I Called The Wellness Program Or I'd Be Dead: Brett Kessler On Addiction & Burnout in Dentistry

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I entered dental school with a substance abuse problem, and I graduated dental school with a worse substance abuse problem.
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And that was how out of hand my life was getting.
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You're the previous president of the American Dental Association.
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Prevalence of burnout, stress, substance abuse is so, so high in our profession.
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I'm sure many of the listeners that are listening right now are going through it.
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82% of our colleagues are experiencing signs of clinical burnout.
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82%?
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It's crazy, isn't it?
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Eight out of ten.
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Right.
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So Brett, Brett Kesler, lovely to have you on the podcast.
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You mentioned earlier on, it's your it's your first time in the UK first time in London, first time in London.
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It's great to be here, Simon.
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Thanks for having me.
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Yeah, it's wonderful to have you on.
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So for those of you that don't know you, you're the previous president of the American Dental Association, correct.
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And I
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We connected, I think I connected to you on LinkedIn after seeing and chatting with Miguel, interacting with you and we connected there and I was really interested by your story.
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I think you have a fascinating career arc and the way in which you got into
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the ADA I think is really really interesting and can hopefully really help our listeners in many different ways.
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I know you're still working with them on some big projects oral health 2050 which we'll get on to later on and obviously the focus of the podcast is all around the future of dentistry so I know you've got some really strong opinions there as well but why don't you start off by just giving our listeners a little bit of a background as to
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some of your early life challenges actually led to you getting to that position of president of the ADA.
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I think there's over a hundred thousand dental professionals that are part of the ADA, so it's the biggest in the world.
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Tell us a bit about that story.
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Yeah, it's crazy when I think back to how far I've come in life compared to where
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When I hit my bottom, so I'll start there.
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So I'm Brett Kessler.
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I'm a general dentist practicing in Denver, Colorado.
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I'm currently not practicing right now, but I had 30 years of practice.
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You know, and I entered dental school with a substance abuse problem, and I graduated dental school with a worst substance abuse problem.
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I hit my bottom in my third year of practice where I took my...
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team from Michigan to Chicago for a dental meeting.
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And I had a drug dealer in Chicago, and I picked up some quantity of drugs, and then I disappeared for the week.
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And that was, you know, how out of hand my life was getting.
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And so I called the Wellbeing Program for the state of Michigan, which is part of our organized dentistry at the ADA.
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And that Wellbeing Program,
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was, you know, they directed me to treatment, and I attribute that phone call ultimately to, you know, the beginning of my recovery and saving my life.
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I was on a path that was not good.
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I was on a quick path towards death.
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And, you know, and the resources that they had really helped me.
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And as I got better with my addiction into my recovery, I was inspired to live my best life.
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And, you know, it started out wanting to be the absolute best dentist I can possibly be.
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And so I started studying under Pete Dawson.
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in Florida and the Panky Institute also in Florida.
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You know, it was where I wanted to be the best possible dentist I could be to provide the best treatment for my patients in a fulfilling way.
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And this is where the best dentists were living.
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They were teaching and where we were all learning, striving to learn.
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And, you know, and so then I moved from Michigan to Colorado
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A few years later, right after we had our first child, and I entered into a practice there that was a very high-end boutique-type practice, and all fee-for-service, and it was an amazing opportunity, and I became partner there.
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But after a little bit of time, I recognized that the partnership wasn't going to be the best thing for me.
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And, you know, the values were different and my goals were different.
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And so I sold back the partnership.
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I lost a lot of money on the deal, but I gained my soul back is how I say it.
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And I was able to sleep at night again.
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And so I started my own practice a few years later from scratch, and it was an amazing
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Amazing practice.
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It was very relationship-based.
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It was, again, fee-for-service.
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It was reconstructive-type dentistry focusing on the health function as a foundation and then aesthetics on top of that.
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And so I attracted people from around greater Denver area.
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But then with some recognitions that we received, we became a destination-type practice.
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And people would come to us from all over the southwest part of the United States.
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um and uh and and we were you know just doing you know great work um and and but it's all you know because of my recovery in the inspiration i got for living my best life you know if it started out i wanted to be the best practitioner and um and you know and and when you're in addiction like my brain is not the same as your brain
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And it's very, you know, I go to extremes with things.
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And, you know, and when I put a substance in my body, it feels good and I just want more and more and more.
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And so our brains are plastic and they can be rewired per se.
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And so I started, you know, my recovery program is a mindfulness program where I, you know, really started focusing on, you know, overriding that addiction pathway.
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And that's how I got sober, and that's how I got inspired, and that's how I decided to start my practice.
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And then when I started the practice, I knew because of the model that I was creating, it wasn't going to be easy.
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And so I had to be in the best shape mind-wise on a regular basis.
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And I also recognized I had to be the best possible leader I can possibly be.
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And so I started growing my leadership acumen, and that was an inspiration from both the Dawson and the Pankey Institute.
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And I needed to be the best leader for my team because we're doing something that's not easy.
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It's not normal.
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We had to be the best leader for our patients to guide them towards choosing their best care.
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And so anyway, I've got this fee-for-service type practice.
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And I'm going to my recovery meetings, and I meet all sorts of people in my recovery meetings.
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And there was always a group that would come from a treatment center who were really doing well.
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And they'd come, this treatment center is called Sobriety House, which was the oldest treatment center in Denver, and it served the homeless population.
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So it got people off the streets, got them sober,
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got them nutrition, started eating again, they cleaned them up, got them vocational training, and they got them out to the workforce again.
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And these people would shine in these meetings and talk about how great their lives were, but I could see the scars of their addiction were still on their face.
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They were missing teeth.
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There was, you could see the disease present when they talk and you could see them
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hiding their smile, their self-esteem.
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But they were so inspiring and living their best life.
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And so I started talking with them and meeting them.
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And I ended up creating a program where if they stayed in treatment, I would fix their teeth.
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And because it was a homeless population, it was very transient, so people would come and go and not stay.
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If they stayed, the odds on them staying sober were much better.
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And so this was a kind of a carrot to keep them in treatment long enough to override the addiction.
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And so I started doing...
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And I treated them just like our normal patients.
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It wasn't a day dedicated to them.
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It was just interspersed throughout my schedule.
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You brought them into your clinic, did you?
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Into my clinic, yeah.
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And my team loved it.
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I loved it.
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The patients really shined.
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And...
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A few other treatment centers in Denver contacted me and asked if I could do similar programs for their treatment centers.
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And I wish I could have, but I had to, you know, mind my business as well and not give everything away for free because it would overwhelm if we did everything for everyone.
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So I called Metro Denver Dental Society, which is my local dental society component of the organized dentistry, ADA.
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And I.
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I asked them if they knew any dentists who were doing this kind of work and could they help me hook them up with these treatment centers.
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And they said no, but it's a great story.
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Let's write an article about it in our journal and see if we can get some dentists to come out of the woodwork.
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And so two or three dentists did come out of the woodwork after the article was published.
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And so these other treatment centers then got taken care of.
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A few years later, this is the mid-2000s, methamphetamines became the drug of choice in America.
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And so news stories started to come up about the devastation of the teeth from meth
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And so, you know, and it trickles in from the East Coast and the West Coast into Colorado, which is kind of the southwest, south middle of the country and, you know, the story.
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So journalists started contacting Metro Denver Dental Society and asking if they knew anyone who was treating meth mouth.
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And so, of course, they called me and asked if I knew anything about it.
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And I said, yeah, I've been treating it for years.
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would you like to go on TV and talk about it?
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And my initial reaction was, no, absolutely not.
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I wanted to be known as veneer guy, not meth mouth guy.
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Yeah, I can see that.
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But I had mentors in my recovery, I had mentors in dentistry, and they both challenged me and said, you know, Brett, the work you're doing
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It's changing these people's lives.
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And it's very rare that they show anything about addiction and recovery in a positive way.
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And here's a really great opportunity to showcase that recovery is possible and how important the teeth are in the psyche of someone who's in recovery.
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And then my dentistry mentor said the same thing.
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It's very rare that they put dentistry in a positive light in the media.
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Yeah, very much so.
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And here's an opportunity to showcase how great and important dentistry is and improving these people's lives.
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And so I listened and I decided to do the story.
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Yeah.
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And, but I wanted the reporter to focus on the patients and not on me.
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And so I called a few of my patients who were success stories from the Sobriety House Project.
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And, you know, they started out living homeless.
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They were, you know, one was living under a bridge, one was living in his car.
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And now they are, you know, full-fledged, active members of society.
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It was a beautiful story.
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And they couldn't wait to share how amazing their lives are and how amazing they feel where they can actually smile with dignity.
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Yeah.
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And so it was a beautiful story.
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And then, you know, several other reporters in Colorado wanted to do similar stories.
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And so we did them all.
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It was the same story, but it was, you know, just everyone had their own little twist.
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One of the stories got picked up by CNN, and it went national on a weekend, so headline news.
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And so 19 minutes after the hour there, my story rang every hour of that weekend, and it was a great story.
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And that's how the American Dental Association found out about me.
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I was not in any kind of leadership position whatsoever.
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And in the meantime,
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I've got this amazing restorative practice, okay?
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And I'm getting all these accolades for, I was actually named the top dentist in Colorado, not on a list, that was the top dentist in Colorado.
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My wife is an orthodontist and we were named the Smile Gurus in another periodical in the Society magazines.
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And so people just started coming to us and we had kind of two different practices that was one practice, we treated everybody the same.
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And so the ADA saw this story and called me up and said, we are doing a, we're trying to push a bill through Congress that would fund treatment for people in recovery, specifically methamphetamine addicts.
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Would you come to Washington DC and testify before the Congress?
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Um, and it was, it was really one of those, you know, moments in your life where you've got a timeline of things that you'll never forget because, you know, I was about 10 years sober at the time and, you know, 10 years prior, I was literally contemplating, should I kill myself or do I want to live?
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Not let alone be a dentist.
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I mean, it was just life or death at that point.
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You know, it was so, so humiliated, so full of shame, so beat up.
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didn't know if there was gonna be hope.
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Here 10 years later, the most influential organization in my profession is asking me to come testify before the US Congress.
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And it was a major moment for me.
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And so I flew to Washington DC and I got to testify and talk about the impact that dentistry has
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on people in recovery.
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And were they able to obviously remove infection, remove pain, smile, face the world with dignity.
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And it was very important.
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During
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the talk, I did share my own journey a little bit about being in recovery.
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And I did say if you only had a limited amount of money to fund dentistry, but not funding addiction treatment, I said it's not worth putting, investing in dentistry if you don't take care of the addiction first because an untreated addiction leads to death.
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There's no doubt about that.
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And so please fund both.
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And so anyway, we didn't get the bill passed, you know, from nothing, and I learned later that nothing really ever happens in Washington, of substance, it's very difficult to get laws passed.
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But in the question and answer session, one of the congressional aides said, Dr. Kessler, you know, you mentioned you were in recovery.
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And frankly, I don't, I can't believe that you don't look like an addict to me.
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And I smiled and took a breath and I said, well, first of all, I'm 10 years sober.
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And so the person you see here is not the person I was 10 years ago.
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Second thing is that I'm white, I'm middle class, and I'm a professional and I'm male.
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And because of that, I've been afforded the opportunity to get treatment.
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And less than 10% of people with addiction and mental health issues are afforded the opportunity to get treatment.
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And that's still the same today.
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It was 15 years later now.
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And he kind of nodded and stopped the conversation and educated him on what the reality is.
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So anyway, I went back home and went on with my life.
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And a few months later, the Colorado Dental Association.
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So in the States, we have what's called the tripartite.
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We have the Metro Denver Dental Society, which is a local component.
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We have the state level, we have 50 states.
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So Colorado Dental Association, and then the American Dental Association, all three are feeding into one.
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And the Colorado Dental Association called me up and said, we've never had anyone from Colorado
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testify before the US Congress.
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And so they saw me in the meantime, I'm the wellness person in Colorado.
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So remember, I made a phone call to access help to the state of Michigan.
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And so now I'm the person in Colorado answering the phone and I've helped hundreds of my colleagues, you know, kind of get back on track with their lives and in addition to get their license under control and stuff like that without, you know, getting in trouble for their addiction.
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And so they saw me as more of a leader than just a wellness person.
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And so they asked me to join their leadership track.
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And I became president of the Colorado General Association in 2014.
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Again, a pivotal moment for me from a few years prior.
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I was not sure I wanted to live or die.
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And now I'm being recognized as a leader.
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My most proud accomplishment that I was able to get, be a part of as in a leadership role in the state of Colorado was we developed a dental benefit for adults in the Medicaid space.
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In Colorado, Medicaid and the states, Medicaid is basically a public benefit system for low-income individuals.
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You know, they fall through the cracks and there was no benefit.
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It was just pull teeth and, you know, drain infections.
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That's it.
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And now we were able to, you know, to formulate a comprehensive dental benefits and now 300,000 people.
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had access to a dental home.
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And these were my people.
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These were the sobriety house people.
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These were the working poor who really had no access.
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And this is a major, major development.
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We testified before our legislature, met with the governor, formulated the plan, and it was wonderful.
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And soon after that,
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At the American Dental Association, one of the leaders invited me to serve on a dental benefit committee, which is one of the most important councils in the American Dental Association.
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And, you know, I said to him, you know, I practice fee-for-service.
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People pay money out of their pockets to see me.
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It's not insurance dependent.
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Why do you want me on this council?
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needs to be expanded around the country.
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And this is a great opportunity for you to do that.
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And so I became a member of this council and again rose to leadership of the council and helped develop a countrywide standard for the Medicaid system.
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And each state manages Medicaid differently depending on what the state budget is.
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It's funded by the state with a grant from the federals, but every state has a little different view of it.
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But ours in Colorado, which I think is one of the most comprehensive plan, it's truly an essential health benefit.
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Um, and you know, and, you know, and I wanted to see it.
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And then we, we developed a plan for Medicare, which is a benefit, a health benefit for senior citizens in, in America.
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And there's no dental benefit in Medicare in the States, which is, uh, surprising.
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Um, cause I learned in, you know, in my, I did a general practice residency, a hospital based residency right after dental school where I got to see, um,
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the the impact of good oral health on the overall health of our patients and you know I saw some very very sick people in in the hospitals and I saw how oral health affected their systemic problems and how their systemic problems affected the oral cavity and you know so right then and there the the
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The mouth was attached to the body, what we learned in school, but it was real for me, and I practiced that way my entire career.
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And when the senior citizen demographics, they retire, they lose their dental benefits, so their dental care really goes to the wayside.
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That's crazy, yeah.
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And so we developed a plan there, and it hasn't been passed as a law in the States at this point, but we're starting to make inroads there.
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From there, I was suggesting, I had worked projects that weren't completed and I wanted to see them through, so I decided to run for the board of the American Dental Association.
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So interesting story, I turned 50 in 2018, and so,
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I asked myself some midlife questions when I was 50.
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And not midlife crisis, but midlife questions.
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You know, I want to live until I'm 100.
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And so I asked myself, what do I want to do with the second half of my life?
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How can I make a bigger impact in the second half of my life?
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And I made a pretty good impact in my first life.
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half.
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But that was the year we decided to sell our dental practice.
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That was the year I did my first Ironman race in the World Championships in Kona, Hawaii, which is another bucket list we can talk about if we have time.
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The third thing was I decided to run for the board of the American Dental Association.
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And it was all on the foundation of it was my 20th year of sobriety.
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That was the foundation of everything.
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No sobriety, none of this other thing happened.
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And so I decided to run for the board of trustees.
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And I developed a vision for my life.
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And I've done this several times as part of my mindfulness program in my recovery.
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In five-year, six-year, seven-year intervals, if my life were as good as it can possibly be five years from now, what would that look like?
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Mm-hmm.
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And in this five year vision, when I turned 50, I wrote that I wanted to give back maximally to the profession that has given me so much.
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And so that was how my decision to run for the board was formulated.
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And so I've got this vision out here and every decision here in the moment, am I bringing myself closer to that vision or am I moving myself further away from that vision?
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And so I chose commitments as a board member of the American Dental Association.
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Am I maximally contributing and giving back to the profession?
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It's giving me so much.
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And that's how I decided where I wanted to go.
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And in my third year, it's a four-year term to be a trustee.
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In my third year, I decided to run for president of the American Dental Association.
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Never, ever thought I would win.
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My goal at this point was, again, maximally contributing back to the profession.
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And I know my ideas were far ahead of what many in leadership at the American Dental Association were ready to accept.
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But if I could plant seeds and I had this one opportunity—
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to share my view across the country to the leadership.
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And if I could plant seeds for them a couple years later, maybe if they germinate, I'd feel good about that.
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And sharing my vision of where the profession is going and where it needs to go for maximal impact on the communities we're serving and contributing to the success of our dentists.
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And...
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But I ended up winning.
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And running for office for the campaign was like running for public office.
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You know, I had to raise a bunch of money.
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I had campaign professionals.
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I had communication professionals.
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I had branding professionals.
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I had pods of people around the country working on my behalf.
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And so I ended up winning and I became president in 2024 through October 24 to October 2025.
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And I ran with a few things to accomplish.
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One was obviously wellness was a big part of my life.
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And I wanted to share that, you know, make sure that our colleagues had access to wellness resources through organized dentistry, through the American Dental Association.
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In the States, we've surveyed our members several times, and some of the surveys have shown 82% of our colleagues are experiencing signs of clinical burnout.
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And 82%, 8 out of 10.
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And so something wrong here.
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The second thing I wanted to do is reconnect the mouth to the body, and not just in theory and in words, but finding true ways for the benefit system to reflect the essentialism of dental health, of oral health, because it's a separate—it's an afterthought, and it shouldn't be that way.
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Yeah.
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And the third was to, you know, create a space in the American Dental Association where every dentist has a place and feels welcome.
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And no matter, you know, what color your skin is, what your gender is, what your sexual orientation, what your practice model is, you know, we're there to support all dentists and we need dentists.
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our dentists to be members to have an adequate lever in advocacy issues.
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Because if we are not the loudest voice, those that do have a great market share, such as the dental insurance company, will be the loudest voice.
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And that's not always in the best interest of our patients.
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And so those are the three things that I set out to accomplish.
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And I feel I did a great job as president.
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And I spent 225 days on the road that year.
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I wanted to be out there and meeting our members and talking to various dental groups to share
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you know, where we're going with the American Dental Association.
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And, you know, I gave over 200 presentations that year.
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Amazing.
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And here we are.
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There you go.
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I mean, what an amazing story, Brett.
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Thank you for sharing that with us.
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And, yeah, I mean, it's really inspiring, I think, in terms of, as you say, going from a
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going from a time where you questioned whether or not you were destined to stay on this planet to then using that hardship to such good use, I think is a really inspiring message.
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I mean,
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I want to just double click on your, on your mindset in those early years and those three years after you qualified.
