Very Dental Student: Is It Ride or Die? with the Dental Guys

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[00:00:48] It's time for a Very Dental podcast just for students and new dentists. Welcome to The Very Dental Student Podcast. And now here's your host, Mohammad Aboubasha. Hello everybody. Welcome to another episode of The Very Dental Student Podcast. I'm your host, Mohammad Aboubasha.

[00:01:05] Today, I have a real treat for you guys. I'm recording with some of the OGs in dental podcasting. I'm recording with the dental guys, Dr. Wes Mullins and Dr. John Rogers. It's really, it's a pleasure to be able to collaborate with them.

[00:01:21] So this is going to be part one of a two-part series. And the topic we will disclose here in a little bit. But first I wanted to give you guys, John and Wes, an opportunity to just introduce

[00:01:31] your podcast to anybody who hasn't heard about it and give us a little introduction to yourselves as well. Yeah. Well, thanks for having us. First of all, Mohammad, it's been, we've had a lot of really cool connections with Very

[00:01:43] Dental Podcast stuff going all the way back to the old talk about OG Alan. And so it's really awesome to get to kind of, you know, in a way sort of full circle back to, you know, being able to not just be the people sometimes asking the questions,

[00:01:58] which we were for so many years, but now it's sometimes having people actually asking us stuff, which is kind of weird. It's kind of weird, but what we do for those who don't know, and I'm John, the dental guy, and of course, Wes also, the dental guy.

[00:02:12] We basically started this podcast as we were like, well, you know, we had an ongoing conversation conversation with ourselves. It was a text thread, back when Google Hangouts was the thing, back and forth, sending x-rays, sending patient, you know, kind of photos and ideas and dilemmas.

[00:02:29] And we said, you know, I wonder if anybody else would want to listen to this as of because we were into podcasts, this is back in 2015. So we started recording some of these basically conversations about things like research articles

[00:02:41] and how it pertained to our practice and difficult cases and practice management. But really what we're most interested in is how do we take really complex topics and break it down into what you need to know for essentially your, your Monday morning clinical practice. And I think

[00:02:56] for the first maybe year, it was my mom and Wes's mom listening and uh, then- RGL And Alan Mead. SM And Alan maybe, yeah. And, and so then we, we actually started having some, some, some uh,

[00:03:08] product reps actually who we were talking about their products and they were like, hey, where are you guys? And long story short, it turned into now almost 10 years of talking about clinical topics, research topics, interviewing some of the biggest names in clinical dentistry,

[00:03:22] research-based dentistry. And really our passion is to try to take our practices and, and you know, hopefully the practices of, of people who listen to us to kind of to the next level, whatever that means for them. You know, we've, we've gone through evolution, our own practices from

[00:03:39] what we knew early on to what we know now. And you know, we want to help others figure out what that next step is for them to try to, to create a practice that, that truly is, you know, what

[00:03:51] they want and, and, and to do the very best dentistry they can do. So Wes, I know that's a lot of talking, but I mean, what does that kind of sum it up?

[00:03:57] RGL That sums it up. Um, you know, Wes, the dental guy, um, and John, the dental guy are better dentists uh, primarily because we had the dental guys podcast. So we said that if, if nothing else

[00:04:12] happens, we're continuing a conversation we were already having. And even to this day, um, we are in, uh, encouraging each other and challenging each other. And, um, we have, um, definitely conquered some of the things faster than we really thought were possible, um, in our practices

[00:04:37] because of the dental guys podcast. And so if we do anything, um, we've, I mean, at first it was kind of selfish and then we were like, does anybody else really want to hear this? And now

[00:04:49] it's kind of humbling, you know? And, um, and so I'm honored and I know John is as well, um, to be able to inspire and to help, um, dentists and future dentists, uh, really just maybe take

[00:05:05] it to the next level of whatever that is. You know, that's been kind of our mantra over the years. So thanks Mohamed for having us on. Thanks for arranging this. I know you and I've been kind

[00:05:15] of talking about this for a little bit and I'm super excited about this topic. So tell us a little bit about what we're going to talk about today. Well, uh, so the, the topic we kind of had picked out for today is what is comprehensive dentistry?

[00:05:30] Um, and what qualifies a dentist as a comprehensive, comprehensive dentist. So the show title is it ride or die? So, um, and you, I'll let you guys kind of unpack that more cause I know you

[00:05:41] guys chose the show title. Um, but really truly the, the question of what is comprehensive dentistry, I feel like is something that you guys' show has kind of inspired me. And you mentioned inspiring

[00:05:54] people to take it to the next level. Um, sometimes when I hear you guys talk and you talk about really holding yourself to a high standard, I feel like you're almost talking directly at me.

[00:06:06] And I know you guys have been mentioning on some of your, some of your episodes, like the younger dentists maybe being too quick to scan thinking it's just going to solve everything for them.

[00:06:17] And I, I will admit that that's exactly what I was thinking before I listened to you guys talk about it. So, so let's start with that first comp, uh, that first part of the conversation.

[00:06:28] What is comprehensive dentistry? You know, this is going to be great because if you're listening to this, this is part one of a two-part series and, um, this is, uh, released in, I think on July the

[00:06:41] 8th. Um, and I think the following next week, you know, the following Tuesday, part two will be on the dental guys podcast, uh, where we discuss the strategies and paths that a dentist should take

[00:06:56] to learn treatment planning and comprehensive dentistry. This is what we're going to talk about next week. We're going to talk a little bit about what CEs you need to take, but, um, and where you

[00:07:05] should go. How do you choose a philosophy of, um, of comprehensive dentistry? But John, I think that this is just right in our wheelhouse because what is comprehensive dentistry? I mean, Muhammad, I will never forget the first time I heard someone say that I have a comprehensive dental

[00:07:25] practice. John, you know, you've seen it even in advertising and marketing. And, uh, John, I, I just want to hear it from you first. I mean, John, you know, I haven't talked about this topic,

[00:07:37] but I know that we have a very passionate opinion about it and why we chose it and can we even implement it today in today's business, uh, uh, market environment. Yeah, it's, it's a, it's such,

[00:07:52] it's for me and for you too. It's, it's some, somewhat of an easy discussion from at the start, but then it gets complicated. And I think that, I think it's easy for easier, easier for Wes and I

[00:08:07] to define this topic now than it was early on because just like we, we've learned over our years, you know, you can only treat what you see. And so when you are in dental school and in the

[00:08:22] first few years of practice, or even if you've been in practice for 40 years, you can only treat what you see. And so many times when we talk to dentists, whether they're, they're beginning in

[00:08:33] their third year or they're in their 40th year, they are, uh, have this idea of maybe, well, I am treating what I see. And so that to them, that is, that is being comprehensive.

