Very Dental: Dr. Lance Timmerman on Guided Biofilm Therapy & Frictionless Case Acceptance

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[00:01:04] [SPEAKER_00] This is a production of the The Very Dental Podcast Network. This is the Very Dental Podcast.

[00:01:19] [SPEAKER_01] Welcome to the Very Dental Podcast, where you'll find entertaining and relevant conversations with visionaries, clinicians, and your friends in the dental space. Now, here's your host, Dr. Alan Mead. Very Dental people, welcome to another episode of the Very Dental Podcast. I'm your host, Dr. Alan Mead, co-hosting with me today the guy who, trying to think, is Tom Hanks the one on Saturday Night Live that is co-hosted the most? I think he is. The Tom Hanks of the Very Dental Podcast. I think it's him or Alec Baldwin.

[00:01:49] [SPEAKER_01] Okay, maybe, yeah. Alec Baldwin, I think, was even a cast member at some point. So, Dr. Lance Timmerman. The Tom Hanks or Alec Baldwin of the Very Dental Podcast Network. Welcome back to the show. Yeah. You know. Thank you. I mean, you could do worse. You could do worse. Yeah. Not much. So, Lance and I have been playing, I don't know if you can call it phone tag.

[00:02:15] [SPEAKER_01] It's like podcast tag, where we've set up dates to record and not and record. So, we finally got together on a Sunday afternoon, as one does. I'm covered in grass clippings. This is great. Oh. I've been out mowing my lawn. It's awesome. I have not. Oh, God. It's terrible out there. Just awful. I mean, it makes me itchy thinking about it. And then I go out and do it, and it makes me even more itchy. Yeah.

[00:02:37] [SPEAKER_02] I sold my house. I don't have a lawn to mow. It's beautiful.

[00:02:40] [SPEAKER_01] That's awesome. Did you sell the lawnmower with the house? So, like, if you wanted to mow something, you don't have anything to mow?

[00:02:46] [SPEAKER_02] We just kind of left it in the garage. And if they don't want it, then they can get rid of it themselves. But, yeah, that was right before COVID happened. And the kids were finishing college, and we're like, wait, you know what they say you can't go home? We made it so the kids can't come home.

[00:03:00] [SPEAKER_01] Yeah, you can't go home. The home is gone. So you sold the house. This was before COVID. So this has been a multi-year process. Where the hell do you live? Where do you live?

[00:03:09] [SPEAKER_02] I would say homeless, but no, we were in a townhouse.

[00:03:12] [SPEAKER_01] I mean, you are in Seattle area. So it sort of tracks, really, the homeless thing. Go ahead. The unhoused.

[00:03:19] [SPEAKER_02] Unhoused. So we sold the house. It was a 45-minute commute previously, and now I have a nine-minute commute. It's beautiful. Same office? Building? Same office. Same space, yeah. I just moved closer. We raised the kids kind of far outside of town just to be a little bit more in control of the environment as much as you could be. But now that they're gone, we're down towards the city, and it's just more accessible to everything. Yeah.

[00:03:46] [SPEAKER_02] And with parents aging and those types of issues, it's just better to be closer.

[00:03:51] [SPEAKER_01] Oh, yeah. Oh, yeah, totally. So I haven't moved anything. I still live on the sticks. I will say that.

[00:03:57] [SPEAKER_02] When you finally do, you're going to find out you're a pack rat, even if you didn't think you were.

[00:04:02] [SPEAKER_01] No, no, no. No, I know that we are. It's actually a nightmare. Okay, so we have –

[00:04:08] [SPEAKER_02] I can admit some things to you. My wife's brother is a cinematographer for TV show Hoarders, so we might just send him out there.

[00:04:15] [SPEAKER_01] Listen, I'm not even joking. It would probably go – like what I will say is we don't have like dead animals in our things really. Okay, this is crazy. Are you sure? Well, the good news is I know my wife doesn't listen to the show, so I can say this with no worries that she's going to hear it at all. But our garage and basement situation has been pretty bad for a long time. And so we have two of – a couple of the boarders at our farm.

[00:04:44] [SPEAKER_01] I don't know if they did it. They would never say this, but they decided that they would help us organize. So they started by organizing one of the barns, and it's freaking amazing. And you also think to yourself, wow, I really did buy multiple things because I couldn't find it. That's a thing for over the last 20 years. Then they moved up to the garage, and the garage is a thing of beauty. Then they went to the basement, and it is revolutionary. Like we have a lot of stuff.

[00:05:14] [SPEAKER_01] And one of the biggest problems is there's – when you have a lot of stuff, there's oftentimes a lot of packaging in the stuff. You know, like in other words, when you don't organize it and you don't keep it organized, it takes up more room than it needs to. All of a sudden, with the packaging gone and with it kind of stacked and organized slightly, it doesn't take up nearly as much room. So we don't have as much stuff as we had just stuff spread all over the place. It's revolutionary. I would say that.

[00:05:40] [SPEAKER_01] I still would not want to be my children when we die trying to get rid of this quote-unquote estate, but here we are. We're in better – they're in much better shape due to – There are boarders that have helped us out than they would have been. So, yeah, that's great. The hoarders crew can just hold their horses for a little while. I don't think they have us yet, but maybe. Maybe. We'll find out.

[00:06:06] [SPEAKER_01] Lance and I have been talking about some stuff over the last couple – I'm just going to cut right to it. So I have been – I know people have heard me talk about this on the podcast multiple times. I have been bordering on obsessed with this concept for dental hygiene that – I don't know. EMS is the company. I don't even know what EMS stands for. It's a European company.

[00:06:31] [SPEAKER_01] They have what they call the airflow and actually it's actually guided biofilm therapy. It's basically like – Yeah, the GPT. It's like dental hygiene kind of brought up to speed with what technology will allow for basically. Yes. And Lance is – I thought this is amazing and fantastic to see. I love looking at the videos and stuff of it. I've not really executed on anything in my office yet. I would kind of like to, but I have not.

[00:07:01] [SPEAKER_01] Part of it is I – outside of Irene who uses it like crazy and has amazing videos and stuff of it, I haven't – I don't know anyone who's using it. So I want to know what it's like. So lo and behold, Lance is all in on this thing. Lance over the last year or so has started to use it with his hygiene program. So I'm just curious, Lance, what got you into guided – I want to hear everything. So what got you into guided biofilm and tell me about it and all that stuff?