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What, what, what do you think was the key that I'm trying to really pull out the value for the listener?
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Because as you say, the prevalence of burnout, stress, substance abuse is so, so high in our profession.
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I'm sure many of the listeners that are listening right now or watching right now are going through it.
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So what,
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What do you think really were the key things that helped?
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You mentioned that your program was like a mindfulness program.
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Can you give us a bit more detail into what was involved with that that could maybe help those that are struggling with it at the moment?
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Sure.
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So first thing for me was recognizing that I'm in over my head here and I needed help.
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And so I sought help and I went to a treatment center for my addiction.
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But it didn't resonate with me.
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I didn't feel like I was as bad off as all the other people I was in treatment with.
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And I felt like I was much younger than most of them.
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They had license issues.
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They had health issues.
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They had marriage issues.
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They had money issues.
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And I didn't have any of that.
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So I didn't feel like I had...
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the uh you know that had an addiction and you know and my i think this is a mindset of all high achievers is that you know if we have a problem we dive into learning all about the problem so we can overcome the problem we don't like to ask for help we don't like to show any signs of weakness yep
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There's a lot of shame and stigma there in our heads, and we've got the story in our head of how we feel the world perceives us.
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And we guard that story very, very closely.
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But I had to recognize that I didn't get sober when I went to rehab.
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I got sober a year later.
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Okay, that's how long it took me to recognize that my broken brain could not fix my broken brain.
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I needed to take advice.
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And when I left treatment, my counselor said that I'm going to have to treat this on a daily basis.
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And if you don't, she told me that I was most likely going to drift back to my old ways.
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And I just absolutely said that's not going to be me.
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I knew exactly what I needed to do.
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I felt great.
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But within a few months, I was back to my old ways.
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Really?
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Okay.
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And so I had to hit that bottom again and finally listen to what my counselor said.
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And so I needed to really work on my mindfulness practice.
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And so my mindfulness practice is pretty simple.
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I wake up in the morning.
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I meditate for about 10 minutes, and I use a meditation app.
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I've used Headspace.
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I've used Calm.
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There's meditations on YouTube.
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Many, many resources out there.
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But I just do a meditation.
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What do you use now of interest?
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I use Calm.
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You use Calm.
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Calm.
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And Calm, I do a daily meditation.
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There's a...
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a theme for the day and the meditation is surround is, is surrounding that theme.
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And it usually is the, the, the right theme for me to put it myself in the right mindset.
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And then after that, I journal, you know, and I, I just brain dump what, whatever, you know, I, uh, insights I came up with from the meditation.
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Um, and, uh, then I, I look at my, my calendar for the day and what do I have scheduled?
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And, you know, are there any, uh,
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difficult conversations I'm going to have to have or, you know, those kind of things.
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And it used to be used to spend time scheming how I'm going to come out on top on those those difficult conversations, you know, and have to win.
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And that's shifted over the years to, you know, how can I show up as my best self?
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So, you know, and when we have this conversation that everybody feels like they've gotten what they wanted out of it.
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And sometimes that means I have to give more than I selfishly would like to.
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But again, for my peace of mind, to me, it's much more important for peace of mind than to win, per se.
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And I'm also an endurance athlete, so I sometimes do this when I'm running or biking or swimming.
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And I get a lot of clarity, mental clarity, when I'm doing exercise.
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And so that comes about.
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And then, you know, throughout the day, I do some breath work if needed to reconnect.
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And, you know, and I've got this sense of gratitude that, you know, I know I should be dead.
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So every day that I'm on this side of the grass, I feel it's a bonus day and I want to live it to the fullest.
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And that's what I do.
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That's a great way to live.
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But the first thing, coming back to your question, is I had to ask for help first and recognize that I could not fix my broken brain with my broken brain.
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And so for those that may be struggling and just not right, you know, seek help.
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You know, and, you know, yeah, I went to treatment for my substance abuse, but I've also had counselors and therapists for depression and anxiety over the years, even when I was president.
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Okay.
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And because I...
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When you're locked up in a mental illness, whether it's depression, anxiety, substance abuse, and stuff like that, your brain is very closed.
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And you lose your all chance of creativity from that.
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And so I need to break...
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through some of those things where I was stuck.
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And so I sought help, you know, in various periods throughout my career, throughout my life, to get clarity on my mindset.
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And I learned that,
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early traumas in childhood.
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Traumas could be big T, and mine were all small T traumas, nothing major.
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I wasn't sexually abused, I wasn't beaten,
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different things that would happen, we develop coping mechanisms to get through those challenges in our lives.
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And those coping mechanisms got us through.
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But then in our brains, they're now part of our defense mechanism when we're challenged again.
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Those coping mechanisms come out.
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And sometimes they're
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not serving us well 30 years later, 40 years later.
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And so identifying those through, you know, through mindfulness, through therapy has been really important for me to be successful.
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Absolutely.
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I mean, you define your earlier brain as a broken brain.
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Yeah.
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Would you now view your brain to be a fixed brain?
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That's a great question, Simon.
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Yeah.
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Addiction, mental illness is a chronic disease that's not curable.
401
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It's manageable, but not curable.
402
00:34:46.790 --> 00:34:49.071
So if you think of diabetes,
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00:34:50.367 --> 00:34:54.871
I don't get credit, if I'm diabetic, I don't get credit for the insulin I took three days ago today.
404
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I need to take my insulin every day.
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For my recovery, I need to do stuff for my recovery on a very regular basis.
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And I'm almost 28 years sober.
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And I don't have any inkling to want to put any kind of mind-altering substance in my body.
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But, you know, my brain drifts to, you know, towards doom and gloom.
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And I need to intentionally, you know, work at it.
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So I see opportunities in my life instead of, you know, as the lens that I look through.
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So I would say it's not cured, but it's managed.
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Okay.
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Yeah.
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Nice sentence.
415
00:35:37.722 --> 00:35:38.503
Yeah, it's really interesting.
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I mean, certainly a lot of the language used there, I feel in my own in my own life.
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00:35:42.927 --> 00:35:55.998
Obviously, I've not had substance abuse problems myself, but certainly reframing the lens with which you look at things, restrictions of creativity in moments of anxiety.
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um are all things that i resonate with and even the sort of childhood trauma issues my sister had cancer when when she was seven i was nine she was my mum and her were in hospital for six months during that time period obviously didn't know if she was going to make it thankfully she did um but all of that is is wrapped up in my own um
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00:36:19.466 --> 00:36:40.181
uh dynamic mentally now i guess which has been as i've mentioned before very productive for me in terms of uh it's led to me being very uh always striving for more being very ambitious being very self-analytical and and looking to be the best version of myself but equally the other side of
420
00:36:42.360 --> 00:37:00.882
catastrophization or over vigilance for threats and uh so it's interesting uh and as you say it's it's probably the reason that i'm like you very uh exercise focus and i'll work out every day and i'll meditate every day to try and manage some of those
421
00:37:01.843 --> 00:37:21.198
complications but I guess the question I want to get to is why do you think that dentistry is has such prevalence of these issues like it seems to me from the research that I've done that it is significantly more prevalent in the dental profession than it is in the general population so what is it about us that uh
422
00:37:22.399 --> 00:37:25.441
makes us susceptible to these issues, I guess, in your view.
423
00:37:26.062 --> 00:37:29.404
Dentistry is hard.
424
00:37:29.944 --> 00:37:30.825
It starts right.
425
00:37:31.926 --> 00:37:36.208
We have to be high achievers to get into dental school in the States now.
426
00:37:36.369 --> 00:37:40.311
You have to be the top of the top and the smartest of the smart because we're smarter.
427
00:37:40.791 --> 00:37:42.893
We're smart enough to go into dentistry and not medicine.
428
00:37:43.573 --> 00:37:47.155
We have an opportunity to have a life as a dentist.
429
00:37:47.315 --> 00:37:56.479
And so in the States, the cost to educate is really, really high in dentistry.
430
00:37:56.539 --> 00:38:04.922
The average is almost $350,000, the average debt of a dental student coming out of dental school.
431
00:38:05.183 --> 00:38:05.623
And so...
432
00:38:06.423 --> 00:38:11.965
they're forced into job opportunities that are in high volume practices.
433
00:38:12.886 --> 00:38:15.607
And I feel they're they're treating teeth and not treating people.
434
00:38:16.567 --> 00:38:24.650
And as I said, in dental school, we're, you know, judged, you know, you know, to be perfect from the get go.
435
00:38:25.051 --> 00:38:26.231
Millimeters are miles.
436
00:38:26.251 --> 00:38:29.112
The level of precision is is unrealistic.
437
00:38:29.292 --> 00:38:29.552
Yeah.
438
00:38:29.672 --> 00:38:32.854
You know, and you know, and bottom line is we all learn differently.
439
00:38:34.574 --> 00:38:37.175
And so we need to learn our own way to find our way.
440
00:38:37.215 --> 00:38:43.037
And in dental school, I failed morphology and occlusion in my first year.
441
00:38:43.117 --> 00:38:44.137
I had no idea.
442
00:38:44.257 --> 00:38:47.558
Dentistry was so hand-skill focused.
443
00:38:47.979 --> 00:38:48.899
I had no idea.
444
00:38:50.139 --> 00:38:51.400
And I had no hands.
445
00:38:52.340 --> 00:38:53.340
And so I had to take...
446
00:38:55.961 --> 00:38:58.142
morphology and occlusion over the summer.
447
00:38:58.402 --> 00:38:59.383
I called it wax camp.
448
00:39:00.384 --> 00:39:06.847
And we got to huddle around Bunsen burners and wax up teeth and sing kumbaya songs and things at wax camp.
449
00:39:07.368 --> 00:39:12.090
But I learned how to do it because I needed that extra help.
450
00:39:12.591 --> 00:39:14.412
And it was very...
451
00:39:15.172 --> 00:39:17.132
you know, fulfilling once I learned how to do it.
452
00:39:17.172 --> 00:39:19.033
And I learned that my hands can be taught.
453
00:39:19.893 --> 00:39:27.734
But so anyway, you get out and we're in these high volume situations where treating teeth, not treating people, and we're just drilling holes and filling holes.
454
00:39:28.575 --> 00:39:41.777
And this is one of the reasons why I formulated my practice model to be very relationship-based, high touch, because I wanted to really see that, you know, the transformation and, you know, and I wanted my patients to feel it.
455
00:39:42.237 --> 00:39:47.501
And I wanted them to be attracted to this kind of dentistry.
456
00:39:48.642 --> 00:39:55.807
And so I feel that a lot of dentists who are in these high-volume practices, they're treating teeth, not people.
457
00:39:55.848 --> 00:39:57.909
They've lost sight of their purpose.
458
00:39:57.949 --> 00:40:02.432
And they're missing out on the relationships with the patients and the opportunity for that.
459
00:40:03.313 --> 00:40:04.754
And then we are expensive.
460
00:40:04.854 --> 00:40:04.954
Yeah.
461
00:40:08.477 --> 00:40:11.559
We're not, it's not a pleasant experience to go to the dentist.
462
00:40:11.639 --> 00:40:12.160
It hurts.
463
00:40:13.981 --> 00:40:23.008
And we're challenged now on a regular basis by informed patients who may be informed or misinformed, however you want to look at it.
464
00:40:24.009 --> 00:40:30.834
And it's draining on us, especially in the newer dentists in the generation that we're in.
465
00:40:30.874 --> 00:40:37.179
You know, a lot of them, you know, went through COVID, you know, before they got to college or dental school and, you know, it was...
466
00:40:39.105 --> 00:40:51.098
some social issues that need to be addressed in their development and the resilience skills of the newest generation.
467
00:40:51.118 --> 00:40:54.221
They haven't been challenged to the level that they're challenged now.
468
00:40:55.162 --> 00:41:02.708
50% of graduating dental students in the States have never served food for a living, pushed a broom for a living.
469
00:41:02.728 --> 00:41:03.969
They never cashed a paycheck.
470
00:41:05.109 --> 00:41:17.318
And we're expecting them to come out of dental school and do this very precise procedure in an unfavorable environment and lead a team.
471
00:41:17.338 --> 00:41:19.260
And they've never led anything before.
472
00:41:20.020 --> 00:41:21.241
And so it's overwhelming.
473
00:41:21.261 --> 00:41:23.402
Do you think it's a skill deficit then?
474
00:41:24.043 --> 00:41:34.169
I mean, I don't necessarily mean a clinical skill deficit, but an emotional or personal skill set.
475
00:41:34.269 --> 00:41:38.952
They haven't had the experience to exercise that way yet.
476
00:41:39.533 --> 00:41:42.294
And again, we're high achievers, so we don't like asking for help.
477
00:41:43.355 --> 00:41:46.818
So, you know, so they don't know how to ask for help, many of them.
478
00:41:46.918 --> 00:41:52.343
And so they just kind of put their head down and they do their job and they they work long hours, five, six days a week.
479
00:41:53.164 --> 00:41:55.766
And they burn out their bodies.
480
00:41:56.466 --> 00:42:01.110
You know, they burn out mentally and their bodies start to fail because dentistry is hard on our bodies, too.
481
00:42:02.612 --> 00:42:10.840
And, you know, and they were sold a story that dentistry is the, you know, one of the best professions to go into.
482
00:42:11.021 --> 00:42:11.241
Yeah.
483
00:42:11.801 --> 00:42:16.206
And, you know, a license to print money, per se, you know, and it's not.
484
00:42:16.246 --> 00:42:17.027
It's very hard.
485
00:42:17.487 --> 00:42:18.808
It's very hard to make it.
486
00:42:19.008 --> 00:42:22.611
And you get out of dental school barely competent.
487
00:42:23.672 --> 00:42:30.677
And the dentist that you are when you graduate is hopefully much different than the dentist you are five years later, ten years later.
488
00:42:31.318 --> 00:42:36.122
And I mentor a lot of young dentists and dental students.
489
00:42:37.082 --> 00:42:40.506
And I always tell them when you graduate, the education is not over.
490
00:42:40.546 --> 00:42:41.327
It's just beginning.
491
00:42:42.188 --> 00:42:53.039
And don't stop learning because there's so many amazing things that you didn't learn in dental school that you can now learn and provide for your patients for the best interest of the finest care.
492
00:42:53.560 --> 00:42:54.261
Absolutely.
493
00:42:54.421 --> 00:42:57.384
So it's multifactorial.
494
00:42:59.506 --> 00:43:03.747
And, you know, the solo private practice, especially isolating.
495
00:43:04.147 --> 00:43:04.367
Yeah.
496
00:43:04.787 --> 00:43:05.147
Okay.
497
00:43:05.207 --> 00:43:05.607
Absolutely.
498
00:43:05.627 --> 00:43:07.228
You know, it's not, it doesn't help either.
499
00:43:07.968 --> 00:43:17.770
So what do you, what do you think those dentists should do that are in those circumstances that are struggling with burnout, with stress and maybe feel ill-equipped?
500
00:43:18.970 --> 00:43:22.151
Is there anything, are you saying you speak with a lot of younger dentists?
501
00:43:22.211 --> 00:43:25.772
Is there some standard points of advice that you tend to give to them?
502
00:43:26.572 --> 00:43:29.075
Easiest is mentorship.
503
00:43:29.696 --> 00:43:30.416
Find a mentor.
504
00:43:30.997 --> 00:43:31.297
Okay?
505
00:43:31.377 --> 00:43:40.748
A lot of times you as a young dentist, if you're struggling, go find a friend, find, you know, and talk to them and, you know, have the courage to be vulnerable.
506
00:43:40.868 --> 00:43:46.254
Find a mentor, find someone who you view as being, as achieved some level of success.
507
00:43:47.115 --> 00:43:50.800
and ask them, how did you get to where you are today?
508
00:43:50.960 --> 00:43:55.286
What was it like when you were in my phase of development as a dentist?
509
00:43:55.767 --> 00:43:56.909
What fears did you have?
510
00:43:56.929 --> 00:44:00.374
What obstacles did you face that you had to overcome?
511
00:44:00.414 --> 00:44:01.595
How did you overcome those?
512
00:44:02.456 --> 00:44:09.325
And, you know, and if they are a, you know, a decent human being, they will they will answer those questions.
513
00:44:09.405 --> 00:44:17.956
And you now have that experience and you can start growing yourself in ways that that you were you might have been stuck in.
514
00:44:18.936 --> 00:44:20.237
So mentorship is the first thing.
515
00:44:20.317 --> 00:44:30.841
And by the way, I run a with a former dental student of mine and a young female dentist who just went pro, just started working for you weeks ago.
516
00:44:31.402 --> 00:44:37.524
You know, we run a mentorship mastermind group for dental students and young dentists.
517
00:44:37.684 --> 00:44:38.745
And there's over 100 dentists.
518
00:44:39.185 --> 00:44:40.805
dentists and dental students as part of this.
519
00:44:40.845 --> 00:44:42.666
We meet every four to six weeks on Zoom.
520
00:44:43.026 --> 00:44:43.626
Love it.
521
00:44:43.766 --> 00:44:44.346
And it's awesome.
522
00:44:44.687 --> 00:44:45.267
So that's first.
523
00:44:45.347 --> 00:44:48.588
Second is invest in yourself and coaching.
524
00:44:49.288 --> 00:44:52.068
OK. And so whether you're, you know, I know you're an avid reader.
525
00:44:52.129 --> 00:44:52.789
I'm an avid reader.
526
00:44:52.809 --> 00:44:54.129
I'm a voracious reader.
527
00:44:54.549 --> 00:44:59.831
I read so many books on, you know, not just dentistry, but how can I be my best self?
528
00:45:00.371 --> 00:45:01.251
And so read books.
529
00:45:01.371 --> 00:45:04.652
Get invested in coaching my entire career.
530
00:45:05.592 --> 00:45:14.896
And, you know, and, you know, if the best athletes in the world have coaches, why can't the best dentists have coaches too?
531
00:45:15.196 --> 00:45:15.776
100%, yeah.
532
00:45:15.916 --> 00:45:20.958
And so with mentors and coaches, I've had people who have seen things in me.
533
00:45:21.758 --> 00:45:23.139
that I didn't see in myself.
534
00:45:23.839 --> 00:45:29.083
And they encouraged me to explore those things and then guided me along.
535
00:45:29.183 --> 00:45:40.770
And sometimes they were spot on and I grew in ways that were so amazing, so fulfilling for me and so impactful for my patients and so impactful for my life and my family.
536
00:45:42.110 --> 00:45:43.631
you know, I never would have done on my own.
537
00:45:44.051 --> 00:45:47.592
And some weren't quite as, you know, as impactful.
538
00:45:47.612 --> 00:45:48.732
And I decided, you know, thank you.
539
00:45:48.752 --> 00:45:49.993
But no, I didn't go that route.
540
00:45:50.133 --> 00:45:55.034
You know, I still have the, you know, the choice of what I want to do and what I want to follow.