[00:08:45] And I maybe want to, to unpack it a little bit by saying, uh, Mahatma, when you saw your first maybe FMX and you saw a faculty member, maybe you've been in a treatment planning session with

[00:08:57] a faculty member who was, you know, taking in a new patient at the school. And they were saying, here's all of the things that I need to know in order to determine what a treatment plan should be

[00:09:12] for this patient. And they were maybe screening them for you to become your patient, or maybe you're involved in the screening. And so there's a series of maybe consults you have to have. Maybe

[00:09:23] you have to talk to oral medicine faculty and oral surgery faculty and perio faculty and pros faculty and endo faculty. Maybe you make some of these determinations yourself through bleeding on probing or gingival index, or maybe, maybe some of these things you're measuring,

[00:09:38] and maybe some of this is through checking boxes of everyone looking at your patient and telling you things, asking you questions, making you start to think about developing a plan. And then there's maybe different phases of treatment you were taught. You know, here's phase one, we're gonna

[00:09:53] control disease maybe, or here's, you know, how to think through how to, how to determine what this patient needs. But that's a start. But what we're talking about here is, is that everything?

[00:10:08] Is that everything? And what we noticed when we were in school, just because we know that this is the perspective you're coming from, it's important I think to start there, is that in school you only have a certain amount of time to teach concepts, topics.

[00:10:25] You can't even do cases involving multiple teeth many times because you're limited in time and your speed and your appointment time is available and the patients you have available, and the faculty

[00:10:37] shortages you may or may not have. So, you have a certain amount of time and a certain amount of things that you can be taught. And so, that is your box. That is what you will then see. You see

[00:10:51] what you have been taught. You see what you know. So, if you see what you know and you treat only what you see because you know a certain amount of things, that is maybe in your mind what your

[00:11:03] comprehensive treatment is. I treated everything that I knew to treat, and I'm not saying that's bad, but in dental school the truth is, and Wes and I both have relatively new dentists in my

[00:11:15] practice. My associate doc's been out for one year and three days or something like that, and so his box of things that he saw as what he knew was mainly single tooth dentistry.

[00:11:30] And so, what Wes and I as we start talking about this, what we mean by that is to say that you only had time to treat one or two teeth in dental school because you just weren't fast enough,

[00:11:40] good enough, or had really the ability for a faculty member to walk you through a comprehensive. And I'll just say one more thing. I want Wes to talk as well, but just think about orthodontists even when they go through residency. It's a two, maybe three-year

[00:11:56] residency. How many cases did they even see from start to true finish? Because they only have a certain number of years, so when we come out of school what we think of as comprehensive is one thing, but when we get out into the world of clinical practice,

[00:12:16] we start to see what specialists are doing. We start to see what research is telling us. We start to see what's challenging ideas that might have been taking a long time to get to the dental

[00:12:29] school world because things take a while to become first of all researched and then proven and then brought to dental schools to be taught. We start to ask the questions, well, what is that?

[00:12:39] And it turns out it might be a lot more than what you not only are taught, but maybe even to give dental schools a little bit of a break what it's possible to teach in a relatively short

[00:12:51] period of time. Wes, I know that's a lot of unpacking. What do you see as comprehensive dentistry maybe as you emerge from the dental school environment, you get out into clinical practice? What are some of the things that you see younger dentists especially get sort of slapped in

[00:13:09] the face with as far as what's the difference? Yeah. Show title, is it ride or is it die? You know? And right now, Muhammad, you're riding on graduation, filling credits, you know? And that's all that really matters. And sometimes in private practice, different aspects of dentistry

[00:13:36] rise to the top and you ride on that, you know? Sometimes stuff has to die. We'll get into that because John and I've been through dying times, you know? And so when you emerge from

[00:13:53] dental school, I think the very first thing that it's obvious is that you know how to treat dental caries. You know, you have a very narrow-minded view of like, dude, I see a class two,

[00:14:08] I know how to treat a class two. I see a class three, a class four, I know how to treat it. At some point, I know when a tooth needs a crown and you know how to treat it. That's the single

[00:14:20] tooth mindset. I feel like the first thing missing depending on the school is the understanding and it's because of how long it takes is the chronic disease of periodontology. And this is one of

[00:14:31] those things where we run into is that these diseases that somehow, you know, we can't see the breadth of what the impact of something is because it's not easy to correct. Those are things that require maybe more time in practice to really understand the therapy, you know? So,

[00:14:53] the longer things take to heal or not heal, it's hard to teach. So, for instance, somebody walks in with a toothache right now in dental school and even in my practice. Dude, ride or die. I can ride

[00:15:11] because I have a narrow-minded diagnosis for that patient. It's either extract it or save it with a root canal, okay? I mean, that's it. It's so comprehensive for that particular problem, okay? So, I think the misnomer sometimes is that comprehensive dentistry means these things.