[00:07:30] [SPEAKER_02] Well, I was looking for a way to be efficient. I didn't want to – right now we give 60 minutes for a hygiene visit, a typical routine hygiene visit. I didn't want to complicate it and add time. In fact, I want to do the opposite. I wanted to be able to be even less time, not necessarily to shorten the appointment, but to be able to get done. Because there's always so much more you want to do.

[00:07:58] [SPEAKER_02] Now we have the iTero and we're trying to scan every single patient. Well, there's five to ten minutes there. What are you carving out to do this? That's exactly right.

[00:08:05] [SPEAKER_01] If you've got a set time and you want to get more things into that set time, you have to figure out how to do it. And every hygienist feels rushed all the time. No matter how much time they have, they feel rushed. So you kind of have to come up with some solutions for them is what it seems like to me.

[00:08:21] [SPEAKER_02] We've also – we're in a situation – for sure in Seattle, I'm hearing it's nationwide, but there's just a shortage. You put an ad out for a hygienist, good luck. Or – I mean I just screenshot it. I'll send it to you if you want to see. Someone was on a Facebook employment page saying, hey, I'm available and gave the dates. And they want $85 an hour to do hygiene. And I'm just like – well, I typed out, fuck no.

[00:08:46] [SPEAKER_02] But then I deleted it and decided I don't want to get – because the hygiene community, I don't want them to give me one-star reviews.

[00:08:54] [SPEAKER_01] Yeah, exactly. Exactly. That was very thoughtful of you to not send that. Yeah.

[00:09:00] [SPEAKER_02] In years past, old Lance would have pressed that.

[00:09:03] [SPEAKER_01] Well, but okay. So the reality is COVID sort of did something to hygiene a little bit. Yeah. And I have – like my hygienists – I have done really well with hygienists, honestly. I actually hired a hygienist because we lost one. It was the craziest thing.

[00:09:19] [SPEAKER_01] Like literally the week before they shut us down for COVID, my full-time at the time, my four-day-a-week person was quitting because she found – she had like an hour and 10-minute commute. So she found someplace closer to home and she said I'm – and it was one of those things where she's like, well, I can give you a couple months to find someone. And it was great. And then the world shut down. Literally. It was right before they shut us down for – and you're like, yeah.

[00:09:46] [SPEAKER_01] Yeah, so hiring for a hygienist in March, April of 2020 was sort of like – literally, if you remember correctly, we didn't know what was going to happen. We had people saying with a serious face that dental hygiene was going to have to be done under – remember, the vacuum rooms or whatever. I forget what they're called. Negative pressure. Negative pressure. Negative pressure operatories. And I mean I literally had Gary DeWood on the podcast saying, well, if that's the case, then dentistry is going to be a hospital-based thing because no one can afford to do that.

[00:10:16] [SPEAKER_01] So if you remember correctly, no one was thinking particularly straight in – Well, we learned a lot from the hygienist group. They really enlightened us on how – I'm grateful to say I am unfamiliar for the – I think I may have seen screenshots. I have not been. Oh, really?

[00:10:30] [SPEAKER_02] You might want to bleep out my mentioning that. That might just get the militant ones on me.

[00:10:37] [SPEAKER_01] Yeah. I mean – but we didn't know anything and I was actually able to hire someone. It was the craziest thing. I hired a part-timer. She didn't have a license because she was still in school and they went ahead and gave her a provisional license because they weren't doing – They weren't doing – Oh. They weren't doing boards. You're just sort of like, wait, what? You're not doing boards? She's fine. She does great. It's an argument. It's more of an argument for why are we bothering to do boards than anything else. Right. But I do have to laugh. So that was my situation.

[00:11:06] [SPEAKER_01] But I do know that there was a lot of talk about, okay, so if a lot of hygienists left the profession at that point or decided they weren't going to or weren't sure, and dentists who have based a fair amount of their model on hygiene were sort of stuck a little bit. We didn't know – they didn't know what to do. So I know a lot of people started looking more seriously at ways to make their existing hygiene situation, whether it was with a hygienist or with a dentist or whatever, more efficient.

[00:11:36] [SPEAKER_01] And so that's kind of where I started seeing a lot of this –

[00:11:39] [SPEAKER_02] Well, for me, my hygienist, when COVID shut down, she retired. She actually – her and her husband, they're both hygienists, created a thing called New Bird. And it's a way of suctioning – it's a mirror that acts as a saliva ejector. Yep, I've seen it. It's pretty cool. Well, it had huge demand because of COVID. So she's like, hey, I'm retiring. She was not retirement age, but she wasn't far off. And she's just like, you know what? Might as well do this now.

[00:12:06] [SPEAKER_02] I'm making enough with this invention and there's a high demand and trying to meet supply. So trying to find a hygienist then was a challenge. What I found was someone who – she's near retirement age as well. And I'll be honest. Thank God she doesn't listen to me podcasting or anything. Every day she's late and she's old. She's late. And I keep thinking, today's the day. She died.

[00:12:28] [SPEAKER_01] Yeah. Okay. You're worried more about your word literally about her. Yeah, that's scary. That's a little scary if that's what crosses your mind. Yeah.

[00:12:35] [SPEAKER_02] So we knew we needed to have some sort of system in place to be able to ride the storm. Also, in the meantime, past few years, I think we've talked about this. I have a friend that runs a DSO and I'll help out in a couple different locations and sometimes on a regular basis for a short period of time. Other times it's just as needed. Someone, death in the family or whatever and I just go. Very, very hygienist-based. Like a minimum of four hygienists at a time. Yeah.

[00:13:04] [SPEAKER_02] Their revenue is big but it's hygiene-driven. Yeah, yeah. And when I would go back after the COVID and everything, it's like a ghost town. And I'm sure they're just sweating bullets because they've got a nut to pay. Yeah, they do.

[00:13:22] [SPEAKER_01] Well, the other thing is I talk about this with my best friend from dental school. What about those practices that really and truly they were so hygiene-based? If you've lost hygienists, it's been hard to find them. And if you kept them, the pay has gone up significantly. So all of a sudden, your profitable model of multiple – these four and five hygienists running at a time, all of a sudden – if you've lost that profitability, all of a sudden your model starts looking a little goofy. Right.