541
00:45:55.234 --> 00:46:02.896
And then if you're, if it's really bad, you know, burnout, depression, you know, suicidal ideation, substance abuse, get help.
542
00:46:03.396 --> 00:46:03.576
Yeah.
543
00:46:03.696 --> 00:46:04.016
Okay.
544
00:46:04.096 --> 00:46:09.378
There's no doubt, you know, that, you know, it's treatable, but you need to take that step to get the help.
545
00:46:11.168 --> 00:46:12.208
Really helpful.
546
00:46:12.809 --> 00:46:20.292
I think all of those messages really have a don't try and do it on your own sub message underneath them, right?
547
00:46:20.572 --> 00:46:24.273
Whether it be your development or when you're really in a challenge.
548
00:46:25.814 --> 00:46:32.317
It's community that I think is our salvation in many of these circumstances.
549
00:46:32.357 --> 00:46:33.637
And I think that's the problem with dentistry.
550
00:46:33.657 --> 00:46:35.158
Oftentimes it can be a lonely place.
551
00:46:36.038 --> 00:46:44.440
For me, the British Academy of Cosmetic Dentistry was my sort of community within the profession from when I was an undergrad.
552
00:46:44.841 --> 00:46:49.922
I'm sure the ADA provides that and has provided you with that as well in many ways.
553
00:46:50.122 --> 00:46:50.342
Yeah.
554
00:46:50.762 --> 00:46:50.922
Yeah.
555
00:46:50.942 --> 00:46:56.564
There's like like I said in my story, you know, the Colorado Dental Association saw me as more.
556
00:46:57.364 --> 00:47:15.584
of a leader than just the wellness guy you know and they encouraged me to to pick up uh you know some some commitments and their leadership track i never would have done that on my own yeah yeah sometimes you need that don't you you mentioned that you're a voracious reader is there any sort of top books that you've that you've read that have had the most profound impact on you
557
00:47:17.070 --> 00:47:18.431
Oh, where to start?
558
00:47:18.451 --> 00:47:25.753
I would say early in my recovery and early in my career, I read Seven Habits of Highly Effective People by Stephen Covey.
559
00:47:26.334 --> 00:47:29.075
And that to me is still the foundational book.
560
00:47:29.095 --> 00:47:33.876
And not just read it, I didn't just read it, I followed the exercises.
561
00:47:33.916 --> 00:47:39.539
And I learned about, explored what were my core values.
562
00:47:40.019 --> 00:47:42.840
I learned about what is my purpose, what is my mission.
563
00:47:43.420 --> 00:47:44.281
What is my vision?
564
00:47:44.301 --> 00:47:56.293
I'm very intentional with that because if you can establish what your core values are, how you live your life, who you are, what you stand for, it's pivotal on how I led and how I continue to lead.
565
00:47:56.993 --> 00:48:05.682
I had some opportunities to join leadership in different organizations, and one of my coaches said, well, Brett, what is your goal?
566
00:48:06.242 --> 00:48:15.107
core values and what are your core values and how do your core values match up with the core values of the different organizations that you have these opportunities to lead.
567
00:48:15.767 --> 00:48:21.210
And when I saw the value connect or value disconnect, it was very easy to make those decisions.
568
00:48:21.810 --> 00:48:26.273
And one of the things I was really proud of with being on the board of the American Dental Association is that...
569
00:48:26.813 --> 00:48:33.942
In six years of being on their board, we never discussed or mentioned the core values of the organization.
570
00:48:33.962 --> 00:48:38.948
We never discussed or mentioned the mission or the vision of the organization.
571
00:48:38.968 --> 00:48:45.856
And it's funny, we've got this wonderful, beautiful boardroom in Chicago where ADA is headquartered.
572
00:48:46.476 --> 00:48:49.817
And, you know, and everybody's sitting around the board table at our board meetings.
573
00:48:50.457 --> 00:48:53.058
And we've got a placard with our name on it.
574
00:48:53.178 --> 00:48:55.818
And the placard has our name on one side and our name on the other side.
575
00:48:56.278 --> 00:48:58.519
And so I decided to, you know, I know my name.
576
00:48:58.539 --> 00:48:59.339
I don't need to see it.
577
00:48:59.799 --> 00:49:04.220
And so I decided to take that side off and put the ADA's core values, mission and vision.
578
00:49:04.740 --> 00:49:08.561
And this is now the lens with which we make our decisions.
579
00:49:09.041 --> 00:49:15.923
And my job as president was to align all of our actions to be in tune with our core values, be in tune with our mission and our vision.
580
00:49:16.824 --> 00:49:18.886
It makes decision making much easier, doesn't it?
581
00:49:18.906 --> 00:49:21.108
When you have that sort of matrix to view things through.
582
00:49:21.329 --> 00:49:21.549
Right.
583
00:49:21.669 --> 00:49:22.650
And it really did.
584
00:49:22.670 --> 00:49:34.143
And so we would read it before every meeting, you know, and sometimes these meetings were three or four day marathon meetings in Chicago in person, or sometimes it was a 30 minute Zoom meeting, but I wanted that to be front and center.
585
00:49:34.163 --> 00:49:34.263
Yeah.
586
00:49:35.104 --> 00:49:41.010
So everybody had that lens to make the decision through the matrix of that.
587
00:49:41.251 --> 00:49:46.316
And we navigated some really rough waters in my year.
588
00:49:47.418 --> 00:49:48.138
But it was easy.
589
00:49:48.179 --> 00:49:50.902
So it was easy when we knew what our core values were.
590
00:49:50.942 --> 00:49:51.803
So, for instance...
591
00:49:52.243 --> 00:50:10.608
you know the the you know um rfk junior head of health and human services went after fluoride and uh you know in one of our two of our core values at the ada are science and evidence-based and so when science is being challenged we need to stand up for for true science and so i was
592
00:50:11.848 --> 00:50:20.078
all over the place making statements in all the news outlets, print, media, TV, whatever.
593
00:50:20.158 --> 00:50:21.039
I was there.
594
00:50:21.079 --> 00:50:27.887
Whatever he said, if fluoride's bad, I would say fluoride is good to the tune of billions of views.
595
00:50:28.148 --> 00:50:30.130
And in the states, 21 states...
596
00:50:32.052 --> 00:50:36.415
introduced legis potential legislation to remove fluoride from the water.
597
00:50:37.416 --> 00:50:39.838
And, uh, we only lost in two of them.
598
00:50:40.538 --> 00:50:40.898
Okay.
599
00:50:40.959 --> 00:50:42.600
In Utah and in Florida.
600
00:50:43.360 --> 00:50:45.602
Um, and you know, but we won in 19.
601
00:50:46.182 --> 00:50:46.483
Okay.
602
00:50:46.683 --> 00:50:52.807
And so I feel like I did a, you know, uh, I did my job to, to, to make sure that science was true.
603
00:50:52.827 --> 00:50:55.709
Science was recognized, um, and front and center.
604
00:50:55.809 --> 00:51:00.753
So that's, that's how, you know, basically I decided to, you know, how I decided where my actions were to be.
605
00:51:01.353 --> 00:51:26.848
to be placed i've got a double click on that fluoride conversation because it's it's a really interesting one i think and especially um because obviously you mentioned earlier and i want to get into it later on the whole mouth body connection and obviously uh there's a subsect of the dental community call them biological dentists call them holistic dentists call them what you will who i have shared uh
606
00:51:28.934 --> 00:51:35.918
shared alignment with in many ways in terms of, you mentioned I've got Peter Attia's Outlive behind me.
607
00:51:35.978 --> 00:51:45.083
So very much sort of a medicine 3.0 modern view on healthcare, which is sometimes associated with being fluoride free.
608
00:51:46.243 --> 00:51:56.509
Because in many ways we are, and I think especially in a post COVID world, we're much more skeptical of medicine provided,
609
00:51:59.499 --> 00:52:06.885
generically and prolifically, especially when it's come from big pharma, which obviously has quite a bad reputation.
610
00:52:06.966 --> 00:52:14.672
So I've always been quite torn on the fluoride debate because as I always say to my biological dentist friends,
611
00:52:15.553 --> 00:52:21.477
Please show me some evidence that shows fluoride being an issue in toothpaste.
612
00:52:22.038 --> 00:52:23.659
Nobody's ever been able to show me that.
613
00:52:23.719 --> 00:52:25.821
And I'm more than happy to see it if it exists.
614
00:52:26.561 --> 00:52:29.023
There are some studies on the water fluoridation topic.
615
00:52:29.083 --> 00:52:31.545
The Harvard study is always the one that I hear referenced.
616
00:52:32.365 --> 00:52:35.886
Are you familiar with that one, the neurotoxicity with water fluoridations?
617
00:52:35.946 --> 00:52:36.827
The Cochrane study?
618
00:52:37.247 --> 00:52:37.787
Possibly, yeah.
619
00:52:37.827 --> 00:52:38.907
Okay.
620
00:52:38.947 --> 00:52:40.248
You tell me your thoughts on that.
621
00:52:40.308 --> 00:52:52.992
I'm going down a rabbit hole here, but I'm interested to know how that debate went from your point of view, because I'm guessing Robert Kennedy Jr. had something to lean on in terms of his position.
622
00:52:53.252 --> 00:52:53.792
Or maybe he didn't.
623
00:52:53.812 --> 00:52:54.212
I don't know.
624
00:52:54.392 --> 00:52:57.033
Well, the studies that he leans on are low quality studies.
625
00:52:57.453 --> 00:52:57.673
Right.
626
00:52:57.853 --> 00:52:58.374
Okay.
627
00:52:58.394 --> 00:53:09.299
The one that we've been fighting the most was a study out of China that showed lower IQ in one community that had fluoride compared to another community that didn't.
628
00:53:09.539 --> 00:53:10.039
In the water.
629
00:53:10.179 --> 00:53:10.620
In the water.
630
00:53:10.720 --> 00:53:12.360
Yeah.
631
00:53:12.400 --> 00:53:16.682
But the quality of the study was very low quality.
632
00:53:16.702 --> 00:53:19.624
There's so many other factors that weren't taken into account.
633
00:53:19.844 --> 00:53:20.524
Yeah.
634
00:53:20.804 --> 00:53:24.965
Like it was a low socioeconomic area already or that sort of thing.
635
00:53:24.985 --> 00:53:25.105
Right.
636
00:53:25.125 --> 00:53:26.106
But what else are they eating?
637
00:53:26.826 --> 00:53:32.307
Is there anything else in the food that could be causing this, could be contributing to this?
638
00:53:32.648 --> 00:53:39.269
And the fluoride levels in the lower IQ community were double that from what we have in the States.
639
00:53:39.549 --> 00:53:39.749
Right.
640
00:53:39.809 --> 00:53:40.110
Okay.
641
00:53:40.190 --> 00:53:40.430
Okay.
642
00:53:40.450 --> 00:53:43.250
So there's all these things, but he hung his hat on that.
643
00:53:45.531 --> 00:53:54.159
Fluoride was introduced in the water to help strengthen teeth against caries.
644
00:53:55.080 --> 00:53:55.400
Okay.
645
00:53:56.081 --> 00:54:01.245
And we've got 80 years of data that shows that it's been effective.
646
00:54:01.906 --> 00:54:05.289
So let's just empirically, let's say my parents' generation.
647
00:54:05.369 --> 00:54:06.090
So I'm Gen X.
648
00:54:06.110 --> 00:54:07.771
My parents' generation is baby boomers.
649
00:54:07.791 --> 00:54:08.132
Okay.
650
00:54:08.912 --> 00:54:11.354
Uh, did not have fluoride in the water when they were growing up.
651
00:54:11.634 --> 00:54:21.860
And as a result, my parents had fillings placed in pretty much every posterior tooth in their mouth because they were carries, they were risk or they actually had carries.
652
00:54:22.481 --> 00:54:22.761
Okay.
653
00:54:23.341 --> 00:54:31.967
And those small fillings over time turned into bigger fillings, turned into bigger fillings, turned into crowns, turned into root canals.
654
00:54:32.856 --> 00:54:40.179
possibly failed root canals, extraction, bone graft, implant, crown, maybe a new crown.
655
00:54:40.619 --> 00:54:49.503
So there's an economy tied to the life of that person, the life of, you know, over the course of time from that very first filling.
656
00:54:52.145 --> 00:54:54.626
Fluoride was introduced as a prevention measure.
657
00:54:55.647 --> 00:55:01.213
I'm Gen X. I had four fillings placed in my teeth over the course of my life.
658
00:55:01.233 --> 00:55:02.234
I'm 58 years old.
659
00:55:02.915 --> 00:55:03.195
Okay?
660
00:55:03.235 --> 00:55:08.741
Those fillings have turned into amalgam fillings into one is still a composite.
661
00:55:09.482 --> 00:55:12.305
The other three are gold on lace at this point.
662
00:55:12.425 --> 00:55:13.866
And I have very little dental needs.
663
00:55:14.147 --> 00:55:14.327
Mm-hmm.
664
00:55:16.167 --> 00:55:18.669
I attribute that to fluoride in the water.
665
00:55:18.689 --> 00:55:22.473
I grew up in a fluoride rich environment.
666
00:55:23.354 --> 00:55:26.416
And is my IQ as good as it can possibly be?
667
00:55:26.436 --> 00:55:27.637
I don't know.
668
00:55:28.518 --> 00:55:29.920
Can you imagine if it wasn't there?
669
00:55:29.940 --> 00:55:33.102
And my head would be like Dr. Demento.
670
00:55:33.603 --> 00:55:35.304
But it works and it's safe.
671
00:55:36.105 --> 00:55:40.027
Okay, and so we've got 80 years to show that.
672
00:55:40.367 --> 00:55:51.291
And now we have studies that show communities in North America where the fluoride was removed without anyone knowing, carries rates went way up.
673
00:55:51.451 --> 00:55:59.494
We saw a 25% increase in decay rates amongst kids in the non-fluoridated communities.
674
00:56:01.155 --> 00:56:03.436
Is that a before and after 25% increase?
675
00:56:03.476 --> 00:56:07.398
Within three years, we see a 25% increase.
676
00:56:07.618 --> 00:56:08.319
That's really interesting.
677
00:56:08.579 --> 00:56:08.879
Okay.
678
00:56:11.140 --> 00:56:11.980
Everything is toxic.
679
00:56:12.000 --> 00:56:12.301
Everything.
680
00:56:13.387 --> 00:56:14.307
At the wrong concentration.
681
00:56:14.327 --> 00:56:14.907
At the dose.
682
00:56:14.927 --> 00:56:15.047
Yeah.
683
00:56:15.267 --> 00:56:15.587
Okay.
684
00:56:15.987 --> 00:56:17.348
And, you know, depending on the dose.
685
00:56:17.948 --> 00:56:30.830
And in 2015 or 16, maybe 17, our Environmental Protection Agency, the EPA in the States, lowered, recommended to lower the community water fluoridation levels.
686
00:56:31.690 --> 00:56:32.430
Okay.
687
00:56:32.470 --> 00:56:37.351
To 0.7 parts per million from 1.1, I think.
688
00:56:37.691 --> 00:56:37.931
Okay.
689
00:56:37.992 --> 00:56:38.272
Okay.
690
00:56:38.992 --> 00:56:40.312
And because...
691
00:56:42.533 --> 00:56:50.959
It showed that through public health modeling that there's now multiple sources for the fluoride and we were giving too much.
692
00:56:53.032 --> 00:56:53.472
Science.
693
00:56:53.593 --> 00:56:55.814
As in from water and then also from toothpaste.
694
00:56:55.834 --> 00:56:59.517
From the food, toothpaste, the dentist, all sorts of things.
695
00:56:59.577 --> 00:56:59.837
Okay.
696
00:57:00.158 --> 00:57:00.438
Okay.
697
00:57:01.018 --> 00:57:07.904
And there's increased signs of fluorosis and things like that, but not devastating or damaging.
698
00:57:07.944 --> 00:57:15.890
But in science, science is a reflection, an observation of what's happening, an explanation of what's happening.
699
00:57:15.950 --> 00:57:16.170
Mm-hmm.
700
00:57:16.490 --> 00:57:25.641
And in true science, when we get the data based on the science and based on the data, we do the best we can with what we have.
701
00:57:25.761 --> 00:57:30.166
When the data changes or when we can look at things better, we do better.
702
00:57:31.327 --> 00:57:33.950
And so that's a perfect example of the scientific method.
703
00:57:34.290 --> 00:57:40.011
You know, we had a model that worked and then we saw that, hey, we can improve it by lowering the dose.
704
00:57:40.751 --> 00:57:42.072
So we changed it.
705
00:57:42.432 --> 00:57:56.995
OK. And until we see a change where, you know, there's there's a substitute or, you know, bottom line is, you know, and this is something that we, you know, that I firmly believe in, you know, we are just trying to help.
706
00:57:58.096 --> 00:57:58.416
Okay?
707
00:57:58.936 --> 00:58:00.117
Sugar causes cavities.
708
00:58:00.678 --> 00:58:08.064
One of the Trump administration's big initiatives is to lower sugar intake and lower the intake of ultra-processed foods.
709
00:58:08.124 --> 00:58:14.930
And we in organized dentistry would very much like to see that happen and we can help with that.
710
00:58:14.950 --> 00:58:15.891
Okay?
711
00:58:16.632 --> 00:58:18.734
But if you got rid of sugar, you wouldn't need fluoride.
712
00:58:19.795 --> 00:58:19.975
Okay?
713
00:58:19.995 --> 00:58:20.615
It's the bottom line.
714
00:58:20.635 --> 00:58:22.076
We're just trying to help the problem.
715
00:58:22.817 --> 00:58:30.247
And so what we are seeing in the middle income and higher income demographics, carries rates are going down.
716
00:58:31.188 --> 00:58:31.508
Okay.
717
00:58:32.350 --> 00:58:37.356
In kids, in the lower income demographics, they're still going down.
718
00:58:39.057 --> 00:58:39.937
Still going up, you mean?
719
00:58:40.037 --> 00:58:42.318
No, no, going down in the fluoridated communities.
720
00:58:42.438 --> 00:58:42.898
Okay, fine.
721
00:58:43.058 --> 00:58:44.338
So they're going down in all communities?
722
00:58:44.378 --> 00:58:45.138
In all communities.
723
00:58:45.158 --> 00:58:45.518
Okay, fine.
724
00:58:45.578 --> 00:58:52.060
In the non-fluoridated communities, the lower income kids increase 25% in decay rates.
725
00:58:52.080 --> 00:58:54.540
Really interesting.
726
00:58:54.580 --> 00:58:54.940
Okay?
727
00:58:55.160 --> 00:59:04.222
And so those kids now have a lifetime of economy attached to those teeth, to those first fillings that were needed.
728
00:59:05.102 --> 00:59:05.422
Okay.