[00:15:35] And I'm not sure if I'm right or I'm wrong, but comprehensive dentistry can mean different things to different people, okay? And that's what I believe, you know, is the misnomer of it. Because for one person, comprehensive dentistry might mean that, well, I treat cavities

[00:15:56] and I treat periodontal disease in my practice and I do – and here's where it's interesting – and I do a little bit of occlusion. I do night guards, you know? And that's comprehensive,

[00:16:13] okay? So, for me, I think, you know, as we emerge from dental school and we have this narrow-minded vision of what is possible, it's very difficult to take, in my opinion, an immediate leap into some of these more specialized procedures that require a greater understanding and vision,

[00:16:38] a broader view of diagnosis and treatment planning. And I think that'll lead into some of the things in the next show. But, John, I think, you know, as we talk a little bit about this is that, you know, does procedure competency mean that you're a comprehensive dentist just

[00:16:57] because you can do some procedure doesn't mean... I think that's a great point, Wes. That's such a great point, and I think that's maybe the thing to kinda maybe close out this part of the thought process is procedural competency or the breadth of procedures you can perform

[00:17:17] is oftentimes mistaken for comprehensive dentistry. And so, you have people that emerge from school or again have been in practice for a long time. This is not a new dentist phenomenon, this is a dentistry phenomenon. Part of it driven by a misunderstanding, we would say, I think,

[00:17:37] and part of it driven by business or the thought process that if I know how to quote do more things procedurally, then I am more comprehensive. And what Wes and I, if you've listened to any of the shows we've done over the last almost 10 years,

[00:17:58] you'll start to see that while we don't have all the answers, what we've come to understand is that being a comprehensive dentist has almost nothing to do with the procedures you can perform,

[00:18:10] and it has almost everything to do with being able to look at a patient and determine what this patient needs and how to go from A to Z, how to take a patient that comes in with

[00:18:27] teeth all in the wrong place, they're all worn, maybe some are missing, maybe some have disease, maybe some don't, and can you return that patient to health, aesthetics, functionality,

[00:18:42] and can we do this in a way that has nothing to do with whether we know how to do every procedure, but can we understand how to achieve this treatment plan, first to develop it,

[00:18:58] and then how to achieve it? I think that's really the key to comprehensive dentistry. It's not about the procedural mix you do or don't know how to do. It's about are you able to be what many times we

[00:19:14] almost don't want to be, it seems, is to be the primary care or the person who can come up with a plan and then determine even if you can only do a limited amount of things, how does the plan

[00:19:30] need to be accomplished? That is really the key, because when this faculty member did the treatment plan, did you know how they came up with a plan? And that is really a big difference between can

[00:19:45] you achieve the procedures that are in the plan. Very different. I think that if I would say that the one problem right now with dental education is the lack of focus on etiology, but the problem

[00:20:00] with that is that we have to teach technical skills as well as medicine, and there's so much, as John said, there's very little time to do this. And so that's why it's a practice.

[00:20:13] It's not a definite. It's not an absolute. And so the etiology of a patient and why they are the way they are when they present to you, what's their history? What is the true

[00:20:30] focus of their problem? What's the chief benefit? What's the chief disability? And what are their fit issues? These are things that even recently that I've doubled down on is that the etiology truly drives the diagnosis. And that is something that is really in some ways it's broken.

[00:20:56] As Kevin Cuishan said years ago about our dental education system. And so for us, this kind of gives you an idea of where we're at as what is comprehensive dentistry. Yeah, I think there's a lot to kind of expand on there because if you would have asked me

[00:21:18] a year ago what a comprehensive dentist was, I would have told you, well, it's a dentist that if you go there and you need Invisalign and veneers and implants and some crowns and a root

[00:21:32] canal, that they would do it all for you there at the office. And basically what you guys are saying is that might be what a comprehensive dentist looks like. But what's more important is their ability to be a comprehensive diagnostician and really set forward a path

[00:21:51] to health. Would I be correct in saying that's what y'all's belief is? Absolutely. Yeah, absolutely. Absolutely. That's what it's about. And that is in the end, if you desire to pursue a specific procedure to be excellent at that procedure, there's room for

[00:22:12] that. But the things that allow for you to truly be a comprehensive dentist from a standpoint of doing things at the highest level are that almost anyone that walks in, you know what they

[00:22:28] need regardless of whether you can provide it. You know what they need. And isn't that what we ask from our physicians? We don't ask our physicians to do every procedure. We ask them to know the best physicians primary care wise aren't the ones who can do everything. They're

[00:22:48] the ones that know who you need to see for the specific thing that you need and they can develop a plan. And we are in the same vein as general dentists. Now we can become in a way experts at

[00:23:01] certain things and do certain procedures at a high level perhaps, maybe even to rival a specialist. But is that the goal of being a great, especially general dentist? And many times I think that is

[00:23:16] the mistake that is made. It's early, early and many of many, and you know that wasn't the case when Wes and I got out of school many times because there was no way to compare yourself.

[00:23:30] There was no easy way at least to compare what you were doing in your practice with another person because social media did not exist. So there was no way to say, oh let me look at this person's

[00:23:44] Instagram and see all these crazy things they appear to be doing at a high level. And usually turns out it's not true, but if it was true there was no way to know. And so we would hear these

[00:23:58] occasional rumors of the super GP and we would think, oh wow that sounds cool doing like you said everything in-house bringing things in that sounded to the immature me to be comprehensive. But as we now see as people are bombarded with all these ways to potentially practice,

[00:24:22] that there is a confusion of what is comprehensive diagnosis as you well said, and what is this idea of just doing everything in the jack of trades and maybe the master of none. And that is what we see far more often in our world versus somebody who said,

[00:24:41] here's I want to understand what needs to be done and then be the one who helps to guide my patients to the right place to get it done. ISKRA Do patients, let me ask you this Mohamed, do people deserve to know that they can have or

[00:25:01] that hey look I see these problems you have and this is the ideal plan, complete care plan to get you on the path to health, dental health. Do people deserve that? MOHAMED Absolutely. I would, I was listening to a podcast the other day where I heard that the

[00:25:19] number one, one of the number one lawsuits against clinicians is the failure to diagnose things. So I think that any patient that comes in it's definitely our job as clinicians to be able to

[00:25:34] identify any problems that they might have whether or not they're gonna go about, you know, solving those problems. But I do think that it's our job to present it to them and to inform them for sure. ISKRA So is it possible to teach

[00:25:55] everything in dental school that to correctly diagnose everything? MOHAMED I mean yeah no way. ISKRA No way. Okay so before we go into that in the next show let's talk a little bit about

[00:26:07] like some of the ins and outs now that we've defined what comprehensive dentistry is which is basically diagnosis, understanding who we see and maybe being able to at least ascertain some type of path for that person to take and choose treatment options along the way that have

[00:26:28] pluses and minuses and then they understand with informed consent that hey I'm choosing this and you're informing them and they're consenting to treatment no matter what they choose they've been offered this complete care plan and you give them a not even a good better best scenario.