[00:13:50] [SPEAKER_01] Like you can't keep employees and you can't pay them enough. So all of a sudden – I mean like I got to figure – and what I know for sure though is people who are taking insurance, the insurance companies have understand our concern and they've raised the amount that they pay us. That's the good news. Wait a second. A couple bucks. Wait a second. No, that didn't actually happen. They haven't done anything. They've literally done nothing. That's complete bullshit. So yeah, insurance companies don't care. Well, no, that's not quite true. That's not quite true.

[00:14:16] [SPEAKER_01] I remember one insurance company gave us like a couple hundred dollars of credit at Shine during COVID to help us out with it, like to help us buy extra PPE. Yeah, we got a little credit at Shine. Thanks. Thanks for that. I do remember. Yeah.

[00:14:31] [SPEAKER_02] That does sound familiar. Well, as a result of all that, our practice now has changed primarily, honestly. All of our marketing is for implants, marches of implants, multiple implants. And we needed a better way to clean the prosthetics because ideally we're not really – we're not removing them. So make them cleansable but also have them in and instead of taking them off and cleaning them, being able to – with EMS, I can spray around it, underneath it, and all that.

[00:14:58] [SPEAKER_02] So it kind of became a perfect storm of having the EMS trainer come in and show on us. It was funny. She did kind of look at my hygienist and do the math that she's going to be near retirement. Yep. And the person most interested was my assistant. Yep. So she was very adamant that this is not a tool to eliminate hygienists. So my assistant had to make sure she aimed the airflow away from the gums.

[00:15:24] [SPEAKER_01] Yeah.

[00:15:24] [SPEAKER_02] Because she's legally allowed to do coronal whatever, but she can't go subgingival. Yeah. And so she was trained to be able to do that.

[00:15:32] [SPEAKER_01] So – oh, that's interesting. So I didn't realize that was a thing. So the reality is – okay. So there – the EMS is meant to be used by hygienists and dentists, I'm assuming. Yes. I'm sure that's with the EMS. Yes. I wouldn't even – politically, I suppose, depends on state-to-state what they're allowed to do. But the bottom line is it's like even anyone using it – okay. So what I know about it is the way that you go about everything is different, maybe even reverse from what a typical hygiene exam was.

[00:16:00] [SPEAKER_01] So you start by disclosing, right? I mean like you –

[00:16:05] [SPEAKER_02] It's just like dental school. Yeah. I mean remember in dental school they had us do the disclosing tablets or disclose somehow and then work on it and do whatever you're doing. I mean the protocol with this is use – like I love to optrogate now. Place the optrogate, put the slide ejector in there and we bought this cool little tool that – it looks like a cobra.

[00:16:26] [SPEAKER_03] Yeah.

[00:16:26] [SPEAKER_02] Where the slide ejector is in there and it's bent so that it kind of hooks the way an isolate would. And you disclose everything. You show the patient real quick what's – and it comes – if you use the GC product, there's three colors. Yeah, it's the tri-color one. Old is teal. Yeah.

[00:16:40] [SPEAKER_01] So you show the patient. So you can say, what are you, some kind of garbage mouse? And then – yeah. Okay, exactly. Yeah.

[00:16:45] [SPEAKER_02] Yeah. And so then you go through and you – their approach is no more instruments.

[00:16:53] [SPEAKER_03] Yeah.

[00:16:53] [SPEAKER_02] Like you have – there's the piezaton that is attached to it as well as this airflow and that's all you need. While you're getting over it, you're probably going to keep a scalar universal or something just to kind of go over it. Because you kind of feel like you have to, yeah. But after you've done it a few times, you realize there isn't anything left. It's all clean. It takes you about 10 minutes.

[00:17:13] [SPEAKER_01] It's basically a dental sandblaster except it's not abrasive. It's not as abrasive as a sandblaster. I mean it's not – it's soft enough to – Yeah, exactly. It's soft enough that it doesn't remove tooth structure and it's like – Nope. Okay. Okay. So – and you basically – you spray all until the blue crap comes off basically.

[00:17:31] [SPEAKER_02] Yeah. And so I got my 6.0 loops. I can see where everything is. I just go right through and really five, 10 minutes later, it's all clean. Mm-hmm. Great. You grab the piezaton and those things are painless. The cavitron can have the zings and the whatevers. Sure, sure. The piezaton doesn't at all. I had one person. I was done completely. And he says, so are you going to clean my teeth? And I'm like, what do you mean?

[00:17:59] [SPEAKER_02] He says, all you've done is spray my – spray water everywhere. Yeah. And I'm like, dude, you're clean. And I had him look at the – this closing everything before we started. So I gave him the mirror again. I said, okay, all the pink is gone. And he's like, oh my God, that was the most comfortable – we were done in 15 minutes.

[00:18:15] [SPEAKER_01] So he was expecting you to start going after him with the instruments. Do you feel like just to give them their money's worth, you just take a universal and just kind of fish hook them in the gum every once in a while just to let them know?

[00:18:25] [SPEAKER_02] What I did is I went through with the jacket scaler and went mandibular linguals just to see if there was anything left. There wasn't anything there. So it was mostly giving him the sound effect so that he felt like he got what he came for.

[00:18:39] [SPEAKER_01] Actually, you know what would be cool is if you just do the sound effect. You just go – with your mouth and then they'll – So my understanding too is that when he felt it, was it like, wow, this feels really good?

[00:18:49] [SPEAKER_02] Yeah, because it warms the water. So you're spraying warm water everywhere and then a couple minutes later, you're done. So if you needed to take x-rays, if you needed to do the iTero scan, if you need to do anything else, you've got plenty of time to do it. You've got plenty of time to discuss whatever and you're still on time.

[00:19:08] [SPEAKER_01] So the reality is this thing actually changes all the order of your entire appointment basically because this is fast enough. This is fast enough. You wouldn't want to do an exam without having – like you'd want to do this first so you could see everything clearly. Is that essentially what you're talking about? Yeah. Absolutely. That's wild because it – I mean it kind of – I mean it kind of turns the appointment on its head a little bit, right? Like all of a sudden the way that you do things.

[00:19:32] [SPEAKER_02] I tell them we got to drag your feet a little bit. They're going to feel like they wasted time. It only took them 10 minutes. It took them longer to get here than worse for the point.