729
00:59:05.642 --> 00:59:10.745
And so from a public health standpoint, any good public health measure flies under the radar.
730
00:59:11.726 --> 00:59:14.648
And, you know, people don't see why because it's working.
731
00:59:14.928 --> 00:59:15.948
Okay.
732
00:59:16.008 --> 00:59:20.551
We're starting to see measles back in the United States.
733
00:59:21.132 --> 00:59:22.732
It hasn't, it was eradicated.
734
00:59:22.772 --> 00:59:23.433
Now it's back.
735
00:59:24.093 --> 00:59:24.333
Okay.
736
00:59:24.353 --> 00:59:28.316
We had two deaths recently in Pennsylvania that were measles related.
737
00:59:28.876 --> 00:59:30.958
That hasn't happened in decades.
738
00:59:32.019 --> 00:59:40.067
And so we're seeing this, and we're seeing the increase in carries in non-fluoridated areas.
739
00:59:40.688 --> 00:59:41.088
Interesting.
740
00:59:42.701 --> 00:59:51.203
Yeah, I mean, I always like to say I'm fluoride agnostic in that I'm open to any new information.
741
00:59:51.223 --> 00:59:56.365
I mean, one of the core quotes behind this podcast is strong opinions loosely held.
742
00:59:56.865 --> 01:00:01.786
And I think your point is really strong there that we've got to try and follow the research here.
743
01:00:01.806 --> 01:00:02.767
Yeah.
744
01:00:03.947 --> 01:00:26.818
and hypothetical risks of toxicity versus concrete evidence of preventing one of the world's most prevalent or if not the world's most prevalent diseases yeah is um you've got to look at the balance of risk versus reward ratio i guess right um and so when there's no meaningful alternative um
745
01:00:28.439 --> 01:00:49.957
you should follow the science and and and that seems fairly robust how about in toothpaste obviously there is now um in my understanding randomized double blind control trials showing hydroxyapatite at the right concentration being as effective as fluoride as far as i'm aware what's your view on it on that topic in uh in toothpaste
746
01:00:50.197 --> 01:00:50.718
Absolutely.
747
01:00:51.358 --> 01:00:51.979
I think it's great.
748
01:00:52.419 --> 01:00:55.742
I think it's a great alternative.
749
01:00:55.882 --> 01:01:01.926
So I'm in Colorado, which is a very holistic demographic.
750
01:01:02.287 --> 01:01:07.451
And so for 25 years, 30 years of practice, I have been asked, do I really need fluoride?
751
01:01:07.471 --> 01:01:08.372
Or I'm anti-fluoride.
752
01:01:08.392 --> 01:01:09.673
I don't want fluoride in my mouth.
753
01:01:09.713 --> 01:01:10.693
I don't want it in my body.
754
01:01:10.713 --> 01:01:11.234
And so...
755
01:01:12.795 --> 01:01:16.558
hydroxyapatite is a fine, uh, fine alternative.
756
01:01:16.678 --> 01:01:23.683
And, and so, and my patients, many of them were very healthy and they did very well with it, but some were more prone to carries.
757
01:01:24.424 --> 01:01:29.648
And as in over time, you get to see that and they would complain, well, why am I getting cavities?
758
01:01:29.688 --> 01:01:36.133
I'm like, you know, we need to, you know, bring in some, some, uh, more armamentarium to, you know, lower your risk.
759
01:01:36.193 --> 01:01:36.293
So,
760
01:01:37.454 --> 01:01:54.775
you know we would we would suggest fluoride and you know and they were sick of getting drilled on so yeah they would they would be more open to it's much cheaper to get fillings fillings will do that and and do you give them any advice in terms of the percentage of hydroxyapatite they should be looking for or anything like that
761
01:01:55.250 --> 01:01:57.951
No, I'll let them do their own research on that.
762
01:01:59.132 --> 01:02:08.635
So, and again, this is all coming up in the last, you know, three or four years, and I haven't been practicing as much, you know, I've been in leadership, so I'm not as in tune with that.
763
01:02:08.655 --> 01:02:15.198
But I know it's a fine alternative and effective, effective treatment to help mitigate the risk of decay.
764
01:02:15.778 --> 01:02:16.479
Yeah, yeah.
765
01:02:17.099 --> 01:02:17.719
Okay, brilliant.
766
01:02:18.940 --> 01:02:19.060
Okay.
767
01:02:20.480 --> 01:02:25.125
I'd love to have you on again one time and have you up against someone who's anti-fluoride.
768
01:02:25.145 --> 01:02:29.168
I mean, you've gone up against RFK Jr., so you've gone in right at the top there.
769
01:02:29.188 --> 01:02:31.731
So that would be an interesting debate, I think.
770
01:02:31.831 --> 01:02:32.992
It's so funny.
771
01:02:33.012 --> 01:02:39.438
I never wanted to be a fluoride expert, but you have to do what's in front of you when you're in leadership.
772
01:02:39.978 --> 01:02:40.379
That's it.
773
01:02:40.519 --> 01:02:41.500
But happy to come back.
774
01:02:41.560 --> 01:02:41.960
Absolutely.
775
01:02:41.980 --> 01:02:42.781
No, it's interesting.
776
01:02:43.121 --> 01:02:52.151
I mean, let's go a bit more into the mouth-body connection then, because I know you mentioned that as pillar two of your time in the ADA.
777
01:02:53.352 --> 01:02:55.094
Why was that an important topic for you?
778
01:02:55.114 --> 01:03:03.443
And especially with your role in the ADA, what were you hoping to bring to the forefront of the profession with that?
779
01:03:03.843 --> 01:03:04.544
Yeah.
780
01:03:04.664 --> 01:03:05.484
Thank you for asking that.
781
01:03:06.265 --> 01:03:09.567
I'll start out by sharing in my hospital residency.
782
01:03:10.448 --> 01:03:11.709
I saw a lot of very sick people.
783
01:03:12.370 --> 01:03:18.854
And I remember a patient who had bacterial endocarditis around two of their heart valves.
784
01:03:18.874 --> 01:03:20.556
So two of their heart valves were infected.
785
01:03:21.256 --> 01:03:23.817
And they were sent to the dentist, to our clinic.
786
01:03:24.357 --> 01:03:27.058
I did an examination, x-rays.
787
01:03:27.778 --> 01:03:30.598
I saw two teeth that had periapical radiolucencies.
788
01:03:31.519 --> 01:03:35.500
And so I recommended taking these teeth out.
789
01:03:35.820 --> 01:03:37.160
This patient was very sick.
790
01:03:37.700 --> 01:03:40.021
I mean, she was her heart, congestive heart failure.
791
01:03:40.041 --> 01:03:42.901
She was in kidney failure, not doing very well, okay?
792
01:03:44.062 --> 01:03:48.683
And so we had to take out a couple teeth that were infected.
793
01:03:49.443 --> 01:03:53.405
One of the teeth, as I took it out, pus came out of the socket.
794
01:03:54.325 --> 01:03:58.267
And my attending said, Brett, quickly culture that pus.
795
01:03:58.287 --> 01:03:59.267
Let's see what it is.
796
01:03:59.287 --> 01:04:04.449
And it was the exact same bacteria that was around the vegetation, around the heart valve.
797
01:04:05.229 --> 01:04:05.749
Okay.
798
01:04:05.890 --> 01:04:09.411
It was, you know, 100%, you know, connection.
799
01:04:09.571 --> 01:04:09.851
Yeah.
800
01:04:09.891 --> 01:04:10.431
Fascinating.
801
01:04:11.052 --> 01:04:11.292
So...
802
01:04:12.440 --> 01:04:15.264
That day, the mouth-body connection was solidified.
803
01:04:15.344 --> 01:04:24.057
We learned it in dental school, but that day I saw the value and the essentialism of dentistry in many cases with systemic problem.
804
01:04:25.810 --> 01:04:34.218
What I later found out was this patient was in the hospital for probably four weeks, and many of it was in the ICU, so very expensive.
805
01:04:35.179 --> 01:04:45.209
And I saw that the ICU doctors got paid, the internal medicine doctors got paid, the cardiologists got paid, the cardiothoracic surgeons got paid,
806
01:04:45.810 --> 01:04:58.552
The anesthesiologist got paid twice, once for me and once for the cardiovascular, the thoracic surgery she had to replace her heart valves.
807
01:04:59.372 --> 01:05:01.593
Nephrologist got paid, she was in kidney failure.
808
01:05:02.493 --> 01:05:03.453
Guess who didn't get paid?
809
01:05:04.133 --> 01:05:04.733
Dentistry.
810
01:05:05.773 --> 01:05:14.315
In our Medicare system, again, dental benefits for our elder population, it says in the law there will be no payments for
811
01:05:15.875 --> 01:05:21.278
dental services under Medicare, except when deemed medically necessary.
812
01:05:22.739 --> 01:05:27.002
And no one ever teased out what is medical necessity.
813
01:05:27.682 --> 01:05:28.783
No one ever defined it.
814
01:05:29.403 --> 01:05:32.705
And so back in, you know, this is the, you know, late nineties.
815
01:05:33.065 --> 01:05:33.405
Okay.
816
01:05:33.705 --> 01:05:35.126
There was no payment yet.
817
01:05:35.566 --> 01:05:38.808
The work that I did was essential to saving this patient's life.
818
01:05:39.028 --> 01:05:41.310
Had we not taken that tooth out, uh,
819
01:05:42.050 --> 01:05:50.037
Most likely she would have had the heart valve replaced and it would have been reinfected quickly after, especially since pus exuded from the socket.
820
01:05:50.077 --> 01:05:54.801
There was active bacteria sprinkling into the bloodstream on a regular basis.
821
01:05:55.701 --> 01:05:56.242
She would have died.
822
01:05:56.982 --> 01:05:59.485
But yet we didn't get paid.
823
01:05:59.525 --> 01:06:00.906
We were not deemed essential.
824
01:06:01.726 --> 01:06:02.927
And so over the years...
825
01:06:03.904 --> 01:06:09.828
we've been trying to find ways to develop an essential health benefit that reflects that in dentistry.
826
01:06:10.308 --> 01:06:22.737
And so Natalia Chalmers, who was the head of CMS, Center for Medicaid and Medicare Services in the US, in the government, she recognized that we've never defined medical necessity.
827
01:06:23.437 --> 01:06:30.060
And so we started to, she started to ask the questions to the various oral health entities around the country.
828
01:06:30.240 --> 01:06:35.683
If you were to define medical necessity for oral care, what would that entail?
829
01:06:36.143 --> 01:06:46.547
And so we said things like bacterial endocarditis, we said things like pre-radiation dental care for oral cancer treatments, pre-radiation,
830
01:06:47.908 --> 01:06:58.755
organ transplants, diabetes, all have a strong connection, and improving oral health will improve outcomes in those cases.
831
01:06:59.375 --> 01:07:01.616
And the government, Medicare, said yes.
832
01:07:03.142 --> 01:07:11.369
to we should cover these things because they are essential, except they didn't cover diabetes.
833
01:07:13.010 --> 01:07:14.571
Why didn't they cover diabetes?
834
01:07:15.112 --> 01:07:25.921
Because there's so many diabetics in our country that it would be an act of Congress to increase the budget for Medicare to treat all of them.
835
01:07:26.221 --> 01:07:31.906
But we know that every dollar invested in a brittle diabetic into periodontal healthcare
836
01:07:32.666 --> 01:07:42.758
they'll save $4 in medical costs down the road because they can better control their sugar levels when there's no infection.
837
01:07:43.880 --> 01:07:46.583
So we haven't gotten that through yet.
838
01:07:47.003 --> 01:07:50.728
So we're starting to see a, you know, you know,
839
01:07:51.088 --> 01:07:56.094
Sprinkles of areas where medical necessity is being funded from a benefit system.
840
01:07:56.314 --> 01:07:57.516
That's great.
841
01:07:57.596 --> 01:07:59.138
So we're very, very happy about that.
842
01:07:59.939 --> 01:08:02.101
A lot of work to do still.
843
01:08:02.882 --> 01:08:10.932
But then you look at a scenario where, let's say I had degenerative joint disease in my hip.
844
01:08:13.949 --> 01:08:20.298
no matter what benefits system I have in medicine, I'm afforded medicals, medicine's finest care.
845
01:08:20.599 --> 01:08:24.665
So if I have Medicaid, okay, I'm, I'm, I can get a hip replacement.
846
01:08:24.985 --> 01:08:27.409
If I have Medicare, I can get a hip replacement.
847
01:08:27.469 --> 01:08:28.070
If I have, if,
848
01:08:28.971 --> 01:08:30.912
private insurance, I can get a hip replacement.
849
01:08:31.532 --> 01:08:35.855
It's not life or death, but it's quality of life and it's important.
850
01:08:35.875 --> 01:08:40.677
Why can't, why can't I get a titanium post here in my hip, but I can't get a titanium post here in my mouth?
851
01:08:41.638 --> 01:08:54.405
Why is walking any more or less important than, you know, the removal of infection, the ability to chew, or the ability to face the world with a smile, with some level of dignity?
852
01:08:54.425 --> 01:08:54.525
Yeah.
853
01:08:55.245 --> 01:09:04.971
Well, certainly if we look at the metrics of longevity associated with having a full set of healthy teeth, they're very integrally linked from what I understand in terms of research.
854
01:09:05.031 --> 01:09:06.372
But why is it an afterthought?
855
01:09:07.132 --> 01:09:14.076
Why aren't we demanding that we be able to afford our finest care to our patients as well?
856
01:09:14.877 --> 01:09:24.603
Because, you know, if you look at the whole joint replacement market, it began from a researcher named Branemark.
857
01:09:24.623 --> 01:09:24.723
Yeah.
858
01:09:25.620 --> 01:09:26.101
Oh, really?
859
01:09:26.121 --> 01:09:28.905
Remember Brandenmark implants, first dental implants.
860
01:09:29.346 --> 01:09:34.693
You know, they recognize that titanium is biocompatible and it osseointegrates into the bone.
861
01:09:34.914 --> 01:09:38.359
And that's how joint replacements were formulated.
862
01:09:39.100 --> 01:09:40.882
We missed out on a huge opportunity.
863
01:09:41.523 --> 01:09:46.546
$40 billion a year in the States goes into joint replacement surgeries.
864
01:09:46.967 --> 01:09:49.308
Less than $4 billion a year goes into dental.
865
01:09:49.348 --> 01:09:50.829
I've never thought about it like that.
866
01:09:50.849 --> 01:09:55.912
I mean, I think it's probably the same in the UK in terms of NHS provision.
867
01:09:56.953 --> 01:10:00.575
I'm sure hip replacements and joint replacements are covered by that.
868
01:10:00.595 --> 01:10:03.157
But as you say, dental implants aren't.
869
01:10:03.437 --> 01:10:04.458
I mean, I'm guessing...
870
01:10:05.648 --> 01:10:07.869
it's because they've almost been grandfathered in.
871
01:10:09.150 --> 01:10:24.878
And if they tried to get joint replacements covered on NHS or Medicaid or Medicare now, because there's no money anywhere, and there's loads of debt, they probably wouldn't introduce anything new because they would say, we don't have the money for that.
872
01:10:25.159 --> 01:10:25.359
Right.
873
01:10:25.399 --> 01:10:26.219
Well, I would guess.
874
01:10:26.519 --> 01:10:27.080
That's why I want to...
875
01:10:27.120 --> 01:10:28.300
There's one more point with that.
876
01:10:28.360 --> 01:10:28.841
If we were to...
877
01:10:31.053 --> 01:10:34.275
you know, translate the dental benefit to medicine.
878
01:10:34.816 --> 01:10:43.081
So let's say if you're, if you needed a joint replacement, or if you had degenerative joint disease in your hip, under the dental benefit model, we wouldn't give you a hip replacement.
879
01:10:43.221 --> 01:10:44.081
We'd give you crutches.
880
01:10:45.602 --> 01:10:47.543
Because that's what a flipper is if you're missing a tooth.
881
01:10:47.623 --> 01:10:48.524
It's a good analogy.
882
01:10:48.564 --> 01:10:48.784
Right?
883
01:10:49.344 --> 01:10:53.727
And so why, and yeah, is it, you know, did medicine grandfather it in?
884
01:10:54.567 --> 01:10:55.148
They had...
885
01:10:56.402 --> 01:10:58.906
they were deemed essential care.
886
01:10:59.827 --> 01:11:04.935
And we as a profession in dentistry don't view ourselves as essential care.
887
01:11:05.035 --> 01:11:07.259
Yeah, we're not strong enough for that.
888
01:11:07.319 --> 01:11:08.480
But it is essential care.
889
01:11:09.282 --> 01:11:10.804
And hip replacement's not essential.
890
01:11:12.133 --> 01:11:17.456
it's not life or death, it's quality life, but it's not life or death, where the heart valve replacement is life or death.
891
01:11:18.117 --> 01:11:24.661
But why does medicine get afforded the opportunity to provide its finest care to its patients in dentistry?
892
01:11:24.701 --> 01:11:26.442
Not, and that's what really needs to change.
893
01:11:27.002 --> 01:11:41.584
And I feel there's some, so I was just at the FDI, World Dental Congress in Prague, Czechoslovakia, and so all the leaders from around the world get together and discuss the dental issues and opportunities in all parts of the globe.
894
01:11:42.144 --> 01:11:55.777
I learned in countries like South Korea, their public benefit system, if you're a dentulist, they just advocated to go from two dental implants into an dentulist arch to four dental implants under the public benefit system.
895
01:11:56.238 --> 01:12:00.221
They're truly providing an essential health benefit for their patients.
896
01:12:00.241 --> 01:12:00.942
Wow.
897
01:12:01.022 --> 01:12:02.423
That improves their life.
898
01:12:02.964 --> 01:12:04.745
It's not life or death, but it improves their life.
899
01:12:05.265 --> 01:12:12.150
And it lengthens the stay that they'll be here on Earth because they're able to chew and they're able to face the world with dignity and they're minimizing infection.
900
01:12:12.551 --> 01:12:20.236
But how do the powers that be, and I mean, I would guess you know this, how are they making their decisions?
901
01:12:20.397 --> 01:12:20.777
Because...
902
01:12:22.309 --> 01:12:32.818
quality of life, is that a metric with which, I mean, you will know more about the American system than anywhere else, but is that a metric with which they're using to make their decisions?
903
01:12:33.098 --> 01:12:42.066
Or is it based on, as you described earlier on, spend one pound on periodontal health, save four pounds on diabetes treatment?
904
01:12:42.386 --> 01:12:43.067
Medical.
905
01:12:43.387 --> 01:12:46.149
Like that is how I would assume they're making it.
906
01:12:46.350 --> 01:12:47.330
Or I think even...
907
01:12:49.152 --> 01:12:56.638
In a good outcome, that's how I would hope they're making their decisions, in the fact that they're working with preventativeness to reduce eventual cost.
