I started my practice in a new, growing area, with signage on a main street and no surrounding competition. My initial marketing were ads in the Yellow Pages, the local paper and on flyers. But my biggest marketing was location—I opened next to a Hy-Vee (a large grocery store here in the Midwest) and soon after, a Walmart supercenter opened across the street. I had only one employee for four months, then had to hire two more. From there, everything just took off from my location and word-of-mouth referrals. My only marketing these days is through my kids’ activities, and that’s more me sponsoring the schools and kids than marketing.

Top Products

SYBRONENDO ENDOTOUCH CORDLESS HANDPIECE
Best accidental purchase I’ve ever made. I was playing with one at one of Dr. Stephen Buchanan’s courses and made the mistake of telling the rep how much I liked it. I didn’t officially order it but by the next workday, one was at my office—I put it to use and loved it. It’s cordless, lightweight, easy to control and adjust settings, and if it doesn’t get charged, just throw in a couple of AAA batteries and you’re good to go.

OPERA DDS PATIENT COMMUNICATION SOFTWARE
Out of sight, out of mind. I asked the front desk what one of their favorite things was, and they immediately said OperaDDS. It’s like having another employee doing all the appointment reminders and confirmations and registration forms.

EDGEENDO ENDODONTIC FILES
The safest files I’ve ever used. Funny, I feel like this is one of the newer products I started using, but my first order was in 2014! I love the X7 line especially—great handling. They unwind and don’t separate, which means I haven’t had to send a patient to an endodontist because of a broken file.

BRUSH&BOND BONDING LIQUID BY PARKELL
I’ve been using this product since it was introduced. I enjoy its ease of use and long-time results. This and 3M’s Filtek Supreme are my go-to restorative products.

FORAMATRON APEX LOCATOR BY PARKELL
Mine is 20-plus years old and I have a backup that’s never been used. Very accurate and easy to use.

Tell us about your team and why you think so many have stuck with you for so long.

Experience. I have an experienced team and they’ve all been with me now for five-plus years. They’ve been around the block and they know what’s out there. They’ve done health services, corporate and high-volume, high-pressure dentistry. They all have families and lives and appreciate a good-paying job with little to no drama. Everyone knows their role and can help where needed. They truly like their jobs, and when someone says, “Hey, my kid is sick,” they can take care of that without question.

During the COVID-19 closures, we tore up the industrial carpet and the glue on the floor and repainted the office. I think we may have kept the local Mexican restaurant open by ordering margaritas every day.

If there’s a snow day at school, I’m also taking one. I’m not risking the lives of my work family.

Years ago, I had production goals and bonuses. Not anymore. The team does their thing and, happily, they also take care of me.

My team and I try to have “fun days” each quarter. My personal favorite was taking a limo to the opening day of a St. Louis Cardinals game. Definitely a fun outing that showed my team how much I truly appreciate them. We had so much fun, I don’t even remember who won. It’s amazing how competitive they get with miniature golf, bowling and ax throwing.

How do you handle the practice management side?

It’s simple: The team tells me what to do and then I do it, unless I forget and then they tell me again. I have Post-It Notes everywhere. On the back door, there’s usually one stating, “Pick up your kids.”

Your practice is in a big college town. Tell us about what that’s like.

We do see a lot of college students. Going to the state university, most are affluent and have been taken care of as far as dental and ortho. We commonly see the PCRN emergency and need for the wizzies to be extracted.

But the hardest thing is college students coming in with perfectly straight teeth, minor O restorations and X-rays showing Class IIs and Class IIIs everywhere. Kids are bulletproof— they can just sit in class all day and sip on their energy drinks and Starbucks and think life is great.

I give them the huge speech on what they’re doing and the need to change, and out the door they go with a PreviDent prescription and reevaluation appointment to see how they’re doing. If things look good and habits have changed, let’s proceed with treatment. If no change and they haven’t filled the prescription or forgot to use it, out the door they go to the new grad or corporate office. I’m not messing with that.