[00:19:40] [SPEAKER_01] I'm wondering if you explain to them that this is just basically the end all of hygiene technology and it's a different – I do. I mean because – I preface it with the next one. You know what they're going to do? The ones that are really going to make a stink are going to ask – they want you to put a profi cup on them and let them choose mint or orange or fruit punch or whatever, that sort of thing. It sounds like there's none of that needed because they're as nicely polished at the end of this thing as they would be with pumice.

[00:20:04] [SPEAKER_02] You can feel that they're clean. They're squeaky clean. You feel it to your tongue. You're like, oh my gosh, this is the cleanest they've ever felt. There is a slight mint flavor to it because there's xylitol in the powder.

[00:20:14] [SPEAKER_01] Okay.

[00:20:18] [SPEAKER_02] They absolutely want something. We can do a song and dance and put a rubber cup on our teeth.

[00:20:23] [SPEAKER_01] Yeah, or just let them rinse with some scope or something. Jeez. I mean it sounds amazing. And honestly – okay. Part of it is that hygienists can get on board with this. Obviously, there's tons of hygienists that have started using this and they love it. It is more efficient. It allows for more communication. I mean because if you're taking less time to do something that used to take you longer, you're buying some time in that appointment. Even if you're not trying to shorten the appointment, you're just trying to do, like you said, scans and that sort of thing. So you can kind of change things around a little bit.

[00:20:52] [SPEAKER_01] It sounds pretty great. Would you – I mean do you feel like – I mean I don't know many people who have switched to this yet. Like what do you – I mean you're a user at this point and you're – have you – do you have user groups? I mean the other thing is I'm wondering like if people learned about this, I wonder if they would seek out offices that have this thing.

[00:21:11] [SPEAKER_02] I would think so. The people that have experienced it with us are – they can feel that this is a better cleaning than what they've gotten before. Part of it – some of the resistance is when you – kind of like when you learn a new approach on a procedure and you kind of think about your old – you see x-rays come through and re-care and you're like, shit, that was me. I did that. Yeah. That was the best I could do with what I had. I can do so much better now.

[00:21:37] [SPEAKER_02] You start – when you really understand biofilm and what is being removed, whether you believe in causation, correlation, all that kind of stuff, it doesn't matter. The biofilm is gone and it's clean. And it lasts longer because when we were having the training, we cleaned my wife. She had been cleaned with my hygienist the week before. Sure. And so we disclosed her and we just found all the stuff that was missed. And Holly wasn't complaining about her cleaning. She thought she was clean. Yeah.

[00:22:03] [SPEAKER_02] And then she was – she could first see the disclosing solution and she's like, man, I thought it was all clean. Sure. And then we cleaned her all up. She goes, it felt great. And then a week later, we figured the same interval. Let's disclose her again. Interesting. And she was still totally clean.

[00:22:17] [SPEAKER_01] Really?

[00:22:18] [SPEAKER_02] Wow. Yeah.

[00:22:19] [SPEAKER_01] Okay. So the funny thing is, is there's – okay, almost no one out there is disclosing. Like, let's be honest. I mean, like, no one else – but in the same way that, like, if you do scaling or planning on a patient that's relatively healthy, that might have bleeding gums and a little bit of tartum, doesn't have any bone loss, or – you know what's amazing is how well they heal. Yeah. Because they never really had any disease. They just had some gunk on their teeth kind of thing. Like, we don't disclose, so it's hard to measure how well we're doing. You know what I'm saying?

[00:22:46] [SPEAKER_01] Like, I don't want anyone to disclose after I got in there because I probably wouldn't do that good of a job either. Like, on some level, the disclosing on its own is kind of revolutionary, the fact that that's, like, part of the system. I know there's hygienists out there that disclose, but I think a lot of them don't. I think a lot of them don't.

[00:23:03] [SPEAKER_02] Well, because they're pressed for time. Yeah. And this is going to take time to do. Well, this – now you have all the time in the world, and it makes it so much easier to have a target to spray. Yes. You just spray until the pink is gone.

[00:23:13] [SPEAKER_01] Well, that's exactly right because, you know, have you ever – I mean, when you hand an instrument after disclosing someone, by the way, not that easy. Like, it's kind of hard to get into all the spots, bits and bits. Like, I say this. It's not like I'm doing a ton of hygiene, but here's my point. So the hygienist should love this and get on board with this. But you're also saying, okay, what about an office that cannot find a hygienist?

[00:23:34] [SPEAKER_01] You're saying the dentist or even, depending on the state, a trained assistant that has the capacity to do coronal polishing or whatever would be allowed to use this. Is that essentially what you're saying? Yeah. Yeah. If you wanted to be a super lean and mean office and not employ a hygienist but still do a good job, literally the dentist could probably do this between patients is what you're saying. Easily. If you had some kind of an organizational situation. Yeah. Yeah.

[00:23:58] [SPEAKER_02] You have your assistant. Go ahead and take your x-rays for you. Put the opturgate in there. Disclose. Show the patient. And then you come in. Everything's already disclosed. Ten minutes of spraying that.

[00:24:08] [SPEAKER_01] Yeah. Yeah. You know, I'm not trying to put words in anyone's mouths and there's obviously people that get all upset about this for us. But the reality is right now there's just basically this company, EMS, has come up with this thing. And they have a really good social media presence. I like what – like I follow them. I like what they've got going on. I'm interested in it. I will say this. A couple – I don't know if it was last year or the year before at the Greater New York. I spent a little time at their booth just looking at the hardware because you're thinking to yourself,

[00:24:35] [SPEAKER_01] unless this is really efficient, like switching a handpiece and stuff, they have quick release. It's pretty slick. Like it's pretty slick. There's not a lot of – I have an AquaCare, which is an awesome piece of equipment as well. It's not quite as easy to – it's not a quick release in the same way that this thing is not very hard. I will say this. The AquaCare is not hard to switch out. But this is – for a busy hygiene practice, man, I mean you end up investing a bunch.

[00:25:00] [SPEAKER_01] It's not an inexpensive product, but my suspicion is it lasts for a good long time and it gets the job done. So you're talking about – but you really have to have – it sounds like a mindset change in hygiene to make this work. In other words, you can't really half – I think so. It's not a half-assed thing to do. You're like, well, I'll do this, but then I'll polish them with a cup too or whatever. This is sort of like your hygienist – whoever is delivering the care has to be kind of bought into it, would you say?