[00:26:45] I don't like to even use that. I like to say these are the different options, this is the most ideal and then if they can't do that then this is the what you're saying you can do this and I want

[00:26:55] to help you because of your fit issues. So as a dentist okay graduating dental school today what would you say most people are most people going out and buying practices today or are they

[00:27:08] becoming associates are they working for DSOs? What would you say that the majority of people are doing in at least in Oklahoma where you're at? MOHAMED I would say that at least half probably

[00:27:19] more than half are going into associate positions at DSOs and then you know the other majority after that would be going into associate positions at private practices and then the very few would

[00:27:35] be going on in Oklahoma there's no required residency so only a few would go to an AGDGPR and maybe one or two out of every class go on and specialize. Is there anybody coming out and

[00:27:48] starting up scratch? I don't know anybody who has done a scratch startup as a fresh graduate. I know one person in my class who plans on buying right out of school but it's like his hometown

[00:28:02] doc that's been waiting for him for a while. Yeah. So for the most part people are going to associate whether it be a DSO or a private practice associateship so I guess can an associate implement comprehensive treatment or comprehensive diagnosis without owner buy-in? John?

[00:28:26] Well I think maybe it's a great question maybe even before asking that I think we have to think about what many times are the things that Wes you and I have emphasized to new doctors as they get out

[00:28:46] into private practice about what to become good at because I think many times it's easy and maybe you listen to this you're like those guys I mean these dudes they're just this like almost it makes

[00:29:03] it sound like some faculty member at some dental school who's saying some BS because we've never been it almost makes it sound like we haven't been in private practice when we talk like that

[00:29:13] I mean am I right Mohamed you know what I'm saying it's like people are like oh you're like oh we're gonna do this comprehensive diagnosis sounds all very nice and it almost sounds like a sales pitch

[00:29:23] or something like we're talking about something that's like an ideal like I'm wanting then my next thing is I'll sell you my course I'm gonna teach you how to do this. Let's be brass tacks

[00:29:36] here because when people get out of school they a lot of times are like come on man I'm just like gonna make some money I gotta pay off this debt that is hanging over my head and you know what

[00:29:49] Wes and I were the same way you know we're the same exact way and you know what there's nothing wrong with that so I think that understanding that while there is this ideal that Wes and I

[00:30:02] believe in very strongly will bring you much more career satisfaction and the ability to feel like you're truly being able to treat your family members like your patients your patients like your

[00:30:13] family members at a high high level there's also that when you get out there's this idea of regardless of the situation that you are in there's a lot to be made for just getting good at

[00:30:26] being a single tooth dentist getting out and and focusing first on just being good at the things that you have been taught at dental school getting those repetitions in on the crown preps

[00:30:40] on the class twos on the root canals learning how to take out teeth a traumatically learning how to get people out of pain learning how to talk to people learning how to to you know set up your

[00:30:52] day to where instead of needing three hours for this restoration you need two hours you need an hour and a half learning how to talk to hygienists and how to involve them in helping you to you know

[00:31:04] get patients trust because you're trying to do the right thing for them and I still strongly believe while while you know I'll tell you at the same time I'm trying to get my associate doc off the

[00:31:17] off the ground as far as possible with seeing more because like I say you only treat what you can see that's not me saying that that comes from spear education Gary DeWood Greg Kinzer

[00:31:28] it's all people that are that are you know people that we look up to they taught us this it's not my saying but it's the truth when you get out how can you treat things you don't even see yet

[00:31:40] so we can't expect people to know how to how to treat everything or how to have this comprehensive look when you've not even been taught how to look at patients from a comprehensive standpoint that's okay you know be able to treat competently what you

[00:31:57] you know in other words you're taught the ideal crown prep right you're taught the ideal crown prep so get good get closer to the ideal with every crown that you prep I think what John is

[00:32:09] saying to focus and then the comprehensive side yeah it can be brought in but back to the question Wes because I don't want to well but what you're saying what you asked about what you're saying John is that the fundamentals there's certain fundamentals that are prerequisites before we

[00:32:25] can even go to the next level because I will we've just recently and we have a show releasing tomorrow on total versus selective etch technique and some of the controversy surrounding that recently in some journals and so yeah we geek out about that stuff even 20 years into practice

[00:32:45] but the things that really matter are there certain fundamentals to treatment planning and there's certain things that I feel like you know the prosthodontist of old that said I only do crown preps I don't do bonding now what we've all heard these people okay and you're thinking

[00:33:05] are all they doing over there is cutting crowns they're like just buzzing down teeth that's an old thought process okay because the diagnosis and etiology of patients we understand more about those things but along the way there's going to be certain fundamental key concepts and key

[00:33:22] techniques and what John is talking about is one communication learning how to communicate I mean goodness most of us graduated high school at 18 and at between 18 and 30 you're in school

[00:33:38] and in a book you don't even know how to operate and communicate outside of the book you don't know how to work with a team you don't know how to work in a business you don't know how to communicate

[00:33:46] across management lines and so like all of this stuff plays a role in even going to the next step and bringing these things into a ideology or a an ideology of that type of practice where you're

[00:34:03] having conversations because the key is your team and if you can't have you can't be a leader enough to get the team behind you because the hygienists are over there seeing these patients on the

[00:34:19] recare they have the patients that have said no 90 percent of the time to treatment because they will and those are the people that are they have to believe you so are you a good communicator are you

[00:34:33] a good leader is that part of your the personage do you need to work with somebody that's a better communicator do you know yourself and I don't even think people know themselves when they come out of