908
01:12:56.698 --> 01:13:03.563
But quality of life doesn't have necessarily a quantifiable cost metric associated with it.
909
01:13:03.583 --> 01:13:04.203
Or maybe it does.
910
01:13:04.584 --> 01:13:05.204
How do they make it?
911
01:13:05.544 --> 01:13:06.445
It absolutely does.
912
01:13:06.465 --> 01:13:07.526
So I feel...
913
01:13:09.737 --> 01:13:13.842
Again, this is my, first of all, everything I'm saying today is me.
914
01:13:13.882 --> 01:13:15.283
I'm not representing the ADA.
915
01:13:15.744 --> 01:13:18.247
I was past present, but this is all just me.
916
01:13:19.108 --> 01:13:24.875
I feel that all these medical conditions have a minimal standard for treatment.
917
01:13:25.896 --> 01:13:28.359
We have no minimal standard for oral health.
918
01:13:29.600 --> 01:13:30.061
What is it?
919
01:13:31.552 --> 01:13:46.050
In the Medicare system, the minimal standard for these medically necessary treatments that I talked about with like joint, I'm sorry, with heart valve replacements, the minimal standard is removal of infection.
920
01:13:46.550 --> 01:13:49.133
It does not provide for reconstruction.
921
01:13:50.366 --> 01:13:55.067
does not provide for anything else, just removal of infection, okay?
922
01:13:55.387 --> 01:14:07.211
So I feel that the minimal standard for cancer treatments, okay, all treatments, the preferred outcome is zero cancer cells.
923
01:14:08.191 --> 01:14:15.193
Okay, so all the treatments then to bring that patient to minimal cancer cells is covered by the benefit system.
924
01:14:15.853 --> 01:14:16.734
We don't have that.
925
01:14:17.295 --> 01:14:22.640
Okay, the private benefit system in the States is a calendarized system, coupon system.
926
01:14:22.760 --> 01:14:31.349
It's $1,000 max or $1,500 max with a certain amount of payment for different procedures and different levels and things like that.
927
01:14:31.710 --> 01:14:32.531
But it's calendarized.
928
01:14:32.551 --> 01:14:33.231
It's not essential.
929
01:14:34.694 --> 01:14:46.281
And so I think until we get a minimal standard for oral health that addresses infection, you know, and inflammation, which is really important, all medicine is going towards reduction of inflammation.
930
01:14:46.441 --> 01:14:47.782
Yep.
931
01:14:47.842 --> 01:14:48.743
The ability to chew.
932
01:14:49.623 --> 01:14:54.706
food, masticate food, and the ability to face the world with dignity with some semblance of a smile.
933
01:14:54.726 --> 01:14:57.428
I'm not saying everyone should get, you know, 20 veneers.
934
01:14:57.668 --> 01:14:58.349
That's okay.
935
01:14:58.609 --> 01:15:02.952
But if you're missing a front tooth, okay, that is, it greatly affects your mental health.
936
01:15:03.152 --> 01:15:03.352
Yeah.
937
01:15:03.853 --> 01:15:05.714
And mental health is part of overall health too.
938
01:15:06.014 --> 01:15:06.314
Absolutely.
939
01:15:06.334 --> 01:15:10.177
Again, that's also forgotten in many, many areas of healthcare systems.
940
01:15:10.737 --> 01:15:22.214
And so I feel that those three things, if they're identified and we get a consensus as a profession, all of these things will start to fall into place for essentialism.
941
01:15:22.675 --> 01:15:24.898
It's really, really, I love the idea.
942
01:15:25.879 --> 01:15:42.465
um what would your what would your minimum be then to go into the details on that i mean would you say uh in where my head goes straight away it's like okay let's say upper and lower five to five shortened dental arch we we have to replace all of those teeth with a fixed solution
943
01:15:43.125 --> 01:15:45.346
Would that be kind of where your mind goes with it?
944
01:15:45.787 --> 01:15:57.373
You know, so I asked my prosthodontist friends because, you know, in dental school, we learned that a minimum amount of teeth to masticate food are premolar to premolar, okay?
945
01:15:57.513 --> 01:15:58.033
Five to five.
946
01:15:58.714 --> 01:16:00.915
And so I asked my prosthodontic friends about that.
947
01:16:01.235 --> 01:16:03.917
And, you know, is that the minimum standard to masticate food?
948
01:16:03.937 --> 01:16:05.418
They're like, no, it's random.
949
01:16:05.898 --> 01:16:07.059
There's no science behind it.
950
01:16:07.079 --> 01:16:07.739
I'm like, shoot.
951
01:16:08.219 --> 01:16:10.801
Okay, we need to, you know, we need to figure that out.
952
01:16:10.921 --> 01:16:11.201
Yeah.
953
01:16:11.781 --> 01:16:15.664
And so if I'm advocating, so again, I'm a vision kind of guy.
954
01:16:16.625 --> 01:16:20.728
If it were as good as it can possibly be, I would say seven to seven.
955
01:16:20.988 --> 01:16:21.448
Yeah.
956
01:16:21.488 --> 01:16:21.809
Okay.
957
01:16:21.969 --> 01:16:22.169
Yeah.
958
01:16:22.289 --> 01:16:22.869
Absolutely.
959
01:16:23.070 --> 01:16:25.812
You know, second molar, we always advocate for the absolute best.
960
01:16:25.872 --> 01:16:27.072
Why sell ourselves short?
961
01:16:28.213 --> 01:16:30.615
If we sell ourselves short, they're going to cut back even more.
962
01:16:30.815 --> 01:16:30.935
Yeah.
963
01:16:31.376 --> 01:16:33.417
If you sell it five to five, it'll end up three to three.
964
01:16:33.437 --> 01:16:33.617
Yeah.
965
01:16:34.838 --> 01:16:40.620
So I think, you know, but there has to be adequate, you know, mastication surfaces.
966
01:16:41.181 --> 01:16:41.381
Okay.
967
01:16:41.401 --> 01:16:45.963
And there has to be a strategy to reduce infection and inflammation.
968
01:16:45.983 --> 01:16:51.805
And there has to be a strategy designed to allow us to face the world with dignity, with a smile.
969
01:16:53.313 --> 01:16:55.415
Yeah, it's a great target to have.
970
01:16:56.156 --> 01:17:01.061
I mean, and how does that, how does it, you mentioned, was it Oral Health 2050?
971
01:17:01.501 --> 01:17:02.122
Is that the name of it?
972
01:17:03.083 --> 01:17:07.487
So how does that, does this fit into that at all in terms of what's going on there?
973
01:17:07.847 --> 01:17:09.409
Okay, well, thank you for asking about that.
974
01:17:09.469 --> 01:17:09.729
So...
975
01:17:10.650 --> 01:17:17.752
One of the most important things that the American Dental Association is undertaking right now is called Project Oral Health 2050.
976
01:17:18.532 --> 01:17:24.514
And it's basically, what will the delivery of oral health care services look like 25 years from now?
977
01:17:25.014 --> 01:17:26.355
So we're designing the future.
978
01:17:27.195 --> 01:17:28.535
Notice I didn't say dentistry.
979
01:17:29.255 --> 01:17:30.796
I said oral health services.
980
01:17:31.556 --> 01:17:34.297
I think it's bigger than drilling holes and filling holes.
981
01:17:35.357 --> 01:17:38.581
And even today, it's bigger than that.
982
01:17:39.782 --> 01:17:43.706
So we have embarked upon this project.
983
01:17:43.966 --> 01:17:49.772
I'm the chair, Dr. Rich Rosado, who is the ADA president, under his direction.
984
01:17:51.554 --> 01:17:53.056
We feel it's one of the most important things.
985
01:17:53.096 --> 01:17:53.997
We did it in...
986
01:17:55.589 --> 01:18:19.532
late nineties and but there were things on there that uh that were not acceptable to leadership at the time and so we got buried and a lot of things that are in that in that uh projection happened to come true was in 2050 at that time it was 2020 it was 2020 of course 2020 basically was what it was so okay oh and and we ignored a lot of things and and you know
987
01:18:20.152 --> 01:18:22.813
So we're looking at five different areas.
988
01:18:23.513 --> 01:18:24.833
Six, and I'll say a six too.
989
01:18:24.853 --> 01:18:27.814
We're looking at, you know, what will the delivery model look like?
990
01:18:28.374 --> 01:18:30.075
What will the benefit model look like?
991
01:18:31.115 --> 01:18:42.158
AI technology, patient wellness, so medical dental integration, how will, you know, dentistry or oral health services play into the overall health of the patients?
992
01:18:42.498 --> 01:18:43.559
Then provider wellness.
993
01:18:43.619 --> 01:18:47.040
So dentists, hygienists, dental assistants, we're at our best.
994
01:18:47.280 --> 01:18:47.960
And the sixth,
995
01:18:48.500 --> 01:18:52.001
panel is reimagining what will dental education look like.
996
01:18:52.762 --> 01:19:00.825
And so we put that to the side because there are entities in the states that are actually doing this as well.
997
01:19:01.425 --> 01:19:09.048
And so one of them is Zadea, the American Dental Education Association, and another one is a group that is headed by Dr. Will.
998
01:19:09.848 --> 01:19:12.669
Ginobili, the dean at Harvard, and he's assembled a group too.
999
01:19:12.749 --> 01:19:19.451
And so we're going to start to see publications around reimagining dental education coming out in the next couple months.
1000
01:19:19.551 --> 01:19:20.071
Very exciting.
1001
01:19:20.111 --> 01:19:28.093
So in the different five different panels that we put together, we've solicited subject matter experts in those areas.
1002
01:19:28.633 --> 01:19:35.695
Some are dentists, some are not, but they have great perspective of where things are going.
1003
01:19:36.155 --> 01:19:47.921
And as we've interviewed them, we've hired the Boston Consulting Group, who has helped us organize this, and they've started the interviews with the different panelists and we're distilling out concepts.
1004
01:19:48.701 --> 01:20:01.507
And we will be delivering, you know, different white papers, a series of white papers in each of these five panel subject matters for discussion.
1005
01:20:01.907 --> 01:20:03.528
OK, and
1006
01:20:06.220 --> 01:20:09.924
These are what I'm going to call their imaginations.
1007
01:20:10.044 --> 01:20:13.708
We're trying to create a vision for what would be best.
1008
01:20:14.549 --> 01:20:15.870
We can't predict the future.
1009
01:20:15.930 --> 01:20:19.013
If I could predict the future, I'd be doing something much different than dentistry.
1010
01:20:20.134 --> 01:20:23.598
But these are the best imaginations.
1011
01:20:23.778 --> 01:20:28.463
If dentistry, if oral health delivery services were the best it could possibly be, what would it look like?
1012
01:20:28.583 --> 01:20:28.823
Yeah.
1013
01:20:29.263 --> 01:20:39.032
And it's to create discussions because it's going to shake some people to the core that it's going to be different than how we're doing it right now.
1014
01:20:39.152 --> 01:20:40.553
People don't like change in general.
1015
01:20:40.613 --> 01:20:43.496
And everybody wants change, but very few want to change.
1016
01:20:44.156 --> 01:20:50.362
Okay, so people are going to dig in, but we're going to create discussions, which is what I think the most important thing that we can do.
1017
01:20:50.862 --> 01:20:56.126
And when someone objects to it, our job now is to ask them, why do you object?
1018
01:20:56.226 --> 01:20:58.808
How did you come up with your idea?
1019
01:20:59.388 --> 01:21:04.552
And show me the science behind it that can predict this in the best possible way.
1020
01:21:05.233 --> 01:21:10.096
And through time, we will be able to come up with what is best.
1021
01:21:10.897 --> 01:21:18.680
When the Affordable Care Act hit in America, Obamacare, I don't think medicine was ready for it.
1022
01:21:19.141 --> 01:21:28.865
And because if you look at who were the big winners in Obamacare, you know, now there's 50 million people now that were mandated to have health insurance.
1023
01:21:29.665 --> 01:21:30.005
Okay.
1024
01:21:30.325 --> 01:21:32.327
And so the insurance companies won big time.
1025
01:21:32.907 --> 01:21:39.551
Health outcomes in the U S have not improved whatsoever and they're pitiful compared to industrialized nations.
1026
01:21:40.332 --> 01:21:41.713
Um, and that's, that's sad.
1027
01:21:41.933 --> 01:21:42.113
Yeah.
1028
01:21:42.273 --> 01:21:55.822
And so when big things happen, you know, with, with the benefit systems in America, we're going to be ready and we're going to drive that change through, you know, having these conversations and developing these, uh, these concepts for the future.
1029
01:21:55.842 --> 01:21:56.202
Mm.
1030
01:21:57.803 --> 01:22:04.629
Yeah, I mean, it's a very interesting time in human history in terms of the speed of change.
1031
01:22:05.630 --> 01:22:12.195
So it's not an enviable task, I would say, to try and predict 25 years into the future, let alone five years.
1032
01:22:12.235 --> 01:22:14.998
I think in 1990, it may have been a little bit easier.
1033
01:22:15.298 --> 01:22:16.999
Things were moving much slower back then.
1034
01:22:17.300 --> 01:22:20.422
Internet was not a thing quite yet.
1035
01:22:20.482 --> 01:22:22.084
AI was not a thing quite yet.
1036
01:22:22.104 --> 01:22:22.244
Yeah.
1037
01:22:22.504 --> 01:22:22.904
That's it.
1038
01:22:23.344 --> 01:22:26.525
I mean, I think the thing is, I always look at the American medical structure.
1039
01:22:26.565 --> 01:22:29.126
And I think there's always a quote that rings in my head.
1040
01:22:29.166 --> 01:22:34.348
I think it's, is it the number one cause of bankruptcy in the US is medical bills.
1041
01:22:34.508 --> 01:22:35.628
Medical debt.
1042
01:22:36.089 --> 01:22:43.111
And I always think about that because obviously in the UK, people have very strong opinions around the NHS.
1043
01:22:43.851 --> 01:22:52.680
and its shortfalls and the direction in which it's moving and so on.
1044
01:22:54.642 --> 01:22:59.347
But I always just think the opposite of that is the insurance model in the States, right?
1045
01:22:59.448 --> 01:23:03.992
And how it's very insurance-led and listen to Peter Attia talking about
1046
01:23:05.333 --> 01:23:13.517
the bills for certain just very straightforward bloods and a bit of saline, and he's coming out with a bill for $6,000 and that sort of thing.
1047
01:23:15.498 --> 01:23:18.759
I mean, in my view, there isn't a perfect model for healthcare.
1048
01:23:19.920 --> 01:23:22.481
Is there something that you think that we should be striving towards?
1049
01:23:22.941 --> 01:23:23.982
Well, the question...
1050
01:23:25.037 --> 01:23:29.060
really that we have to ask, is healthcare a privilege or is it a right?
1051
01:23:31.121 --> 01:23:37.485
The question before that question, from our perspective, is oral healthcare essential or not?
1052
01:23:37.825 --> 01:23:42.408
If we think it is, then it should be included in the question, is healthcare a privilege or is it a right?
1053
01:23:43.188 --> 01:23:48.538
In the States, health care is a right, oral health care is a privilege.
1054
01:23:49.399 --> 01:23:49.720
Okay.
1055
01:23:49.860 --> 01:23:55.209
But even, you know, health care, there's a privilege factor to it because of the model that we're in.
1056
01:23:57.659 --> 01:24:02.501
The British NHS is grossly underfunded, and that's the problem.
1057
01:24:03.122 --> 01:24:08.845
And so the question you need to ask your government, is healthcare a privilege or is it a right for this?
1058
01:24:09.225 --> 01:24:18.990
And we found the highest reimbursement rates in the dental insurance markets are in the least –
1059
01:24:19.810 --> 01:24:21.211
densely populated areas.
1060
01:24:21.611 --> 01:24:35.198
So in the States like North Dakota, you know, there's not a lot of people that live in North Dakota, but the insurance industry, you know, sells their product to the employers and they have to create a network of providers to take that insurance.
1061
01:24:35.658 --> 01:24:39.800
The only way to attract them to take it is to raise the reimbursement rates.
1062
01:24:40.141 --> 01:24:40.321
Right.
1063
01:24:40.561 --> 01:24:40.881
Okay.
1064
01:24:41.341 --> 01:24:42.302
In Medicaid, uh,
1065
01:24:43.843 --> 01:24:47.665
in Colorado, we have the highest Medicaid reimbursements in the country.
1066
01:24:48.145 --> 01:24:57.331
And before the Trump administration took over and cut a lot of the Medicaid funding, we were getting our full fees for the services we're providing.
1067
01:24:58.251 --> 01:25:02.074
And in other parts of the country, we're getting 30 cents on every dollar.
1068
01:25:03.194 --> 01:25:09.618
Where is it that we thought it was okay that we get paid less to treat poor people?
1069
01:25:09.839 --> 01:25:11.400
They're the most complex...
1070
01:25:12.280 --> 01:25:30.498
difficult patients that we treat because of the social determinants of health and you know they they you know can't take off to go to their dental appointments because they're working if they don't work they lose you know everything they're gonna not be able to pay their rent many families can't afford toothpaste they've got one toothbrush for the entire family yeah and
1071
01:25:30.818 --> 01:25:31.959
They've got big issues.
1072
01:25:32.299 --> 01:25:38.705
Why is it – where did we decide it was okay to get paid less when we treat poor people?
1073
01:25:38.905 --> 01:25:45.270
And because in Colorado our reimbursement rates are so high, we've got a great network of people who want to take it.
1074
01:25:45.610 --> 01:25:47.092
They want to serve this community.
1075
01:25:47.892 --> 01:25:51.875
But we can't – if we can't afford to do it, we can't do it.
1076
01:25:52.516 --> 01:25:53.056
There's no –
1077
01:25:53.817 --> 01:25:55.799
business if we're not in business.
1078
01:25:56.740 --> 01:25:57.060
Okay.
1079
01:25:57.080 --> 01:26:04.306
So it has to be able, we have to be able to work, work a successful business model for, for us to provide the care.
1080
01:26:05.247 --> 01:26:06.248
And that's across the board.
1081
01:26:06.568 --> 01:26:06.809
Yeah.
1082
01:26:07.729 --> 01:26:07.830
Yeah.
1083
01:26:07.850 --> 01:26:16.697
I guess the challenge becomes, and I think it's going to get worse as, I mean, there's so much money going into longevity and the whole wellness industry now,
1084
01:26:17.578 --> 01:26:24.383
You look at Bezos and Musk and all these guys are putting loads of money into the longevity space.
1085
01:26:24.423 --> 01:26:26.904
Tony Robbins that we mentioned earlier on.
1086
01:26:27.165 --> 01:26:27.785
Peter Attia.
1087
01:26:27.985 --> 01:26:28.305
Yeah.
1088
01:26:28.385 --> 01:26:34.049
And I feel like maybe there's the first thing that comes to mind is a hyperbaric oxygen chamber.