[00:25:24] [SPEAKER_02] Yeah, yeah. Yeah, and I think after a little while of using it, you'll buy in. You might do the rubber cup for the first couple weeks and then you just realize, what's the point? It's clean. It's really clean. But you're talking about how things heal. So even though I'm going to be doing like an all-on-X, upper and lower on someone, there's two different types of powder. There's the regular and then there's the classic. It's a little bit more abrasive, but it's for the tenacious stuff. So we bring them in and we'll still do this.

[00:25:50] [SPEAKER_02] Even though I'm going to pull all their teeth, I'm cleaning them with this so that the tissues heal better when I extract them.

[00:25:57] [SPEAKER_01] Yeah, well, you're removing a bunch of biofilm that's going to be gunking up your surgical site. I mean literally you're like cleaning them before you – that's wild. How long – okay, if you were going to do that for like an all-on-X, how would you time that? When would you do that? When would you do the EMS? When would you take the biofilm off? Would you give them a couple days after that for their gums to get in? Okay.

[00:26:17] [SPEAKER_02] Because usually we're going to – I'm going to do that on the records appointment where I need to take CBCT and iTeroScan and all the things I'm going to need. And we just run them back. It's only an added 15 minutes, maybe half hour because there's going to be a bunch of barnacles or something to go with. But it's not that much extra time. And we're not trying to necessarily be absolutely thorough because I'm taking the teeth out. I just wanted it a little easier to grab hold of the teeth to extract. Or see the teeth in some cases. No, I get it.

[00:26:47] [SPEAKER_02] So it's just a few extra minutes makes – it's kind of like iTero when I'm doing a crown. Yeah. It might take a little bit longer to do the scan, but my crown seat appointment is five minutes instead of a half hour. Oh, yeah. Yeah, totally. So I'll front load it.

[00:27:01] [SPEAKER_01] Yeah. No, that's awesome. Okay. So I fully expect there will be people that have questions, concerns, comments. There will probably be hateful comments. I love hateful comments. I mean if you're a listener of the podcast though, just go to the Very Dental Facebook group and ask. If you're not a member, ask for an invite. You've got five passwords. One of them is Timmerman. It has been from the very beginning. Timmerman. We have Timmerman, Lipscomb, Papa Randy, Hornbrook, and McQuethy. Those are five passwords you can use to get in.

[00:27:30] [SPEAKER_01] Timmerman was the first and the longest lasting because you were the first guest of the Very Dental podcast. You're also the first guest of the Dental Hacks podcast. I'm Tom Hanks. Just Tom Hanks. This is the Tom Hanks of the Very Dental podcast. Yeah, exactly. So I want to ask you something else, and then I got another topic I want to hit you. So you had a bicycle crash last year or something like that. I mean – Exactly one year from today. Is that right? It was a Sunday morning. Okay.

[00:27:57] [SPEAKER_01] Okay, so I've told my story, but you came out – I got hit by a truck, and I didn't have surgery. I think you win. Yeah, I win, except I didn't because you had to have surgery. So what happened? I did. Okay. We're both old men that shouldn't be crashing on bicycles. I'm a part of the – I can say that much, but yeah.

[00:28:16] [SPEAKER_02] I'm part of Dave Clark's lecture, God's Mistake for BioClear. Yeah, yeah. So I had a tooth. I had just a groove on number 12. Yeah. It goes straight from – I remember that nightmare. I remember that nightmare. Oh, God. And so it broke. And so anyway, he restored it, and I don't have a crown on it. He did the endo. He did the buildup. More of a kind of a BioClear onlay kind of a thing.

[00:28:44] [SPEAKER_02] And he wanted to have pictures.

[00:28:46] [SPEAKER_01] They should call it a BioClonlay. That's what they should call it. Pretty much. Dave, you can have that for free. That's a BioClonlay that you have there. I like that.

[00:28:55] [SPEAKER_02] Yeah. So he – it was kind of like us trying to get this podcast, and the schedule's just in fit, this and that. And finally, he wanted me to come down to his office. So he brought all of his cameras to my office on a Sunday morning. So I came in, and we took the pictures and all that kind of stuff. And then he went home, and I'm – it was a beautiful Sunday morning. So I rode my bike to the office. Since I've moved, I'm only nine minutes of a car ride. It's about 20 minutes on a bike. So I do that.

[00:29:23] [SPEAKER_02] Well, on Sunday mornings, there's not a lot of traffic. So a lot of the cars in the area of Renton that I was biking through, it doesn't matter if the light was red or green. People are just going to go. And so I'm coming through. I didn't realize that was an option. Who knew? Yeah. You know, it's the tree in the woods. If there's no one witnessing, did you really run the red light?

[00:29:45] [SPEAKER_01] Yeah. Ask Lance that question.

[00:29:46] [SPEAKER_02] Well, the truth is yes. Yes. Yes, you did. So I have an electric bike. This is what's even better. It's this big, beefy electric bike. They have a limiter, so you can't go past 20 miles an hour unless you hack into the computer and make it so you can go 28 miles an hour.

[00:30:07] [SPEAKER_03] Hmm.

[00:30:08] [SPEAKER_02] Who would do that? Yeah. Because, you know, it's so much fun. Yeah. So I'm going about 28 miles an hour. Oh, wow. Turning left in the street, and a car was right there. And so I swerve, and I miss. In hindsight, I wished I would have hit the car because I went straight into the light pole.

[00:30:27] [SPEAKER_01] Oh, no.

[00:30:28] [SPEAKER_02] Which doesn't have any give.

[00:30:30] [SPEAKER_01] No. No. At all. I will say the truck that hit me had some give because I marked his car up pretty good. It was literally, it was the only thing that I can say, at least I beat his car up because, yeah. Yeah.

[00:30:43] [SPEAKER_02] And so this car missed me and just kept driving. Oh, are you serious? And I'm in a pile.

[00:30:47] [SPEAKER_01] Oh, my gosh.

[00:30:48] [SPEAKER_02] I'm in a pile on the car sidewalk. So I get up, and I'm like looking for my phone. I have my phone mounted as a GPS.

[00:30:56] [SPEAKER_01] Yeah, I did too. I did too. Yep.