[00:34:43] school because they haven't had the opportunity to because we're just it's your writing now it's like okay what do I need to die to like what do I need to let somebody though in the first couple of years that devotes themselves to basic dentistry and gets very

[00:35:03] good at it long before I would take somebody who says I can do the following 10 procedures that I didn't learn in dental school 100 and because that is a foundation and the foundation the dental

[00:35:18] school gives you is very strong as much as we criticize it sometimes for not exposing you to certain things and I will criticize it because there are certain things we should be doing

[00:35:27] better but I also understand there's so much to learn and so if you can get good at these things in the first year too but back to the question though if the owner of the practice whether it

[00:35:39] be private practice dso whatever it is doesn't have a focus at all of comprehensive if there's no pathway to get yourself to that next step of okay let's say I've got 100 crowns under my belt

[00:35:54] or whatever it is or I've got 50 root canals and I'm getting better at managing extractions knowing when to refer I'm getting comfortable with checking hygiene and knowing what dental school taught me I've seen enough things to understand who needs scaling and replanting and who needs carries

[00:36:10] control whatever you're finding out how to make money too right I mean like you're hey this is actually working I'm putting money that's right yeah you know you're getting confidence that's

[00:36:19] right I'm hitting my goals I'm doing okay all right well if there's not a path to that next step if someone's saying look what I want you to do is just do more of that that's not bad okay that's

[00:36:33] not necessarily bad it's just a different philosophy and that's when you might come to the point in your career and I don't know that it should be on day one because you don't know enough

[00:36:46] you don't know enough in your first few months or years or even a few years sometimes to know I mean how can you be you know placing 17 implants in a day if you've never restored one

[00:37:01] you know and how can you be doing bone grafting when you've never taken out more than 10 teeth like it doesn't make it you have to build and so the the idea behind this is build your skills to

[00:37:15] be good at what you have been taught at an ideal level strive for that ideal and then determine what type of dentist you want to be and look at the practice you're in and say

[00:37:27] is this going to work do I have mentorship do I have someone who's willing to invest time in me or is willing to send me somewhere that will help me to understand how to see these patients

[00:37:42] where I've taken these alginates I have these models or scans and I have these printed models and they're sitting on my desk and I have no idea what to do with them you know if there's nobody

[00:37:53] that can help you determine an algorithm yeah or a way to think about those types of difficult cases that you'll encounter shortly and you'll start to go well I've not seen this before I don't know

[00:38:06] how to treat it because now you're outside of things you've seen things you were taught so now is the big time to determine is this practice some a practice that I can if this is what you want

[00:38:21] to become someone maybe different not necessarily better because there's lots of single two dentists that that's their comfort zone and they do great dentistry and there's nothing wrong with that if that's what you want to do but if if this idea of comprehensive dentistry makes you

[00:38:40] kind of just intrigued you're like I like that idea giving having an answer for people that come into my practice that I could tell them well then you look around and you go is there someone else

[00:38:51] here that is doing that is there someone else that I want to be like in my own practice somebody that I could say man I wish I was that lady or that gentleman mentorship and if you and if you don't

[00:39:03] have that or you don't have a way to find that or you don't have a practice leader who says you know what I don't know how to do that but I'd love for you to that's gonna be a challenge you know

[00:39:15] John and I have a very similar but different folk start to our our careers my career started out in residency and a general practice residency which was very private practice based even though it

[00:39:30] was in a hospital and my mentor there several mentors were both masters in the academy of general dentistry that was a very restorative focused full arch type style of practice but it had an emphasis on the basics and fundamentals of good general dentistry and so John stepped into

[00:39:52] a practice that was a family practice and he had it was built on the same principles it had a mindset of good fundamentals in restorative dentistry and had a mindset of of continuing education and

[00:40:07] continuing to grow and learn and being open to what everyone else my specialists are doing how I can help them how my interdisciplinary team how we can operate and communicate with one another

[00:40:20] we've got to travel and go and see and both of us had that ingrained in us that this is what you do and how you build your mind surrounding an interdisciplinary team and the approach to

[00:40:34] doing more which requires diagnosing correctly and so what we did is for the first five years of our practices I started from scratch John walked into where he was building a practice inside of his father's practice it was very similar because we're both learning these things of communication

[00:40:58] and we didn't have the patient base per se to just jump in and start doing full arch implants or start doing Invisalign we had to actually learn the fundamentals of dentistry which is good communication good team team management and teamwork and then the fundamentals of just good

[00:41:23] single tooth quadrant based dentistry and then from there we got inspired to do more because of our mentors and because of the things that we saw and so that that can you do it in a

[00:41:37] practice where there's no one else around you that are inspiring no but that isn't where you probably need to start you need to start where you can actually get some reps yeah I mean what

[00:41:47] one the first thing I thought of whenever John you brought up that the best primary care physicians we expect them to be great diagnosticians and give us everything that we need to know well

[00:41:59] they're not practicing in the regular model that a primary care physician would and I almost feel like based on what you guys are saying is that you really can't be a comprehensive treatment planning

[00:42:13] dentist unless the practice is designed for you to do that so it's impossible even if you did have your owner dentist's permission to go into a Medicaid mill office and decide to offer comprehensive treatment plans so you really have to seek out a mentorship opportunity in a practice

[00:42:34] that's that's designed to offer that kind of that kind of dentistry yeah yeah you're gonna have a hard time without it from this standpoint you know again it doesn't have there and the thing

[00:42:47] that again I mentioned earlier there's lots of ways from a business standpoint to be successful in dentistry you know there's lots of ways from a business standpoint and you do have to know your market and where you are and what's needed because there are some places where frankly

[00:43:06] it's difficult to break into a market with a with with a trying to define who you are in a crowded marketplace is very challenging so you have to be smart about it if you desire to live

[00:43:23] in Denver you're gonna have a hard time because there's a lot of people that are going to say I'm a comprehensive dentist regardless of whether it's true or not it's a marketing can be a

[00:43:32] marketing strategy for some there's and that again as you it might it probably doesn't mean what you think it means as you said earlier it probably just means they have a lot of things