1089
01:26:35.150 --> 01:26:39.453
There's incredible research on the anti-inflammatory benefits of using one of those things.
1090
01:26:39.473 --> 01:26:41.774
They cost like 100 grand for a proper one.
1091
01:26:43.355 --> 01:27:09.515
but there's huge known and scientifically provable medical benefit to them it's but it's realistically going to be impossible to filter that out across the whole population so it's i think as science develops and these new uh incredible outcome devices become more apparent especially with ai backing them i feel we're going to see even more of a health divide across the population yeah i i i want to say that
1092
01:27:12.256 --> 01:27:18.742
As I mentioned before, carries rates are going down in the middle income and upper income demographics.
1093
01:27:19.783 --> 01:27:23.586
And people are looking for ways to be healthier.
1094
01:27:24.286 --> 01:27:26.749
And dentistry, we own prevention.
1095
01:27:27.249 --> 01:27:31.152
No other healthcare industry owns prevention like we do.
1096
01:27:31.192 --> 01:27:31.713
We live it.
1097
01:27:32.113 --> 01:27:36.554
We talk about things like we take yearly bite wings and that's prevention.
1098
01:27:36.634 --> 01:27:40.055
And that that to me is if you see something on a bite wing, it's already happened.
1099
01:27:40.596 --> 01:27:41.536
That's not prevention.
1100
01:27:41.936 --> 01:27:44.637
The latest in prevention is saliva.
1101
01:27:45.617 --> 01:27:48.118
OK, and I view saliva as the new blood.
1102
01:27:49.038 --> 01:28:01.341
Okay, we can do diagnostics and look at what's in the saliva, what bacteria are growing, what's the microbiome look like, and what's the oral DNA.
1103
01:28:01.881 --> 01:28:14.523
What are you most prone to chronic disease-wise based on all sorts of salivary diagnostics, combine that with medical history, family history, and environment.
1104
01:28:15.483 --> 01:28:17.864
And if you think about 40 years ago,
1105
01:28:18.944 --> 01:28:21.285
lipid levels were starting to be measured in the blood.
1106
01:28:22.425 --> 01:28:24.186
And it changed cardiology.
1107
01:28:24.946 --> 01:28:32.828
If you had high cholesterol, you were given nutritional counseling, which by the way, medicine got paid for, okay?
1108
01:28:33.228 --> 01:28:38.750
And you were given statins to lower your cholesterol, to lower your risk for cardiovascular disease.
1109
01:28:39.270 --> 01:28:42.791
We can now do similar things like that in saliva.
1110
01:28:42.951 --> 01:28:46.532
We can tell if you have a high propensity towards Alzheimer's.
1111
01:28:47.492 --> 01:28:54.637
And we can treat it right then and there in a preventive standpoint as opposed to letting it go and ignoring it.
1112
01:28:55.237 --> 01:29:04.584
And then the last eight years of your life, you're under 24-7 high-level care at tens of millions of dollars.
1113
01:29:05.477 --> 01:29:09.202
when we could have treated it for $50 early on in the life.
1114
01:29:09.842 --> 01:29:16.691
And so dentistry, because Carey's rates are decreasing, our profit centers right now are the baby boomers.
1115
01:29:17.692 --> 01:29:21.957
We've got all this dentistry that is failing and it needs to be revised.
1116
01:29:24.259 --> 01:29:25.140
But they're going away.
1117
01:29:25.200 --> 01:29:25.960
They're going to die.
1118
01:29:26.760 --> 01:29:29.701
And my generation, Gen X, doesn't have as much dentistry to do.
1119
01:29:30.261 --> 01:29:34.543
Your generation has even less dentistry to do in the middle and upper income.
1120
01:29:35.103 --> 01:29:41.685
And therefore, the only way we get paid is our drill has to be spinning or we have to be scraping something.
1121
01:29:42.426 --> 01:29:43.326
In the traditional model.
1122
01:29:43.386 --> 01:29:43.706
Right.
1123
01:29:43.846 --> 01:29:45.547
And so it's a surgical-based model.
1124
01:29:46.450 --> 01:29:51.712
So we need to shift this from a surgical-based model to management of chronic disease-based model.
1125
01:29:52.513 --> 01:29:55.534
And we're already doing it with diagnostics.
1126
01:29:55.554 --> 01:30:00.296
We're already doing it, so adding technology into the deal with x-rays.
1127
01:30:00.336 --> 01:30:12.702
We can now set the AI program to determine, my eyes, I can see 12 shades of gray, but we can test it to 1,056 shades of gray.
1128
01:30:13.022 --> 01:30:14.983
And we can see defects in enamel
1129
01:30:15.963 --> 01:30:36.280
before there ever even a spot on the x-ray and uh based on this and though and we can paint nanohydroxyapatite we can paint some kind of remineralize yeah yeah and and um you know and and it never we never have to put a drill to the tooth yeah so it's a very exciting model when you
1130
01:30:39.646 --> 01:30:49.291
I'm on an advisory board for a toothpaste called Even Mouth, and it idealizes the microbiome in the mouth, okay, the oral microbiome.
1131
01:30:49.791 --> 01:30:59.957
Imagine, they've figured out in populations in this world that have never seen a dentist, never had caries, and never had periodontal disease, what is the oral microbiome?
1132
01:31:00.917 --> 01:31:02.058
And if we can guide that,
1133
01:31:03.771 --> 01:31:13.620
you will be much less at risk for all of these problems, including caries, including Alzheimer's, colorectal cancer, low birth weight premature babies, cardiovascular disease, diabetes.
1134
01:31:15.522 --> 01:31:16.883
That's the ultimate prevention.
1135
01:31:17.844 --> 01:31:20.566
And we can own that.
1136
01:31:21.127 --> 01:31:22.488
We need to own that.
1137
01:31:22.908 --> 01:31:26.491
And I guess that preventative model
1138
01:31:27.649 --> 01:31:32.773
because it's actually lower cost over the lifetime of the individual especially.
1139
01:31:33.694 --> 01:31:36.236
And to the whole healthcare system.
1140
01:31:36.336 --> 01:31:48.526
Indeed, yeah, and therefore to the whole population that actually it should move, shift things into a more cost positive scenario, I guess.
1141
01:31:48.546 --> 01:31:51.248
Cost positive and better outcome.
1142
01:31:51.268 --> 01:31:52.089
Better outcome, yeah.
1143
01:31:52.109 --> 01:31:55.531
So with any new material, any new technology,
1144
01:31:56.312 --> 01:32:03.617
We rate it by, you know, it's brought to market and it expands based on efficiency and efficacy.
1145
01:32:04.217 --> 01:32:05.057
Better care for cheaper.
1146
01:32:05.998 --> 01:32:14.263
Okay, and we, in the science, you know, especially with some of the biological dentists and holistic type dentists, the science used to be fringe, but it's not fringe anymore.
1147
01:32:14.303 --> 01:32:15.604
It's robust and compelling.
1148
01:32:15.824 --> 01:32:16.545
Yeah.
1149
01:32:16.685 --> 01:32:17.225
It's real.
1150
01:32:17.245 --> 01:32:18.186
Absolutely.
1151
01:32:18.406 --> 01:32:21.728
And for us to ignore it is irresponsible.
1152
01:32:22.308 --> 01:32:24.129
Yeah, you have to be open to change.
1153
01:32:24.509 --> 01:32:25.090
That's the key.
1154
01:32:25.830 --> 01:32:27.371
But change is hard and it takes time.
1155
01:32:27.571 --> 01:32:28.051
It's slow.
1156
01:32:28.471 --> 01:32:39.597
And we're starting to see more holistic, whole body health, oral care in the states, in the private practice market.
1157
01:32:39.937 --> 01:32:41.538
We're seeing it in the dental schools.
1158
01:32:41.558 --> 01:32:45.660
We're seeing it in some dental support organizations, DSOs.
1159
01:32:45.700 --> 01:32:49.342
We're seeing it in the high-end private practice, fee-for-service market.
1160
01:32:49.562 --> 01:32:50.302
I think I said that already.
1161
01:32:50.322 --> 01:32:51.743
But, you know, so we're seeing it.
1162
01:32:52.584 --> 01:33:00.910
and the demand is growing for it as well the demand is growing yeah yeah we've seen that in the UK as well you mentioned DSOs there Brett
1163
01:33:02.948 --> 01:33:11.030
I believe that the American market is significantly more... What's the word I'm looking for here?
1164
01:33:11.090 --> 01:33:11.790
Corporatized.
1165
01:33:11.930 --> 01:33:12.690
There's another word for it.
1166
01:33:12.710 --> 01:33:13.251
I can't remember now.
1167
01:33:13.591 --> 01:33:20.853
Anyway, there's a lot more of the market is taken by corporates than in the UK, but we're certainly moving in that direction.
1168
01:33:21.473 --> 01:33:29.635
What's your view on that corporatization of the industry and the impact that it's having in the States that maybe...
1169
01:33:30.515 --> 01:33:35.597
will give us a bit of a future view on where things are probably going to move in the UK as well.
1170
01:33:35.917 --> 01:33:37.818
Yeah, so DSOs are growing.
1171
01:33:37.858 --> 01:33:40.760
Group practices are growing in the market.
1172
01:33:41.720 --> 01:33:48.723
I will support any practice model where the doctor-patient relationship is viewed as a sacred cow.
1173
01:33:49.463 --> 01:33:57.027
Okay, that every decision that is made is decided with the patient in the best interest of improving that patient's oral health.
1174
01:33:57.995 --> 01:33:58.275
Okay.
1175
01:33:58.315 --> 01:34:04.818
So whether it's a private practice fee for service, whether it's a public health model, whether it's a DSO, I will support that.
1176
01:34:05.539 --> 01:34:06.259
Okay.
1177
01:34:06.279 --> 01:34:13.683
Any model that doesn't support that, I will, you know, not be in support of that.
1178
01:34:14.323 --> 01:34:19.605
And so there are many DSOs that are practicing that way.
1179
01:34:19.625 --> 01:34:20.406
There are many that aren't.
1180
01:34:20.786 --> 01:34:22.867
There are many private practices that are practicing that way.
1181
01:34:22.887 --> 01:34:23.667
There are many that aren't.
1182
01:34:24.367 --> 01:34:33.611
And for me, I think it needs to be that, that the patient should be the center of all decisions to improve their oral health.
1183
01:34:37.085 --> 01:34:40.167
Private practice in the States, the market is shrinking.
1184
01:34:41.168 --> 01:34:47.472
It's harder and harder to make it under the insurance benefit system that we're under.
1185
01:34:48.272 --> 01:34:54.857
The benefit system has not really kept up with the cost of living with their reimbursements, and therefore,
1186
01:34:55.978 --> 01:34:58.320
you know, we're starting to really get squeezed by this.
1187
01:34:58.721 --> 01:35:01.564
And I feel it's contributing to the workforce issues as well.
1188
01:35:02.105 --> 01:35:13.317
Whereas, you know, even 10 years ago, I was able to offer my dental assistants, my office managers, my hygienists, opportunities at a career with me.
1189
01:35:13.897 --> 01:35:19.303
You know, and, you know, the dental benefit, although we all hated it, most of us took it.
1190
01:35:19.323 --> 01:35:20.864
90 plus percent of us took it.
1191
01:35:20.924 --> 01:35:24.428
I didn't take it because the kind of dentistry I was doing did not fit in that model.
1192
01:35:24.808 --> 01:35:25.589
But we all took it.
1193
01:35:25.709 --> 01:35:26.410
We all hated it.
1194
01:35:26.470 --> 01:35:27.591
But we all did really well.
1195
01:35:28.452 --> 01:35:28.772
Okay.
1196
01:35:29.192 --> 01:35:31.375
But now we're not doing well anymore.
1197
01:35:31.395 --> 01:35:32.496
And it's becoming a problem.
1198
01:35:32.776 --> 01:35:34.578
Reimbursements in the model isn't working.
1199
01:35:35.670 --> 01:35:42.516
And so therefore, we have to find ways to be more efficient in the business.
1200
01:35:42.596 --> 01:35:48.881
And DSOs are offering business services that the private practice dentist may overlook or may have overlooked.
1201
01:35:49.241 --> 01:35:54.565
And now they're in a situation where they can't grow to the level because they're leveraged financially.
1202
01:35:55.245 --> 01:35:56.847
So that's what I think the market is growing.
1203
01:35:56.867 --> 01:35:57.427
Yeah.
1204
01:35:57.827 --> 01:36:08.713
The new dentists who are coming out of school, many of them are going to a DSO model because we in the private practice model don't have the opportunities for them.
1205
01:36:09.453 --> 01:36:21.220
And where, you know, and where, you know, when I was president of the Colorado Dental Association, I attended the very first DSO panel put on by the California Dental Association.
1206
01:36:21.300 --> 01:36:25.102
And they put dentists who are DSO dentists up on a stage and.
1207
01:36:25.542 --> 01:36:48.161
you know and they we just grilled them for an hour it was kind of traumatic i think um but you know we're very anti-dso um but what i what i heard from these young dentists who were working there is that they were able to just focus on their dentistry and not the business and that's what they needed to do at that time you know because all the other factors were overwhelming to them because they had
1208
01:36:48.881 --> 01:36:52.082
steady flow of patients with procedures that they can grow their skills.
1209
01:36:52.402 --> 01:37:02.644
They had mentorship, they had CE, they had their health insurance covered, they had vacation covered and things, and their salary.
1210
01:37:03.304 --> 01:37:15.567
And so I realized that if a dental student needed $100,000 in salary, I would have to, or a young dentist needed $100,000 in salary, I'd have to have $400,000 of dentistry lying around in my practice.
1211
01:37:16.127 --> 01:37:20.908
Because as I said before, they're coming out of dental school barely competent.
1212
01:37:20.948 --> 01:37:29.951
They can barely do the procedures, let alone provide enough confidence in their patients to convince them to do the procedures.
1213
01:37:30.151 --> 01:37:32.012
So I would have to guide them and mentor them.
1214
01:37:32.512 --> 01:37:35.473
And there's a risk of them leaving the practice after I've grown them.
1215
01:37:36.153 --> 01:37:40.034
And many private practice dentists aren't taking the time.
1216
01:37:40.054 --> 01:37:42.195
They're not taking the risk for that.
1217
01:37:42.255 --> 01:37:45.616
So the dental service organizations are
1218
01:37:46.316 --> 01:37:50.080
are, are, you know, attractive to these young dentists.
1219
01:37:50.180 --> 01:37:58.107
We had found that, that many dentists who are working for DSOs will eventually come back and start their own practices.
1220
01:37:58.808 --> 01:38:04.593
And that's delayed significantly than what it was even 10 years ago, where it was three or four years in the DSO.
1221
01:38:04.954 --> 01:38:08.497
Now it's about 10 to 15 years before they decide they want to open their own practice.
1222
01:38:08.837 --> 01:38:09.258
Interesting.
1223
01:38:10.526 --> 01:38:27.349
I wonder if anyone has any research in terms of what we were discussing earlier on in terms of burnout and stress in a DSO environment versus a, I mean, I know the single practitioner, the solo practitioner has higher presentation of mental health issues.
1224
01:38:27.429 --> 01:38:28.229
That kind of makes sense.
1225
01:38:28.249 --> 01:38:37.751
But I wonder how the small practice versus DSO young dentist, especially what the variability there is in terms of their lived experience of dentistry.
1226
01:38:37.951 --> 01:38:43.816
Yeah, and I mentioned before that when we surveyed our members, 82% showed some signs of clinical burnout.
1227
01:38:44.216 --> 01:38:48.720
We did not parse it out to small practice, large practice, group practice, and stuff like that.
1228
01:38:49.100 --> 01:39:04.933
But from my experience in the wellness side of dentistry, those that are in DSOs have a lot more resources available to them to get help, and there's a lot more opportunities for them to be
1229
01:39:06.154 --> 01:39:18.538
found out earlier because they're in a team setting that they can see the change in behavior and call them out on it.
1230
01:39:18.818 --> 01:39:22.479
And the biggest fear for people seeking help is time out of the office.
1231
01:39:23.320 --> 01:39:29.642
And in a DSO setting, they've got dentists that can fill in very easily as opposed to the private practitioner that...
1232
01:39:30.842 --> 01:39:39.549
And if the private practice, the wellness, the person goes away for help, for treatment, who's going to pay the staff?
1233
01:39:40.770 --> 01:39:44.433
Okay, because there's no one providing the income anymore.
1234
01:39:44.493 --> 01:39:48.937
So there's bigger opportunities, in my opinion, in the larger groups.
1235
01:39:49.738 --> 01:39:55.943
So it sounds like what you're saying then is, I mean, as with anything, there are good actors and bad actors in all areas.
1236
01:39:57.490 --> 01:39:58.231
In all models.
1237
01:39:58.731 --> 01:40:01.173
And that's the case in any industry.
1238
01:40:01.253 --> 01:40:17.485
But from the sounds of it, you feel like the DSOs actually net-net maybe are now being a positive and something which is providing maybe a more stable environment for dentists to practice with them.
1239
01:40:18.046 --> 01:40:18.406
And...
1240
01:40:20.047 --> 01:40:21.188
In many cases, yes.
1241
01:40:21.588 --> 01:40:22.789
In many cases, the private practice is.
1242
01:40:22.809 --> 01:40:28.492
I mean, it's really, it's specific to the individual and what their goals are.
1243
01:40:30.713 --> 01:40:34.916
You know, and there's always, this leads to the discussion of private equity.
1244
01:40:35.916 --> 01:40:37.277
How does private equity play in this?
1245
01:40:37.297 --> 01:40:39.979
Because there's a lot of investment going into the dental space.
1246
01:40:40.179 --> 01:40:40.419
Yep.
1247
01:40:40.699 --> 01:40:41.039
Yep.
1248
01:40:41.059 --> 01:40:41.400
And, um...
1249
01:40:42.702 --> 01:40:48.125
And I'm concerned about that, obviously, because the goal for private equity is to produce multiples.
1250
01:40:48.545 --> 01:40:48.705
Yeah.
1251
01:40:49.226 --> 01:40:49.526
Okay.
1252
01:40:49.546 --> 01:40:52.908
The goal for dentists is to produce good oral health.
1253
01:40:53.528 --> 01:40:55.189
Sometimes that doesn't jive.
1254
01:40:55.549 --> 01:40:55.869
I know.
1255
01:40:56.090 --> 01:40:56.770
Okay.
1256
01:40:56.890 --> 01:41:10.257
And so if private equity is going to invest in dentistry, again, the center of all decisions can't be what's in the best interest of improving the multiples.
1257
01:41:10.277 --> 01:41:11.258
Yeah.
1258
01:41:11.739 --> 01:41:17.285
It has to be what is in the best interest of providing the best care for our patients, appropriate and ethical care.
1259
01:41:17.606 --> 01:41:17.826
Yeah.