[00:30:58] [SPEAKER_02] And I can't find my watch. Yeah. I can't find my phone. Just knock the shit right out of you.

[00:31:03] [SPEAKER_01] Just, it was like when you're skiing and someone does, what do they call it, a garage sale when they lose everything? You were a garage sale, basically.

[00:31:11] [SPEAKER_02] I was that. Yeah. So then I get the bike on. The throttle was still on. So the wheel's spinning. So when you put it up, all of a sudden it's leaving me.

[00:31:21] [SPEAKER_01] Yeah, exactly. Oh, my gosh.

[00:31:22] [SPEAKER_02] I have to run to go get my bike. And finally I'm like, how do I, I got to get home. I'm still about a mile and a half away from home. I'm like, well, she, well, actually since the throttle still works. You rode home? I just got on my bike and just kind of, you know, Charlie Browned it all the way through everything. Yeah. All the way to back home. And so it's a Sunday morning. This is like 9 a.m. at this point. And I come up the stairs and I find Holly. And I say, hey, can you help me go find my phone? And she's like, where's your phone? I'm like, I don't know.

[00:31:52] [SPEAKER_02] That's why I need you to help me find it. Oh, my God. And then she looks at me and I'm all scraped up. She goes, are you okay? I'm like, no. Yeah. And so I go to take my coat off. And then I went, I realized, you know, things weren't moving normal. I'm like, okay, after we get my phone, can you take me to the hospital? To the hospital?

[00:32:07] [SPEAKER_01] Yeah, exactly. Yeah. I think I lost my phone, but I was able to find it right away because I called my wife after I dragged my bike off to the side. I mean, I got hit crossing a highway. It's five lanes of two and two. Yeah. So it's five lanes total. It's not a huge highway. It's out in the country. But, and I had the light and he just didn't see me. He was turning left. He just didn't see me. And I'm still really paranoid. I don't, I'm really paranoid to drive on the road now.

[00:32:35] [SPEAKER_01] I just, I just, but I dragged my bike. What I was worried about is that people didn't see me and that, cause people like to like speed on this road and like not pay close attention. I'm like, you know, the guy, the first one didn't get me, but the next one probably will. So yeah, I, I didn't realize that I had broken my back or anything like that. I was sore, but I mean, you figure you're pretty sore after getting hit by a truck and you just kind of, a lot of road rash and stuff like that. So then you went to the hospital and what broke? What all was busted?

[00:33:03] [SPEAKER_02] Several ribs. Dislocated my left knee, my right shoulder and I'm right-handed. So that sucks. My right shoulder had a class three ACR tear. Oh geez. So I had to have surgery and typical thing you can call it to say, well, I need to get in to see the surgeon. They're like, well, he's busy for the next three months. So luckily Holly can get her inner Karen. Yeah. Which isn't that inner. Yeah. She was able to bring it out. Say, look, he, he, he's a dentist.

[00:33:32] [SPEAKER_02] This is his career. He needs to be seen. And so I got in the next day, but then they only do surgeries on Wednesdays and, or no, Tuesdays and Fridays. And I said, I'll take this Friday. Well, he was full. We have all this insurance paper we've got to get through. So I couldn't do it till the following Tuesday. So luckily Clint is a dentist and hadn't bought a practice yet. So he was able to come in and kind of cover for me a little bit. The other Timmer.

[00:33:58] [SPEAKER_01] That's yeah. The other doctor.

[00:33:59] [SPEAKER_02] Yeah.

[00:34:00] [SPEAKER_01] Yeah. So Clint covered you, but that's pretty cool. I mean, that's the, so that was a year ago. So you're, have the Mariners tried to draft you as a pitcher or not so much?

[00:34:10] [SPEAKER_02] They have officially retired my eligibility.

[00:34:13] [SPEAKER_01] Oh shoot. I was hoping for that, but you know, that's what happens. Shoulder surgeries will do that to you. Sometimes it'll do it.

[00:34:18] [SPEAKER_02] Yeah.

[00:34:18] [SPEAKER_01] All right. The next thing I want to talk to you about, we don't have to, we don't have to belabor this, but something I've, I've, who, who was I talking to at first? It really inspired me to do it. My, my orthodontist does it actually, but so you, you will oftentimes use, use a, like do a virtual consult or a, or a, I don't know what you want to call it, but basically you will record like a case presentation. Yeah. And that's essentially what we're talking about is, is you, you've gotten some records and instead of having the,

[00:34:48] [SPEAKER_01] I have to say, I'm always torn by this. The new patient exam, they show up new patient. You don't know anything about what they need until you look at them and stuff. And if it's a simple case, okay, it's not such a huge deal to just sit down and tell them, but a lot of cases you'd like to take a little time with the records. You'd like to, to, to kind of, and, and so instead of having them come back for the consult, although you might sometimes I suspect you're at least giving them something. We have this crazy internet thing where they could, they could look the consult on their TV or their phone or their,

[00:35:17] [SPEAKER_01] their, you know, their tablet or whatever. So you put something together for that. I'm just curious, like how, how did you start doing this and why did you start in and how do you, how do you find that working? I have to say I'm inspired. I think it's a great idea. And I have a, I have the setup in such a way that I could, I could do it. I could do it if I figured out if it's worthwhile and if, if it's useful and stuff. So I want to hear what you're going to do.

[00:35:38] [SPEAKER_02] It'll take you about 10 minutes, 15 minutes tops. Okay. Since you know the gear, you know how to do it. It's, it's super easy. Now, you know me, I'm, I'm not that smart and I'm not original. I copy and steal from other people. And so this came from Danny domain down in Louisiana. Yeah. I was taking a class and he was saying that he takes the patient records that really their first visit is a records visit. It's not a lot of time with him. He's not explaining anything.

[00:36:06] [SPEAKER_02] And the second visit is when they're going to go over it. But the second visit ends up being much easier because they're not going to ask any questions because they've already been answered. And so what you, what I do is I, and it helps to have a library of other cases to kind of pepper in there as well. Sure. Showing what you've done and things. These are for most of these, these are specifically for all on X type of cases. And so you do a Camtasia is a great software. Any,

[00:36:34] [SPEAKER_02] any screen grabbing software is great. And you just kind of go through. Now, what I do is I, I just press record and then go. And so sometimes there's a whole bunch of dead space where I'm clicking and grabbing and dragging and dropping. When you edit, you can just snip that out. And so it just moves along. So you might have a, your raw recording is 15 minutes, but the actual result is seven because, or if you're more prepared than I've been, you might have it all lined up. So you can just click and make it really, really fast.