[00:43:40] they say oh we'll do it all here doesn't necessarily mean what we're talking about but my point is you have to know your market and there's nothing wrong with getting out and saying

[00:43:50] look I I know like I want to live in xyz place this is my goal to live here if that's one of your primary focuses is a specific location then you have to understand there may be compromises

[00:44:02] that's one of the most critical things I tell dental students is in this discussion I can't I cannot emphasize how important this is where you want to live will determine whether or not

[00:44:16] this discussion is not only easy but possible if you determine that you want to live in a certain area because your that is above all else for you then you really have to look carefully

[00:44:31] at the type of dentistry that you might want to do and determine if there's room for that doesn't mean you can't do it in a comp in a in a in a very competitive environment but what we're

[00:44:41] talking about here is much easier to accomplish in a shorter period of time I'm talking about devoting yourself to being an excellent diagnostician a comprehensive dentist it's much easier in a situation where you can choose in your locale to be one of the few people

[00:44:58] who actually because it's the rarity to be a true diagnostician comprehensive dentist in most areas but man marketing speaks for a lot right if you spend a hundred thousand dollars a year on

[00:45:11] marketing a lot of people in some of these areas can can can kind of say well that looks like something I want because it's market based so you have to be smart about this think about where

[00:45:22] you want to be the kind of dentist you want to be maybe it's starting off in one type of practice because you're trying to sort of build the foundation and then it's determining is this

[00:45:32] really where I want to be is this really the kind of dentist I want to be is this the place I want to live is this practice conducive to me doing the type of dentistry that I really want

[00:45:41] to do there's a lot of ways to be successful but there's not a lot of ways to do what we're doing except one and that's to really say I want to be able to to have an answer for everyone who comes

[00:45:55] in. I think too like John it's perfect you know what you're saying because the patient demographic that is built in see most of most of the students graduating right now from the fourth year sounds

[00:46:08] like they're going to be going to a built-in demographic of 2,500 patients in that dental practice that they join and so those patients already have a certain mindset of how they got

[00:46:22] there okay and so now it's what's going on in the front end you know whenever new patients call and how are they being received and how is that navigating through the practice and number two is

[00:46:40] how are your hygienists bringing up concerns and so that you have the opportunity to maybe even bring it up during an exam you know a limited oral exam and a periodic and so because what we're

[00:46:56] talking about here is you're flipping the mindset of the entire practice and the demographic starts to change and it's very difficult because patients don't even know to look for this because the market is so clustered up that's why it's easier for John in a mid-sized town of what

[00:47:17] 60,000 people John maybe more yeah yeah with towns 25 and the county 75 yeah so in my town relatively small in my town you know 700,000 and growing at a rate that's incredible and so for me you know it's a little bit of a different conversation you know the people I'm receiving

[00:47:39] are different than the people John is receiving and it may not be easier it could be easier to navigate that in one way versus another depending on how you handle that as a dentist and how your

[00:47:53] team handles that because people's mentality okay so we live in the south and the people's mentality begin to look at the surrounding people's mentality so right now if I look at myself and I

[00:48:09] weigh 220 pounds well at six foot two I'm obese okay but if I but if people look at me in southern part of the United States they actually think that I'm a pretty thin fit guy in fact people

[00:48:23] think right now that I look too thin because everybody around them is sick so they're not seeking out like this type of care automatically because the mindset you see at West Virginia

[00:48:39] University whenever Dean Koble walks into the room and he says hey guys I want to tell you about the time whenever the mind started to shift in me about the people I was seeing and a mom walks in

[00:48:53] with his 18 year old son and says it's time and he's like what's time for what man what's time for John to get his teeth taken out and get dentures and you can see the mentality of the

[00:49:05] demographic and now what kind of conversation would I have to have to offer them comprehensive treatment philosophies you see it's very different based on the demographic that you choose and where you want to practice and so I put that in there in our show notes because I think

[00:49:22] it's uh it's something to think about that not everybody thinks about and everybody wants to move to these larger cities and John and I've had this conversation before on our show is about big cities versus large cities and there's advantages and disadvantages and I'm not saying

[00:49:37] one's right or wrong but you've really got to think about that it doesn't mean you'll be doing more procedures in the small cities it just means that you're going to have a different probably a

[00:49:46] different kind of conversation yeah so would you say that it's easier to be a comprehensive diagnostician in a smaller market is that what you is that something I can kind of draw from what

[00:50:02] you guys are saying I think that it is a situation where it's easier to develop a niche in a market that is less saturated it's not always smaller versus bigger okay so let's let that's

[00:50:17] important distinction because you have a you know certain metro areas where you might you know you look at the demographics of the dentists and you have a lot of folks that are nearing retirement

[00:50:31] for instance and maybe it's a prime place for you to come in and establish a niche and associate and buy into a practice or buy out a practice and maybe you can be the next person who kind of

[00:50:41] pushes that practice to that next level easily and some places you have a small town where you know the average income is seventeen thousand dollars a year right so you can't generalize exactly but I

[00:50:52] would say I will say I think I can make the statement that it is easier easier potentially in a market that's not saturated which in general in general it tends to be a less served area to be

[00:51:05] able to establish a niche that is a more comprehensive dentistry focused practice when there aren't 30 other people in a two three mile radius saying that they're doing the same thing who may not be yeah probably not marketing is a powerful beast and if you look at you know

[00:51:27] if you searched comprehensive dentistry Chicago or comprehensive dentistry Denver or comprehensive dentistry Miami you know you're going to see a lot of hits and that doesn't mean that those people are bad they may all be truly doing what we're talking about but there's usually a good number

[00:51:45] of them that are using that as a mechanism to attract patients for the reason you said earlier they just like saying well comprehensive to them is will we do everything in house

[00:51:55] and that is not the same thing so smaller markets may make it easier at least to get started but you also have to realize that smaller markets mean that you don't have as many patients

[00:52:07] potentially with the means to a bill to be able to do certain things so there's a balance I think that you have to do your research and this is why we're bringing this stuff up because it's the