1260
01:41:18.707 --> 01:41:18.807
Yeah.
1261
01:41:18.827 --> 01:41:29.821
And it seems to me anyway, I mean, I've not been involved in private equity in dental practice purchasing or DSOs myself, but from the stories that I've heard, it seems like.
1262
01:41:30.662 --> 01:41:49.443
when private equity gets involved, the dentists that have either sold their practices into these groups or they've ended up with some sort of share provision within the larger group, the dentists oftentimes get, what's the best way to describe it?
1263
01:41:50.823 --> 01:42:05.036
They get wrapped up in share conversations that maybe they don't quite understand and they end up being the loser in the scenario, which I think is quite a cautionary tale for people because these guys in private equity, this is their bread and butter.
1264
01:42:05.056 --> 01:42:05.837
This is what they do.
1265
01:42:06.217 --> 01:42:12.423
As you say, their goal is to make money for their shareholders and to see that growth in the exit value.
1266
01:42:14.423 --> 01:42:20.310
the dentist that sells in that has a lower class of share may oftentimes not actually get any, any payment at all.
1267
01:42:20.391 --> 01:42:22.233
So it's, it's an interesting one, I think.
1268
01:42:22.713 --> 01:42:22.994
Yeah.
1269
01:42:23.134 --> 01:42:23.314
And.
1270
01:42:24.818 --> 01:42:29.279
generally we're not very good at reading the contracts and understanding what we're signing.
1271
01:42:30.260 --> 01:42:32.941
And it produces a level of disappointment.
1272
01:42:33.061 --> 01:42:49.166
And so the young dentists are burning out at a high rate, but the level of disappointment for those that have sold and had unrealistic expectations and unrealized expectations, their burnout is really bad too.
1273
01:42:49.586 --> 01:42:52.527
Depression is off the charts in that demographic.
1274
01:42:53.187 --> 01:42:59.795
Yeah, I mean, I've heard of individuals in the UK that have been in that scenario and unfortunately ended up taking their own life in that situation.
1275
01:42:59.835 --> 01:43:10.388
I think the best advice that I've heard in those deals is if you're going to sell your clinic to a private equity backed corporate, especially, you're going to sell your clinic.
1276
01:43:11.188 --> 01:43:13.550
make sure you're happy with the upfront cost.
1277
01:43:14.070 --> 01:43:15.431
Anything that's in the future...
1278
01:43:15.451 --> 01:43:16.251
Right.
1279
01:43:16.291 --> 01:43:18.732
It's a house of cards.
1280
01:43:18.792 --> 01:43:20.833
...is never a guarantee.
1281
01:43:20.973 --> 01:43:21.334
Right.
1282
01:43:21.474 --> 01:43:24.535
And so that was, I think, sound advice that I heard.
1283
01:43:24.795 --> 01:43:24.976
Yep.
1284
01:43:25.576 --> 01:43:26.857
Who did you sell to out of interest?
1285
01:43:26.877 --> 01:43:28.357
Did you sell to a private individual?
1286
01:43:28.377 --> 01:43:33.660
So I sold to an individual, and we started a five-practice group.
1287
01:43:34.060 --> 01:43:36.061
Okay.
1288
01:43:36.201 --> 01:43:36.862
After the sale?
1289
01:43:37.262 --> 01:43:37.482
Right.
1290
01:43:37.502 --> 01:43:38.563
So you had your one location.
1291
01:43:38.583 --> 01:43:39.083
The owner...
1292
01:43:39.683 --> 01:43:43.885
that bought my practice, acquired three other practices, and he had his practice.
1293
01:43:44.505 --> 01:43:52.628
And so they were trying to start their own group and it didn't work out very well for them.
1294
01:43:52.808 --> 01:43:53.128
Okay.
1295
01:43:54.235 --> 01:43:56.477
they got in over their head and it was underfunded.
1296
01:43:57.918 --> 01:44:18.415
And so I left that practice after working for them for about two years and went to work as an employee for a friend of mine who was one of the very first hundred accredited members of the AACD, the American Academy of Cosmetic Dentistry, and a good friend of mine.
1297
01:44:18.455 --> 01:44:20.576
And Stephen Weinstein.
1298
01:44:21.597 --> 01:44:23.237
and a great dentist.
1299
01:44:23.377 --> 01:44:25.358
And so I worked a couple of days there.
1300
01:44:25.378 --> 01:44:32.019
And as I rose in my leadership focus, I cut back on my practice.
1301
01:44:32.039 --> 01:44:34.280
So I was working just a few days a week the last several years.
1302
01:44:35.200 --> 01:44:36.940
Do you miss, so you're not working clinically at all anymore?
1303
01:44:36.960 --> 01:44:38.401
I'm not working clinically at this point.
1304
01:44:38.441 --> 01:44:38.921
Do you miss it?
1305
01:44:39.561 --> 01:44:40.121
Yes and no.
1306
01:44:40.701 --> 01:44:41.221
Yes and no.
1307
01:44:41.261 --> 01:44:42.661
It was very hard, very hard on the body.
1308
01:44:44.602 --> 01:44:48.103
Very labor intensive, emotionally, connecting with the patients.
1309
01:44:51.226 --> 01:44:59.128
And I exited the role from being president to the American Dental Association as one of the most informed dentists in the world.
1310
01:45:00.009 --> 01:45:05.470
And I sort of asked myself, now how can I use this experience to keep pushing the profession forward?
1311
01:45:06.071 --> 01:45:09.051
And I can do it, make an impact, one patient at a time, chair side.
1312
01:45:10.412 --> 01:45:19.895
Or I can continue to advocate and have opportunities to really push communities forward and push ideas forward that will affect millions of people.
1313
01:45:20.695 --> 01:45:49.107
so that's what I'm attempting to do at this point love it I've got a few more questions before we wrap up I'd really be interested to know your thoughts and especially as it fits into Oral Health 2050 I guess in terms of robotics we've got Gallup Guerrero who's one of the co-founders of Lupin Lupin Robotics coming in on the podcast next week one of my
1314
01:45:49.867 --> 01:46:06.834
colleagues uh dev patel who's been on the podcast already here owns a a dso in the uk that's having one of those robots being delivered next month i believe okay um and so given that one of your pillars on the oral health 2050 was around
1315
01:46:07.463 --> 01:46:08.243
AI and technology.
1316
01:46:08.604 --> 01:46:10.705
Well, yes, that, but also wellness of the team.
1317
01:46:11.065 --> 01:46:14.847
And you mentioned dentists and the dental nurses and the assistants and everything.
1318
01:46:15.387 --> 01:46:21.690
So I'd be interested to know your thoughts on robotics and the potential impact on the whole team.
1319
01:46:21.750 --> 01:46:28.214
Because I think it's obviously you won't know the full answer because it's an imagination as you describe it at the moment.
1320
01:46:28.234 --> 01:46:29.514
Because we don't know how it's going to turn out.
1321
01:46:29.534 --> 01:46:31.695
But what are your thoughts on that whole space?
1322
01:46:32.976 --> 01:46:34.838
Okay, so let's back up 30 years.
1323
01:46:36.200 --> 01:46:40.666
When I first started practicing, we had a paper charts.
1324
01:46:41.367 --> 01:46:43.510
We had a paper appointment book.
1325
01:46:45.052 --> 01:46:46.213
Excuse me, that was in pencil.
1326
01:46:47.214 --> 01:46:49.677
And practices started to...
1327
01:46:51.048 --> 01:46:53.408
integrate computer systems into their practice.
1328
01:46:54.089 --> 01:46:54.409
Okay.
1329
01:46:54.649 --> 01:46:58.069
And the big fear was computers are going to take over.
1330
01:46:58.450 --> 01:47:08.231
And, you know, in my job as the, you know, appointment coordinator, office manager is going to be superfluous and I'm not going to be out of the job and now and things like that.
1331
01:47:08.251 --> 01:47:09.252
And so it never happened.
1332
01:47:10.112 --> 01:47:10.392
Okay.
1333
01:47:10.932 --> 01:47:15.053
So I think that, you know, integration of technology is really exciting.
1334
01:47:16.894 --> 01:47:19.696
You know, reimagining how healthcare is being delivered.
1335
01:47:19.716 --> 01:47:29.302
It's already prevalent in medicine, but our patients, the medicine patients that are using robots on or remote robots, they're asleep.
1336
01:47:29.743 --> 01:47:30.003
Yeah.
1337
01:47:30.203 --> 01:47:31.204
Okay, so it's different here.
1338
01:47:32.505 --> 01:47:35.086
I don't think our culture is quite ready.
1339
01:47:36.247 --> 01:47:41.549
to have dentistry delivered to them by a non-human form in the mass.
1340
01:47:42.129 --> 01:47:50.192
The early adopters who are providing this care are all in on it, and the early adopter who are patients that want it are all in on it.
1341
01:47:52.433 --> 01:47:54.714
Do you have driverless cars here in the UK?
1342
01:47:54.854 --> 01:47:56.395
They're just landing as we speak.
1343
01:47:56.415 --> 01:47:58.996
I think we've got, I think Waymo has landed in the UK.
1344
01:47:59.016 --> 01:48:02.278
So Waymo's in various cities around the United States.
1345
01:48:02.398 --> 01:48:06.780
And I remember my first Waymo experience and I was really excited.
1346
01:48:06.860 --> 01:48:08.780
So I'm a early adopter on things.
1347
01:48:08.800 --> 01:48:13.263
So back in the days, Google had Google Glass.
1348
01:48:13.443 --> 01:48:15.864
And so I was one of the beta testers for Google Glass.
1349
01:48:15.884 --> 01:48:17.124
I loved it, absolutely loved it.
1350
01:48:17.164 --> 01:48:18.465
I was so disappointed when it went away.
1351
01:48:19.265 --> 01:48:24.427
So when Waymo opportunity arose in a city I was visiting, I jumped on it.
1352
01:48:25.247 --> 01:48:26.747
And I loved it.
1353
01:48:27.147 --> 01:48:28.028
I absolutely loved it.
1354
01:48:28.048 --> 01:48:35.610
And I will always choose a Waymo if given the choice.
1355
01:48:36.950 --> 01:48:43.332
When I take an Uber, I always take the comfort category because I want quietness.
1356
01:48:43.492 --> 01:49:10.470
it I'm usually on the phone you know and and and I don't want to talk to you as a driver I don't want you know I just want you to get me there and so in a Waymo I don't have to talk to anybody I can do my thing and it's a Jaguar it's a nice car isn't it and you know I know you drive a Tesla but it's got the you know the the the screen visual so it you see everything that the computer sees and it and it drives okay are there issues with it absolutely
1357
01:49:10.770 --> 01:49:13.751
just as there are issues with human drivers.
1358
01:49:14.471 --> 01:49:23.114
Okay, so I think as people become more comfortable with driverless cars, that people will become more comfortable with robotics.
1359
01:49:23.574 --> 01:49:27.315
Okay, but I think in mass, we're not there yet.
1360
01:49:28.195 --> 01:49:31.756
Because my understanding in the States is, I think you've got, is it Yomi?
1361
01:49:31.896 --> 01:49:32.736
Yomi.
1362
01:49:33.036 --> 01:49:38.538
And I think what I understand is hundreds of thousands of dental implants have been placed with Yomi in the States already.
1363
01:49:38.938 --> 01:49:39.398
Is that right?
1364
01:49:39.578 --> 01:49:40.218
Yeah.
1365
01:49:40.518 --> 01:49:43.039
And that's provider assisted.
1366
01:49:43.919 --> 01:49:45.059
It's not driven.
1367
01:49:45.079 --> 01:49:45.819
It's not autonomous.
1368
01:49:45.959 --> 01:49:46.780
It's not autonomous.
1369
01:49:46.960 --> 01:49:47.140
Yeah.
1370
01:49:47.200 --> 01:49:47.380
Okay.
1371
01:49:47.400 --> 01:49:50.581
There are some autonomous in beta testing.
1372
01:49:53.005 --> 01:50:01.049
Two years ago, the FDI World Congress was in Shanghai, China, and I saw many of the robots there.
1373
01:50:01.449 --> 01:50:03.290
And it's so interesting to me.
1374
01:50:03.810 --> 01:50:05.611
And so… Doing what sort of procedures?
1375
01:50:06.151 --> 01:50:06.491
Anything.
1376
01:50:06.752 --> 01:50:07.032
Really?
1377
01:50:07.192 --> 01:50:07.392
Yeah.
1378
01:50:07.692 --> 01:50:09.733
Restorative as well as surgical.
1379
01:50:10.113 --> 01:50:14.775
And the question people always seem to lean to when we talk about robotics and dentistry is…
1380
01:50:16.436 --> 01:50:45.783
fixation of the patient in terms of what happens if the patient moves right um i mean my answer to that would be what happened when the patient moves when you're you're a human right so is there any difference but did they have any um yeah i went and tried one and and asked that same question and they moved the they moved the the head around and it moved with them right okay because it's it's it's watching it's watching and and feeding back on everything um and it will be a uh
1381
01:50:47.595 --> 01:50:50.237
I think it'll be a great adjunct to us.
1382
01:50:50.337 --> 01:50:53.939
And so with any technology, as I said before, there has to be efficiency and efficacy.
1383
01:50:53.959 --> 01:50:56.500
It's got to be cheaper and better for it to be integrated.
1384
01:50:57.581 --> 01:51:06.526
There's a law of diffusion that Simon Sinek talked about it in his book, Start With Why.
1385
01:51:08.327 --> 01:51:13.150
Miller's law of diffusion of technology across a world.
1386
01:51:14.191 --> 01:51:14.711
a community.
1387
01:51:15.152 --> 01:51:15.452
Okay.
1388
01:51:15.512 --> 01:51:18.035
And so there's the early, the innovators.
1389
01:51:18.155 --> 01:51:18.335
Yep.
1390
01:51:18.575 --> 01:51:18.936
Okay.
1391
01:51:18.956 --> 01:51:23.080
And then the early adopters, the, um, and there's a chasm, isn't there early?
1392
01:51:23.100 --> 01:51:23.620
Yeah.
1393
01:51:23.640 --> 01:51:24.702
There's a, there's a big chasm.
1394
01:51:24.722 --> 01:51:26.383
Early majority, late majority, right.
1395
01:51:26.403 --> 01:51:30.447
And the early majority, when you get to like 34% of the early majority, that's the tipping point.
1396
01:51:30.628 --> 01:51:30.888
Mm hmm.
1397
01:51:31.068 --> 01:51:41.351
And so right now we're all in the innovator and early adopter phase with many different things, not just technology, but practice models as we mentioned before with like the holistic biologic dentists and things like that.
1398
01:51:43.291 --> 01:51:44.252
But we're making it work.
1399
01:51:44.312 --> 01:51:55.235
And so we have to keep pushing to jump across that chasm and early majority will start to grow and being accepting of this kind of treatment.
1400
01:51:56.195 --> 01:52:02.599
But it's very well described in the science and how it gets integrated.
1401
01:52:02.959 --> 01:52:09.942
I don't think our culture is ready for someone to drill on my teeth and mass yet.
1402
01:52:11.443 --> 01:52:12.784
Not someone, maybe something.
1403
01:52:12.804 --> 01:52:14.565
That's what I mean, something.
1404
01:52:14.625 --> 01:52:18.267
I think that with the Yomi, it's guiding people.
1405
01:52:19.147 --> 01:52:20.348
I'm still holding on to the handle.
1406
01:52:20.368 --> 01:52:21.189
The human hand is on it.
1407
01:52:21.209 --> 01:52:22.309
I'm still holding on to the handle.
1408
01:52:22.530 --> 01:52:27.693
The patient's comfort of that is reassured the fact that I'm next to that patient.
1409
01:52:27.833 --> 01:52:28.073
Yeah.
1410
01:52:28.153 --> 01:52:28.453
Okay.
1411
01:52:28.754 --> 01:52:33.337
When I'm not in the room, that's going to be – I don't think our culture is ready for that yet.
1412
01:52:33.737 --> 01:52:34.257
But it will.
1413
01:52:34.277 --> 01:52:40.341
The more – and I use the driverless cars as an example because it could cause great damage.
1414
01:52:40.601 --> 01:52:40.702
Yeah.
1415
01:52:40.722 --> 01:52:40.922
Yeah.
1416
01:52:41.582 --> 01:52:45.403
Okay, you know, to you or to someone else, if it's if it's messed up.
1417
01:52:45.483 --> 01:52:49.384
But as with the driverless cars, as you say, it's all about percentages, right?
1418
01:52:49.404 --> 01:52:50.984
And it's all about research at the end of the day.
1419
01:52:51.024 --> 01:52:57.625
And driverless cars, I don't know the exact research, but I imagine significantly safer than human drivers.
1420
01:53:11.628 --> 01:53:35.013
robotically provided dentistry far outstripping the safety profile of human provided dentistry fairly quickly i would imagine i believe that too but again people make decisions for anything based on emotions then they justify it with logic yeah okay and you can give them all the science okay but emotionally if they're not there yet it's not going to happen yeah but it will happen
1421
01:53:35.313 --> 01:53:36.313
Yeah, it will.
1422
01:53:36.353 --> 01:53:37.294
It's just going to take some time.
1423
01:53:37.334 --> 01:53:42.955
And I think it's the most exciting period of dentistry is in front of us.
1424
01:53:43.555 --> 01:53:46.916
OK, with things like that, with the adjunct of AI.
1425
01:53:47.517 --> 01:53:52.238
And and, you know, and so, you know, I look at, you know, AI, so, you know,
1426
01:53:52.598 --> 01:54:00.600
One example that I share when I speak to different audiences is using AI as your most amazing digital assistant you can imagine.
1427
01:54:00.640 --> 01:54:05.781
So I have an earpiece in my ear, and I'm going from operatory two to operatory three.
1428
01:54:06.461 --> 01:54:13.683
And as I enter into operatory three, my digital assistant, AI assistant, is saying, you saw Mrs. Jones six months ago for a cleaning.
1429
01:54:13.743 --> 01:54:15.523
At the time, you did two fillings for her.
1430
01:54:16.003 --> 01:54:17.365
One of those fillings was sensitive.
1431
01:54:17.405 --> 01:54:19.968
She came back twice for adjustments.
1432
01:54:20.008 --> 01:54:21.289
We haven't heard from her since.
1433
01:54:21.730 --> 01:54:26.275
At her last appointment, she said that her family was going to take a trip to Disney World.
1434
01:54:26.576 --> 01:54:31.421
She has three kids, ages six, eight, and four, and they've got a dog named Spot.
1435
01:54:31.441 --> 01:54:31.622
Wow.
1436
01:54:32.122 --> 01:54:32.402
Okay.
1437
01:54:32.563 --> 01:54:40.830
Those are things that I would write in my chart, but I have to run back to my office, find it, read it, then come back and act like I remembered it.