[00:37:03] [SPEAKER_02] I'm usually doing this kind of in between patients or slightly after hours or something. So I'm trying to just get through this. And what's cool about it is now when you have it all edited and you can, you can throw pictures, you can go screen grab a video off of YouTube on showing animations. You can do screen grab. If I'm like using a co-diagnostics as a software, using blue sky bio would work as well. You could do a screen grab of that showing here's where I plan to place your implants. Right. This is how it works. If you want to show a video,

[00:37:33] [SPEAKER_02] this is how an implant works. You show a real quick video on that. It can be as detailed as you want. And so you can then upload it to a YouTube channel, but put it as private. So they, it's not a HIPAA violation that nobody else can find it, but if they want to share it with other people, they can. You can put it so private that only you have the link and people have to get the link from you.

[00:37:55] [SPEAKER_01] Yeah.

[00:37:55] [SPEAKER_02] But if you have make it slightly less private, then they can share it as well. So kind of the, what I've found is if they've only watched it a couple of times, I'm probably not going to close the deal. If they watched it more like five to eight times, they're in, we're going to do something. And usually in the treatment plan, I'll show the best and an alternative, maybe a third, but usually I'm only going to show two options just to keep it less complicated. And then, um, so we know they're going to do something if they've watched it that many times. And if they've watched it like 15 to 20 times,

[00:38:25] [SPEAKER_02] that means they've shown their friends and their family and everybody. We might get, look at it as a marketing expense.

[00:38:31] [SPEAKER_01] Yeah. Yeah. But I mean, the reality is, is a lot of us, the technology is such that if you've got even a laptop at your office, you probably have more than enough from what you'll need to be able to do something like this. It's, it really, and, and like an enthusiast with a great mic and a really good, it's fine, but you probably don't even, you probably don't even need that when you think about, I mean, let's be honest, Tik TOK and fricking Instagram videos are done on a phone and they, they, if you, if you were able to take your,

[00:39:00] [SPEAKER_01] your iPhone back 25 years ago and show everyone, they wouldn't even believe it, you know? So the reality is that we,

[00:39:05] [SPEAKER_02] the technology is not, it shouldn't be the issue. I think Danny, when he was showing his demo, I think he just used the mic from the webcam on his computer. Yeah. And so, you know, it's a, it's a, it sounds a little bit different than if you have an actual microphone. Sure. But patients don't give a shit. They just want to get it, get the information. So essentially when they come in for their consultation, they're just saying how I chose plan B, and so you already gave them a price. They already know the price. There, there's really not a lot of questions. It's just, which,

[00:39:35] [SPEAKER_02] which one did you want? And let's sign.

[00:39:37] [SPEAKER_01] You're saying patients are, patients are into this. This isn't, this isn't where, and I guess it, it makes sense. I think I'd be into it. If I, I've had, I've seen my orthodontist do, do a meeting with me on their plan for their plan for a patient, you know, like that he'll send me a short video of that. And I'm like that. And all it is, is him talking about, you know, he shows me the Invisalign setup or whatever, and show what he wants to do with it, which is pretty impressive. Honestly, it's, it's a lot of information in a short amount of time. That's very helpful.

[00:40:07] [SPEAKER_01] I guess. I feel like that. What, what wouldn't patients like?

[00:40:10] [SPEAKER_02] Well, they can also go back to it. Yeah. It's, they can go back forth as many times they need to answer the questions that they might've had. Um, and so, pills you want, uh, you can make it a little vague so that they call you. Sure. You can answer the questions directly. It's kind of up to you.

[00:40:26] [SPEAKER_01] So you've been, how long have you been doing this? A couple months, a couple months. And patients are, patients are down with it. They like, you know?

[00:40:33] [SPEAKER_02] Yeah. Yeah. They, they think it's pretty cool. Um, I mean, people are, like you said, Tik TOK and Instagram and everything has got us so programmed. You're right. This, they almost expect it. They didn't expect it, but they didn't, I don't want to say they weren't impressed. Um, but I don't think they were impressed, but they, they,

[00:40:51] [SPEAKER_01] no, I get it though. It's, they, I, it is different. I mean, it's different. Every, every dental office of, you know, like I'm sure you've gotten this. I've gotten this, but I've never seen this before. I mean, you know, like the microscopes or, or, or, or I've never seen this before. So on some level they, they're impressed with the technology, but they're also showing them. This video is not that foreign to them if they've ever been on YouTube or, or Instagram or TikTok or whatever. So it's kind of, it's kind of something new, but also something they've seen a bit of. I kind of love that actually. I think that's really smart.

[00:41:19] [SPEAKER_02] So it's not like they have to learn how to play a YouTube video. Everybody knows how to click play.

[00:41:25] [SPEAKER_01] They do. Exactly. I know that sounds sort of silly, but you're based. So, and you end up sending it via email or a link, a link via text or, okay. So you can, it's a link via email. Okay. And it's a private YouTube channel that only they can get to basically.

[00:41:38] [SPEAKER_02] Yeah. That link is unique and it's private. It's not searchable. It's not anything. So, uh, only they can see it. Um, but if they want to share the link with a family member, maybe there's someone who's, that would be helping them financially. Well, maybe they are the ones. I mean, how many times you have the wife come in, but the husband has, makes all the decisions, but he's not there at the consult. Yeah. It's why I got to go home and talk it over with my husband. Well, they're only just going to tell them the price and they're going to say no.

[00:42:02] [SPEAKER_03] Yeah.

[00:42:02] [SPEAKER_02] But if they actually see the video and the reasoning behind. Yeah. Why zygoma implants are the only option or, or whatever the case is, it makes a little bit more sense.

[00:42:12] [SPEAKER_01] I, you know, in part of me figures that you, you would reserve this for big cases only. But honestly, I feel like depending on the patient, you probably could do it for smaller stuff too. I mean, it's, it's,

[00:42:21] [SPEAKER_02] you could do it for a single bridge because it's not, it's going to be,

[00:42:25] [SPEAKER_01] especially if you've got the setup, it's not very hard to do. Like, yeah, it's fast. Once you've done it a few times. Yeah. Yeah. The payoff is big for, for just a little practice on getting, I feel like, I feel like this is smart. I feel like this is probably what's coming, you know, any listeners.