That said, some of the most rewarding dental work has been on college students. I’ve treated at least five true emergencies of what I call “the crescent moon.” Crescent moon doesn’t discriminate between regular students and sorority girls or jocks—everyone goes out and parties too hard before their parents come to town. Crescent moon is that perfect chip that happens to the MFIL of #8–#9 when your drunk body hits the curb, bottle, pole, car door, etc. The joy and satisfaction in these kids’ faces after I’ve bonded the teeth back together so their parents won’t notice makes me smile as they head out the door. (And that’s when I start laughing, because they’re still on their parents’ insurance.)

What gives you the most professional satisfaction?

Just being out and having that random person look at me smile and say, “Hey, Dr. Nick!” But my best moment ever was early in my career, when I saw an ER patient after-hours and pulled her tooth. She just looked me right in the eyes and said, “Oh, doctor! You are so strong.” Best feeling ever.

This past summer, while I was attending my children’s swim meet, an 8-year-old swimmer managed to knock out her permanent #25. Because her family and I have mutual friends, they hollered at me to come over and assist. I was able to set the tooth back in place and later had her parents follow me to my office, where I bonded it back in place. The little girl was a rock star—she was so calm given the situation. I’ve run into her parents since then and spoke to the girl’s regular dentist and been told the tooth looks great. I felt fortunate to be at the right place at the right time.

So much of this business revolves around relationships. For docs who lack or wish to improve soft skills, what’s your advice?

That’s a hard challenge. I grew up in a small town where my dad was not only a dentist but also the mayor, so everyone knew me, and I was expected to be polite and talk to everyone. My dad has the gift of gab and can talk to anyone, anytime, but I’m not the same.

Sitting in my office, I can easily relate to someone and go over common grounds like MU sports, the Cardinals, the Kansas City Chiefs, gardening, farming ... there’s always something there. I make notes and have everyone make notes in our software. But the easy thing is just to ask the patient, “How are you doing? What’s been going on?” and actually listen and respond. But if you do have good clinical skills, the word will get out and you’ll do just fine.

I often joke with people and tell them never to go to a dentist who has perfect teeth. You want a real dentist who’s been through the trenches of experience. I was a Class II bucktoothed kid. Started with a Bionator in third grade, then fell at the ice rink during my sister’s birthday, breaking off #8. (A toothless guy working the rink was so proud of himself for finding and bringing me my piece of tooth left on the ice.) RCT/CR #8. Started full braces from fifth to seventh grade, and did another round again from ninth to 11th grade.

Somewhere in there, killed #9 playing dodgeball in gym—another RCT/CR. Mom was happy that #8 and #9 finally matched.

I have personally experienced it all as a patient. First year of dental school spring break, Dad had me in the chair and took out my wisdom teeth. I still remember him bringing VHS tapes and Vicodin home to me.

What about the profession has surprised you most during your career?

Technology. I am most amazed but also disappointed by it. Love digital imaging—best time-saver ever. But as far as charts, software, updates, constant new operating systems, noncompliance issues, ransomware and now viral insurance, you can be fined so much per chart (but I’m the victim who should be seeking legal compensation for the theft).

The other part of that is dentistry itself. I have seen a decrease in quality. The same-day milled and bonded restorative is absolutely nothing compared to a cast metal crown done 50 years ago. Just ask “Almunk” on the Dentaltown message boards. Please go to his postings and look at the quality and fit of those castings. They are fantastic and last forever.

I’ve made a career of redoing other offices’ same-day, lab-fabricated junk. I love my job but I don’t see pushing my kids into it. If I’m investing in my kids’ education, I’m taking that money and putting it into a service industry where they will enjoy building a career. I’m so tired of these institutions and their professors promoting need but completely pricing the students out of going there.

Give us a snapshot of your life outside of dentistry.

Several years ago, I restructured my office hours to be conducive to my family lifestyle. I have the daily pleasure of dropping my twin boys off at school at 7 a.m., and I start work at 7:30. I try to be done by 4 p.m. so I can pick them up after school or after practices.

My best life involves spending time with my wife and three kids (twin boys and a daughter). We enjoy exploring state parks, our national parks and any beach.

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