[00:52:18] things that neither Wester I really understood when we were at especially that dental student level of you maybe even you maybe you even have maybe if somebody even gives you the the you know

[00:52:30] the the fire to want to do that type of dentistry you're like I don't even really know what it is but I have some idea sounds like what I want to do but then you don't you're like well I really

[00:52:41] want to live in Denver you know and just be aware like that's you're gonna have a hard time it doesn't mean Denver's not awesome but you got to think about like what does that look like for

[00:52:52] you and how much are you willing to kind of maybe put up with you know in order to get to that point and how many people will mentor you and how cutthroat is the environment and what your student

[00:53:04] loan debt look like and what's that do and are you okay with living like a resident for another five years you know and that's the kind of stuff that's real deal stuff every day this is something

[00:53:17] that you've got to devote yourself to Wes and I have probably spent I don't even know how much money in continuing education to be able to achieve just an understanding of what we're

[00:53:28] talking about I because it's not us that figured this out it's us that figured this out only through what other people taught us we didn't have some grand epiphany we just went to smarter people

[00:53:40] than we were but you know what that cost time and money and time and money and time and money how much of that can you do or afford to do that is that's another factor that you have to be

[00:53:51] realistic about I think the disappointing thing you know recently at Spear Summit I love the segment at the end where Greg Kinzer, Bob Winter, and Jeff Roush get up on the stage and and one of

[00:54:04] the things that the theme surrounding the entire summit was the fact that you know we really aren't seeing what is clinical reality when we do look at and it was even grayed out on certain

[00:54:20] screens Instagram education and so one of the things that kind of goes along with Spear is their treatment planning philosophy and how we get a more etiology or we get it we get an actual

[00:54:36] diagnosis from what we're looking at and how we achieve that and so they sometimes get a bad rap and what Greg was saying about how they go about that because it does lead to a more ideal treatment

[00:54:49] plan and that doesn't mean that it gets completed but what it does do is it does kind of shed light on some things that don't really show up you know in media so for instance what Jeff said at the end

[00:55:07] is he said so I went to YouTube Instagram and PubMed on certain things and what he found was that just in simple veneer cases where we were altering certain aspects of the aesthetic case that

[00:55:30] 99% of the time all he was seeing was these pre-operative photos that everything was ideal that we weren't modifying you know much in way of like what would require a greater understanding of how this patient got here and so where are the hard cases is basically what he's saying

[00:55:53] and he said what this does to our mindset is it tells us that it's easy you know that it can be done super quick super fast and they put up one picture of something Bob said at the beginning

[00:56:07] of this conversation he said in 19 or in 2004 2003 he put up the word extreme makeover the logo now I was graduating dental school when that show was coming on and basically what that show showed is

[00:56:24] how to do dentistry very fast with disregarding the etiology of the cases and what we're seeing is some of the same things right down to people showing why they're doing what they're doing

[00:56:40] on Instagram to attract millions of followers and yet they fail to understand the true etiology so this one guy calls a guy they tell the story they're like I just called him I asked him I

[00:56:53] said doctor I'm Dr. such and such from such and such you know and I just want to know how you came about this and he said well I just kind of made it up he just made it up and so it's like

[00:57:06] where does this begin where do you begin treating cases because the easy cases they don't even they don't even require thinking because you understand it's the hard stuff that comes into the office all the time and you see it and you're just like how's this even being missed

[00:57:27] because now you know and that's what's exciting about comprehensive dentistry I'm getting passionate because what you do is it's unlocking your brain like John said once you see it you can't unsee it

[00:57:40] and then you want to tell that patient hey I know what's going on in your mouth and I know how to help you find health do you want to hear more about it and they're like you say a few things

[00:57:51] that they're like how did you know that I have that and it's because you understand and it doesn't mean you're treating it it just means you're offering some solutions and they start to open

[00:58:03] up and I'm telling you right now the greatest thing in the world is when a patient gets up out of the chair and says no one not even a physician has ever been able to tell me what

[00:58:15] you told me in 30 minutes and it's it's in it's unlocking and I haven't done anything and I haven't done anything you know and so that's the excitement and the passion behind it but there's also this side over here that we don't really see that's a pseudo reality that

[00:58:34] I feel like that everybody is living in that's feeding us this ideal thing and that's really dangerous. Yeah my instinctive question to follow up with that is how do you even get there to the

[00:58:49] point where you can even think about comprehensively treatment planning but I don't want to ask you that just yet because I know that's what our topic is for the next episode but I do have one more

[00:59:00] question that I want to cover on this is you know how can you even get started setting up an office or optimizing your office to while you're training while you're getting good at the basics

[00:59:18] to even be able to learn or get started learning the more comprehensive diagnostic stuff so is that just a matter of having enough time off built into your schedule where you can go seek the CE

[00:59:33] or do you really need to have your office set up in a way where you can maybe be seeing these kind of patients because I have no clue obviously. So I'll take that yeah it's the first thing I would

[00:59:45] say is that not ever not everybody deserves to be treated the right the same way okay because not everybody's coming with a host of problems Gary DeWood basically said that the greatest inequality

[00:59:57] in dentistry is that we treat everyone through the same way and you might think what you know recently Paul Homily told me the same thing Amy Morgan at Spear Education who owned Pride Institute Paul Homily who worked at Pride great coaches not everyone deserves to be treated

[01:00:17] the same way the greatest inequality in dentistry so how do we treat people it starts on the phone and it starts with people and how they're you ask a few questions you know you ask you know

[01:00:29] basically are you just look have you had a lot of dentistry done are there frustrations are you hearing that in there is there is there a ton of dentistry that's been done that you're

[01:00:39] frustrated about you know you start taking in patients and you spend time with the people that want to be heard now that's you know in the beginning you know I didn't even know what I

[01:00:52] just said so I'm like how do you even start I was seeing every new patient and so was John in our chair versus hygiene because we were told that more treatment planning more money comes out

[01:01:06] of the chair that the dentist sees the new when the dentist sees the new patients first so that was our reason for seeing it had nothing to do with comprehensive presentation but what I would