[00:42:40] [SPEAKER_02] Well, when you figure the cost of acquisition, you know, you make all these, do all these marketing things. Therefore you finally got them in the door. Yeah. If it only took you five more minutes of a video. Yeah, exactly.

[00:42:50] [SPEAKER_01] Yeah. I kind of liked it. I kind of liked that. So I, now here's the other thing, listeners, if you're, if you're listening to Lance and I and thinking we're complete idiots because you do it way better and you're doing something awesome, then you have to go on the Facebook group and tell us how you do it because we're both, we're, we are likely idiots. We've, we've been here. It's not our first rodeo on being idiots. So we are, we are very open to open to suggestions here, but I think this is really cool. And honestly, Lance, we've already gone like 40 plus minutes. Oh, it's,

[00:43:18] [SPEAKER_01] it's like time sure flies when you're having fun sort of thing. And this is what we were planning on talking about. So, uh, and, and a little, little bike crash, you know, a little to, to cleanse the palate a little bit, really as one does to prove how much of an idiot I really am. I, I, uh, I mean the, I can't believe. Okay. So I, I don't know if I've told you this. I have a, so I, I mountain bike now cause I found a hundred percent less pickup trucks on mountain bike trails than on,

[00:43:47] [SPEAKER_01] on roads. Um, I mean, I, I, I do road stuff a little bit, but I prefer mountain biking is more fun anyhow, but I will say I, I crash on my own quite a bit more on a mountain bike than I ever did on the road. Like, like it seems like on a mountain bike, things sort of jump out from the trail, like, like trees and trees and stuff like that. Yeah. Or, or you're like, I literally, the last time I crashed before I got my, my body armor, which I'm going to tell you about, um, I was enjoying myself and, uh, going along. I wasn't going too fast.

[00:44:17] [SPEAKER_01] And then all of a sudden I'm on the ground. I have no idea what happened. I didn't hurt myself real bad at that time, but like, I literally went from, Hey, this is fun to wow. What the hell just happened? I literally like, I, what I think it was, was I think I got a, a handlebar caught on it, like, like hung up on a tree just enough to throw me over, over. So I went over the front and I, I didn't get hurt or anything like that, but I'm thinking to myself, had I done that, had that turned out a different way, I may have gone Lance style and needed shoulder surgery or something like that. So, and I don't know if this would help,

[00:44:45] [SPEAKER_01] but I went ahead and full Kevlar body armor for the, I don't have the pants. I just said, so apparently my legs can be crushed like a nut, but I'm, I literally look like a football player. Now I've got the full Kevlar pads and everything. It looks, it's in, with my helmet, it looks very, um, Oh, what's the, what's the, uh, Mel Gibson, you know, or eighties movies, mad, it's very Mad Max. It's very, it's very, it's very road warrior. It's very road warrior. Yeah. It's got, it's got a road warrior. Yeah.

[00:45:11] [SPEAKER_02] I, I into Whistler years ago. Uh, we used to take the family to Whistler for a week every summer, used to be previous, the winter. And then it's a crowd. We summertime was fun too. Well there, they have these trails. Now, if you've ever gone skiing, they've got a map, a trail map, and there's a blue and a green greens for easy. Blue is average. and black is don't do this. Yeah. Um, they have the same with mountain bike trails. And so the biggest thing with mountain biking for me was the riding up the hill. I hate that part, but I love just riding down the trails. It was cool.

[00:45:40] [SPEAKER_03] Sure.

[00:45:41] [SPEAKER_02] But if you're not very good on a bike, yeah, it doesn't really matter. You, the colors, they're all the same. You don't see colors. You just,

[00:45:48] [SPEAKER_01] they're all, well, well, I mean like for me, I'm, I'm a Midwestern mountain biker. So like literally the only time we ever go down is after we've pedaled our asses off for a while. So there's no, so I think to myself at a ski place, I'm, I'm going to kill myself. They let you ride the chairlift up. And those trails are pretty fast. Even when I've had,

[00:46:09] [SPEAKER_02] I'm taking a green. Yeah. I took a green one down at the very end is, is kind of a sharp hook. It's, it's like an acute angle. And as I'm coming around there, I just didn't make it. Yeah. I just bit it and just slid. And so I'm like, God damn it. So being the person that, you know, get off back on the horse, I went and did this right again. Yeah. And bit it there again. Same spot. Yeah. So then Holly says, you should get protective armor. Yeah. So I did. Yeah. And I look at road warrior for sure. Yeah. And then I'm like,

[00:46:39] [SPEAKER_02] God damn it. I'm going to, I'm going to do this, this trail. I did the trail and I failed again, but now I had armor. Yeah. It didn't hurt as much. It still hurts. Yeah. Yeah. I just,

[00:46:48] [SPEAKER_01] I just figure like, I like dentistry enough that I need to be able to keep doing it at least a little bit. And I just, I lucked out. I broke my back in two places and literally was back to work in like three days with a, with a, Oh, this really lovely brace on like, yeah. So I, but I'm like, I kind of don't want to destroy myself, but I still, and mind you, Midwest mountain biking is definitely a different and lamer. Animal than out West, but I, I still don't, I'm an old decrepit man. I don't want to be breaking myself.

[00:47:17] [SPEAKER_02] Holly did point out, she goes, Lance, you're too old for this. It's true. She's not wrong.

[00:47:25] [SPEAKER_01] But again, we're not, we're not smart people. We've, we've, we've gone through this before. We're not. Yeah. I think we've established. Yeah. I'm dumb. Yeah. That's, I'm glad to hear I'm not the only one that's looking for road warrior stuff. It's really good. All right, Lance, it's been too long. I appreciate you being on and this is an excellent episode. If you have any questions or comments for Lance or myself, the two stupidest people in the room, feel free to, to put them out on the very dental Facebook group. I gave you the passwords before I'll give them to you again. You only need one password. That's Timmerman.

[00:47:55] [SPEAKER_01] Last name of this guy right here. I mean, it could be Clint, but it's also Lance. Timmerman, same, same way works. All right. And Lance, thank you a ton for being on. We'll catch you again on another episode. All right. Thanks.