[01:01:18] say is that spending more time with your patients having a schedule that allows you to see more because if you only have five minutes to do a new patient exam you can just forget it you know

[01:01:30] yeah and that's a lot of times that's what a lot of practices have they have five or ten minutes they don't spend talk time introducing themselves spending time talking those type of things if you

[01:01:41] just have time built into your schedule to see new patients a couple times a week strategically scheduling that way like for instance Tuesdays and Wednesday mornings from 8 to 10 are my new

[01:01:55] patient mornings and I see patient new patients from 1 to 2 and then the rest of the week I don't see new patients unless they're a type of patient that has limited problems in hygiene so I set aside

[01:02:09] time even now today to talk to my patients so that I can see more because in five minutes man I don't care how good your diagnosis is I don't care how much you know you have not enough you don't have

[01:02:19] enough time yeah I would I would say that for me time is definitely a completely agree with Wes that having time set aside to see patients whether or not whether or not you see everything at that time

[01:02:36] whether or not you know how to treat everything at that time you might come you trust me 10 years from now you'll look back at that patient that you treat implant a certain way and if you do pursue

[01:02:47] a higher level of kind of learning you'll go back and go man if I only would have known what I knew that's okay but I really think from a team standpoint really the keys to me for this is

[01:03:00] my opinion on this is you have to do you have to pursue excellence in the basics you have to pursue excellence in the basics your team needs to see that your focus especially as a starting off

[01:03:11] newer dentist is that you don't know everything and you're okay with that but you're trying to always improve you know what ideal is you know what ideal is for what you should know right

[01:03:27] you're not going to know what ideal is for every procedure and that's okay so refer when necessary you know take plenty of time to do procedures do it the ideal way know when to stop and put up the

[01:03:44] red flag and go no this isn't working how it should I know it's not I know enough to know that I can't find mb2 I'm sending this to the endodontist and next time I do another ce course

[01:03:57] I'm going to try to find one on good molarendo because I'm not having success or it's just reading journals it's getting subscriptions to journals that will take your understanding to the modern from what you learned in dental school because the things you're learning are 10 years

[01:04:15] older or older I guarantee it and so you need to find out what's new it doesn't mean you do it all right now but you need to find you need to get involved with the journals that are the newest

[01:04:28] and best and even those are old information sometimes right because it takes a while to do a study and publish it and then you need to become critical about the data and understand

[01:04:37] what is a good study that's a whole other show and I would also say you need to develop a relationship with an excellent laboratory and a laboratory that has somebody who will mentor

[01:04:49] you because of the years of experience they had although they might not be a doctor that they will call you out for the things that you need to be better at and help you to become better

[01:05:00] if your team sees you being humble knowing that you want to be great but knowing that you don't know everything they see you trying to do be excellent even if it takes longer they see that

[01:05:10] you're willing to read journals and maybe teach them something they didn't know because you learned and you're trying to get better they see that instead of wasting time playing golf you're you're watching a video on crown preps you know instead of rushing out at 501 you're staying

[01:05:26] until 601 to figure out what you could have done better on that root canal if they see that they buy into hey this person cares and then when you introduce a new idea that that office maybe has

[01:05:40] never seen whether it's a new procedure whether it's just a new way of thinking and I would emphasize the ways of thinking much before the procedures then they start to go okay I know this

[01:05:53] person I know what they're about they're about trying to do it well but they're not about just trying to do everything at once they want to do it well and they want to do it right and we have a

[01:06:03] lab now that's supporting us and they're they're helping us they're not just some random that we never even know who they are and they're in some other country and we've never met them and they do

[01:06:12] terrible work and we remake the crown seven times you know if they start to see who you are then when you start to go hey it's time to go and take another course on this new idea of way of

[01:06:24] thinking about patients they will be much quicker to buy in you're going to come back and you're going to see them go hey I trust this doctor I trust this person because I've seen how they have

[01:06:35] grown in in the things that they wanted to be better at and you can then say to these hey what what can we do better as a team and they're like hey I'm on board what what do you think

[01:06:47] all of a sudden it becomes you know what I know where you're trying to go so I see what you want and what do you think and all of a sudden it starts to get exciting is people are like all right

[01:06:57] what's next what's next what what do we what do we need what do we need to know and you become a leader at that point and it becomes stops you become you're not no longer are you just

[01:07:09] you know the new doctor but you're actually now a leader whether or not you're the senior doctor it's amazing how it can transform if you just I think focus on just trying to be good

[01:07:19] at the basics and then and then gradually try to introduce the things that you feel are your next your next thing you know and it takes time it's going to take a while before you get yeses

[01:07:30] yeah I think you know John says it well is that the team around you has to see this and I will say that recently I was told this too and I've definitely flipped a team in the last four years

[01:07:43] and the dental office this was told to me is not a safe place for the uninspired and so what happens is is that if you're an inspiring person to continuously one of our core values in our office I know John's as well is continuous improvement integrity always looking

[01:08:03] for what we can do better a systemized approach and so these core values are on the wall they're being repeated by other individuals your manager is evaluating people based on those things

[01:08:15] and so with that what it comes is that it comes responsibility and so when you get a people behind you and trust me come into either one of our offices and you will see the inspiration not

[01:08:29] happening from me now but it's happening from my my adjuncts and my team leaders those are the people that are inspiring me to even go further and so this is this is the exciting part about

[01:08:42] this and so I can't wait for the next show tell us a little bit about what's what's to come so I guess in the next show which will be which will be dropping on the dental guys podcast so

[01:08:52] for all the very dental listeners you guys will have to go ahead and and seek that out um you can just find them on apple podcasts I believe they're on Spotify as well and YouTube and everywhere you

[01:09:04] find podcasts so that episode will be dropping next Tuesday so that's going to be on what are the strategies and paths that a dentist can take to then become a comprehensive treatment planner and a comprehensive dentist awesome so without further ado thank you all for listening and I

[01:09:27] would highly recommend that you tune in to next week's episode on the dental guys podcast and I mean I'm already very eager to hear what the path is so I'm sure you guys are too