1438
01:54:41.390 --> 01:54:41.630
Okay.
1439
01:54:41.650 --> 01:54:51.219
But here it, it, you know, it's, it's, it's whispering in my ear and I could come right in and, and does that detract from the experience?
1440
01:54:51.279 --> 01:54:59.666
No, it enhances the experience because the patient, you know, whether they believe that I remember this or not, they, they, they know that I care enough to bring it up.
1441
01:54:59.826 --> 01:55:00.046
Yeah.
1442
01:55:00.247 --> 01:55:00.607
Okay.
1443
01:55:00.707 --> 01:55:04.971
And when a patient understands that you care for them, the trust goes way up.
1444
01:55:04.991 --> 01:55:13.580
And when the trust goes way up, they're more comfortable in your recommendations and ethically suited for the best care for them.
1445
01:55:14.161 --> 01:55:14.501
Okay.
1446
01:55:14.681 --> 01:55:21.408
And so it's a driver of enhancing the doctor-patient relationship, which I view as the sacred cow of dentistry.
1447
01:55:21.788 --> 01:55:22.029
Okay.
1448
01:55:22.049 --> 01:55:22.349
I love that.
1449
01:55:22.409 --> 01:55:26.130
But then in the meantime, I'm having the discussion with my patient.
1450
01:55:26.350 --> 01:55:36.512
The AI scribe is scribing it all down and recording everything and articulating everything into a chart note that I can then review later.
1451
01:55:36.992 --> 01:55:41.033
Because a lot of the burnout is coming from non-dentistry work.
1452
01:55:41.073 --> 01:55:47.735
And if you're seeing 20 patients in a day, you don't have time to scribe out your chart notes.
1453
01:55:47.955 --> 01:55:49.855
And when you do, you're being rushed.
1454
01:55:49.915 --> 01:55:52.356
And is it as complete as it could possibly be?
1455
01:55:52.476 --> 01:55:56.737
And then you miss something and then you have the legal suit on the back of it.
1456
01:55:56.997 --> 01:55:58.738
Does that exist, that?
1457
01:55:59.118 --> 01:56:00.138
In forms, it does.
1458
01:56:00.839 --> 01:56:08.261
I know the scribes do, but the actual, the way you described the digital assistant in your ear...
1459
01:56:09.121 --> 01:56:12.242
Is that a live technology or is that your own invention?
1460
01:56:12.522 --> 01:56:19.423
Different pieces of it are in place, but this whole thing has not been put together yet.
1461
01:56:19.743 --> 01:56:20.723
This is an imagination.
1462
01:56:21.583 --> 01:56:22.504
It's a very interesting one.
1463
01:56:22.524 --> 01:56:23.784
We should start a business, Simon.
1464
01:56:24.724 --> 01:56:28.425
Yeah, you heard it here first.
1465
01:56:29.005 --> 01:56:32.545
I think my wife would kill me if that's not it.
1466
01:56:33.366 --> 01:56:35.026
Yeah, but no, as you say, I think...
1467
01:56:36.086 --> 01:56:51.874
That really lit me up, the way you described that, because as you say, at the moment, a lot of this technology has been developed in silos and AI-assisted radiographic interpretation, the scribe.
1468
01:56:52.694 --> 01:57:13.520
recording the notes with the patient, intraoral scanning, all these, and then obviously robotics and everything else, all this different technology is developing side by side, but I'm just waiting for that full integration where actually, like the way you described it there is just such a wonderful example of where actually technology can improve human connection.
1469
01:57:13.780 --> 01:57:14.000
Right.
1470
01:57:14.040 --> 01:57:19.662
Which is like, for me, where the magic is, is that human technology interplay that I think
1471
01:57:20.810 --> 01:57:27.036
the more pessimistic individuals miss the fact that actually technology can be used for better human connection.
1472
01:57:27.336 --> 01:57:27.716
Yeah.
1473
01:57:28.017 --> 01:57:43.551
And so like say in your front office, you know, a lot of the, you know, the making of appointments and answering questions for the patient could be done digitally, could be done through AI technology, which then gives your, or even like the, you know,
1474
01:57:43.911 --> 01:57:46.733
dental insurance reimbursements and submissions and stuff like that.
1475
01:57:46.753 --> 01:57:54.358
I mean, we would have a, you know, someone dedicated to sit on hold all day with the insurance industries to get reimbursements.
1476
01:57:54.438 --> 01:58:00.042
And all that can now be automated, which then frees up that person now to help with,
1477
01:58:00.702 --> 01:58:04.164
improving the patient experience as they enter your practice.
1478
01:58:04.864 --> 01:58:26.916
You know, and so that's where I think the success will be shown where the people who are leveraging the technology to do the work that doesn't need to be human, done by humans now can, you know, and allowing, freeing up the humans to enhance the patient experience.
1479
01:58:27.096 --> 01:58:28.417
That's where the success is going to lie.
1480
01:58:28.817 --> 01:58:29.518
For sure.
1481
01:58:29.718 --> 01:58:35.703
Real quick, I was thinking, as I say this, robotics to scan the mouth.
1482
01:58:36.543 --> 01:58:36.784
Okay?
1483
01:58:36.824 --> 01:58:39.205
There's no reason a robot can't do that.
1484
01:58:39.786 --> 01:58:40.066
Okay?
1485
01:58:40.086 --> 01:58:42.668
That would free up 10 minutes of a dental assistant's time.
1486
01:58:42.868 --> 01:58:43.089
Yeah.
1487
01:58:43.269 --> 01:58:46.331
That could be done for, it could be then put to better use in other areas.
1488
01:58:46.431 --> 01:58:47.612
I'm sure that would be coming soon.
1489
01:58:47.752 --> 01:58:47.933
Right.
1490
01:58:49.374 --> 01:58:51.397
As you say, it's a very exciting time.
1491
01:58:51.457 --> 01:58:55.642
Is there anything else that you're particularly excited about in terms of what your view of the future is?
1492
01:58:56.563 --> 01:59:03.112
Anything that we haven't discussed already that you think is going to have a really positive impact on the profession?
1493
01:59:03.856 --> 01:59:10.420
I think I really want to emphasize the essentialism of dentistry.
1494
01:59:11.301 --> 01:59:25.329
And the better that we can advocate for it by developing a minimum standard for oral health and then being recognized as key members of the healthcare team and not as an adjunct.
1495
01:59:25.349 --> 01:59:27.931
I think it will happen in the next 10 years.
1496
01:59:29.352 --> 01:59:33.114
And then using this technology and owning prevention and
1497
01:59:34.275 --> 01:59:42.024
will change the scope of how we practice now, which is a surgical-based model, to the management of chronic disease-based model.
1498
01:59:42.384 --> 01:59:48.591
And I think it'll bring a level of excitement to all of the dental team, which will then...
1499
01:59:50.553 --> 01:59:53.934
help with the wellness of us as a profession.
1500
01:59:54.314 --> 01:59:58.695
Yeah, I think it gives even more meaning to the work that we do.
1501
01:59:59.415 --> 02:00:03.656
It's not just filling this hole with a plastic material.
1502
02:00:04.817 --> 02:00:11.878
It's actually you're helping the health of another human being, which is an incredible gift to be able to have.
1503
02:00:11.898 --> 02:00:17.200
Obviously, already those of us that work in the cosmetic space have benefited from the
1504
02:00:18.840 --> 02:00:43.434
the human connection of giving someone back their smile and their confidence and their dignity as you describe it but I think those of us that work maybe more foundationally in dentistry the endodontists the periodontists the oral surgeons anyone else that's working on a more foundational level has maybe not been able to garner the same level of
1505
02:00:44.334 --> 02:00:58.922
uh impact and so i think the more patients are aware of that and the more we're aware of that the more fulfillment and meaning that we can all find within the profession and and the same goes for all of our uh team members that allow us as clinicians to do what we need to
1506
02:00:59.362 --> 02:01:10.649
Yeah, there's nothing better, no feeling better than when you deliver a set of veneers on a patient and it comes out exactly what they had envisioned their smile to look like.
1507
02:01:10.829 --> 02:01:11.990
There's no better feeling.
1508
02:01:12.690 --> 02:01:15.832
And it's a team effort.
1509
02:01:16.192 --> 02:01:18.934
You know, it does involve the endodontist sometimes.
1510
02:01:18.954 --> 02:01:20.676
It does involve the periodontist sometimes.
1511
02:01:21.036 --> 02:01:21.877
It involves the lab.
1512
02:01:21.897 --> 02:01:22.878
It involves the team.
1513
02:01:22.938 --> 02:01:31.385
And in my practice, my expanded function dental assistant would create the temporaries and, you know, the trial smiles, what I would call it.
1514
02:01:32.066 --> 02:01:34.528
And, you know, and I'd come in and finish it, but they loved it.
1515
02:01:34.568 --> 02:01:35.529
They love being part of it.
1516
02:01:35.569 --> 02:01:35.669
And.
1517
02:01:36.509 --> 02:01:47.413
Those kind of things there will always be a need for in our profession, but it all has to be on the basis of health and the basis of the ability to function.
1518
02:01:47.433 --> 02:01:51.994
And that's the penultimate.
1519
02:01:52.734 --> 02:01:54.736
uh, level of dentistry.
1520
02:01:55.336 --> 02:02:04.223
And we need to come together as a profession to answer some of the questions that, uh, that I've been raising, you know, what is the minimal standard for oral health?
1521
02:02:04.563 --> 02:02:08.266
Who is best to advocate for these changes and how do we do it?
1522
02:02:08.687 --> 02:02:17.793
And, um, and, and the conversations, uh, are, are, are growing and in importance because the current practice model is starting to not work.
1523
02:02:18.254 --> 02:02:18.354
Yeah.
1524
02:02:18.374 --> 02:02:19.074
Yeah, absolutely.
1525
02:02:19.114 --> 02:02:19.575
Absolutely.
1526
02:02:20.909 --> 02:02:21.149
Brilliant.
1527
02:02:21.169 --> 02:02:26.151
Well, Brett, before we finish, I want to just go into dentistry reimagined.
1528
02:02:27.612 --> 02:02:33.335
You've mentioned the word imagination, interestingly, and reimagined quite a lot today.
1529
02:02:34.475 --> 02:02:38.157
So it's clearly, I think, one that is an important part of your vocabulary.
1530
02:02:39.397 --> 02:02:41.699
But I believe dentistry reimagined is a...
1531
02:02:43.039 --> 02:02:48.385
an executive coaching or a leadership mastermind or service that you're focused on.
1532
02:02:48.405 --> 02:02:50.067
So why don't you tell us a bit more about that?
1533
02:02:50.107 --> 02:02:50.347
Sure.
1534
02:02:50.488 --> 02:02:50.848
Thank you.
1535
02:02:51.689 --> 02:02:59.858
So my, my next venture is a business I call dentistry re-imagined and I'm, I'm helping a lot of dentists who are, you know,
1536
02:03:00.518 --> 02:03:04.420
They seem to be doing well with their practice, but they're not fulfilled.
1537
02:03:04.840 --> 02:03:06.140
And the burnout is happening.
1538
02:03:07.021 --> 02:03:09.822
They're not practicing the type of dentistry they want to practice.
1539
02:03:10.042 --> 02:03:14.303
And dentistry affords us this opportunity to live this amazing life.
1540
02:03:15.003 --> 02:03:18.825
And many of us forget to live our lives because we're so into the practice.
1541
02:03:19.585 --> 02:03:35.822
And in my own experience of being coached most of my career, I want to give back in the same way that I had been given and help our colleagues determine what their purpose is.
1542
02:03:36.243 --> 02:03:40.808
And again, just like I'm doing for Dennis Reimagined, I ask my colleagues.
1543
02:03:42.329 --> 02:03:50.616
uh, colleagues and my clients and my people that I mentor, if we're, if life were as good as it can possibly be five years from now, what would that look like?
1544
02:03:51.157 --> 02:03:52.778
You know, what would your family life look like?
1545
02:03:52.798 --> 02:03:53.498
Do you have a partner?
1546
02:03:53.538 --> 02:03:54.299
Where would you live?
1547
02:03:54.339 --> 02:03:55.660
What kind of house would you be in?
1548
02:03:55.680 --> 02:03:57.602
Uh, do you have kids?
1549
02:03:57.622 --> 02:03:58.482
Do you have a dog?
1550
02:03:58.583 --> 02:03:59.944
What kind of vacations do you take?
1551
02:04:00.604 --> 02:04:00.964
And then, uh,
1552
02:04:02.250 --> 02:04:03.932
Tell me about your work.
1553
02:04:03.992 --> 02:04:05.413
Is that the best it can possibly be?
1554
02:04:05.453 --> 02:04:11.739
Can we design a work life that feeds your real life?
1555
02:04:12.200 --> 02:04:15.143
Because the bottom line is, do we work to live or do we live to work?
1556
02:04:15.803 --> 02:04:22.130
And so if we can get aligned with helping our colleagues determine who they are, what they stand for,
1557
02:04:22.690 --> 02:04:25.132
how they want to spend their time and where they want to go with it.
1558
02:04:25.512 --> 02:04:30.555
And then aligning all of their actions along that line, fulfillment occurs.
1559
02:04:30.955 --> 02:04:32.937
And we can do great things with intention.
1560
02:04:33.397 --> 02:04:34.578
And so I'm helping people do that.
1561
02:04:35.278 --> 02:04:35.919
And it's been great.
1562
02:04:35.939 --> 02:04:44.124
And I'm also working with a dental organization as well that is growing its leadership pipeline and membership.
1563
02:04:44.704 --> 02:04:45.065
It's great.
1564
02:04:45.685 --> 02:04:47.486
So how would Density Reimagined?
1565
02:04:47.546 --> 02:04:49.667
Is it done on a virtual basis?
1566
02:04:49.687 --> 02:04:50.628
Is it done in person?
1567
02:04:50.648 --> 02:04:51.969
Is it done in group settings?
1568
02:04:51.989 --> 02:04:52.729
Is it done one on one?
1569
02:04:52.749 --> 02:04:53.409
All of the above.
1570
02:04:53.610 --> 02:04:54.170
All of the above.
1571
02:04:54.250 --> 02:04:54.690
Okay.
1572
02:04:54.770 --> 02:05:02.595
You know, it starts out as individual coaching, discovery sessions to help you think about your life.
1573
02:05:03.395 --> 02:05:06.697
And even just going through the discovery, your brain changes.
1574
02:05:06.837 --> 02:05:09.639
It opens up areas of your brain that have been locked up.
1575
02:05:10.658 --> 02:05:17.420
And then I help, you know, through individual coaching, through mastermind, through retreats.
1576
02:05:19.040 --> 02:05:23.562
And, you know, we develop plans for living your best life.
1577
02:05:24.602 --> 02:05:25.022
Beautiful.
1578
02:05:25.862 --> 02:05:30.124
Yeah, I see a lot of similarities in me and you in terms of the way that our minds think about these things.
1579
02:05:31.684 --> 02:05:34.145
And one of the things that we mentioned just before we started was...
1580
02:05:36.105 --> 02:05:42.513
a topic that I've discussed on the podcast before, which is what's, what's your definition of success or a successful life, I guess.
1581
02:05:42.533 --> 02:05:44.976
So what, what would your definition of that look like today?
1582
02:05:45.726 --> 02:05:48.889
And, you know, I want to live my best life.
1583
02:05:49.410 --> 02:05:50.591
And what does that look like?
1584
02:05:50.631 --> 02:05:57.418
You know, I want to create an impact, positive impact on the world and every interaction I have.
1585
02:05:58.219 --> 02:06:04.065
And so, you know, there's a, in my world, I look at wellness in five dimensions.
1586
02:06:04.125 --> 02:06:06.167
You know, I look at it in a lot
1587
02:06:06.547 --> 02:06:07.607
Uh, physical wellness.
1588
02:06:07.627 --> 02:06:11.128
So I want to, you know, be healthy and, and I'm an endurance athlete.
1589
02:06:11.148 --> 02:06:13.829
So I do crazy, stupid things, long races and things like that.
1590
02:06:13.849 --> 02:06:14.869
I want to continue doing that.
1591
02:06:14.929 --> 02:06:16.010
So that's part of my success.
1592
02:06:16.510 --> 02:06:23.812
Um, emotional wellness, you know, I want to be, you know, emotionally stable and connected with, uh, you know, with the world in a positive way.
1593
02:06:24.092 --> 02:06:27.874
mental wellness, keeping finding ways for my brain to grow.
1594
02:06:28.254 --> 02:06:44.563
So reading books like, you know, or behind you and next to me, listening to podcasts, attending lectures where, you know, where I can continue to grow my brain capacity, a spiritual wellness, you know, and that could be, you know, religion, where you feel your places in the universe, or what's your purpose?
1595
02:06:44.743 --> 02:06:51.047
What lights your fire that when you get out of bed in the morning, that you just want to, you know, maximally impact along that way?
1596
02:06:51.767 --> 02:06:59.091
And then social wellness, you know, choosing the people around me that that make my world bigger.
1597
02:06:59.111 --> 02:07:03.674
OK, there's so many people in your lives that, you know, make your world smaller.
1598
02:07:03.694 --> 02:07:05.335
I don't want to be in relationships with them.
1599
02:07:05.355 --> 02:07:07.396
I want to be in people that are growing.
1600
02:07:08.176 --> 02:07:11.138
My why is I'm a catalyst for positive change in the world.
1601
02:07:11.818 --> 02:07:14.179
And so that, you know, I want to be around people who are growing.
1602
02:07:14.199 --> 02:07:16.080
I want to be around entities that are growing.
1603
02:07:16.820 --> 02:07:20.121
And so, you know, those are the five elements that I look at.
1604
02:07:20.241 --> 02:07:23.643
And then I get compensated for it in a meaningful way as well.
1605
02:07:24.083 --> 02:07:25.223
And so my needs are met.
1606
02:07:26.384 --> 02:07:26.764
Beautiful.
1607
02:07:27.364 --> 02:07:27.845
I love that.
1608
02:07:27.965 --> 02:07:29.406
But we'll leave it there, Brett.
1609
02:07:29.446 --> 02:07:30.948
And it's a really inspiring story.
1610
02:07:30.968 --> 02:07:36.053
As I say, it's been been fascinating to hear your thoughts and to hear about the journey that you've been on.
1611
02:07:36.133 --> 02:07:42.039
And yeah, looking forward to seeing the positive change that you continue to make across the profession across the world.
1612
02:07:42.079 --> 02:07:43.180
So it's been a pleasure to meet.
1613
02:07:43.380 --> 02:07:43.801
Thank you.
1614
02:07:43.861 --> 02:07:46.485
And I really appreciate the opportunity to come here.
1615
02:07:46.505 --> 02:07:48.768
I have a lot of respect for what you're doing.
1616
02:07:49.229 --> 02:07:55.498
You know, when we do these kind of podcasts and you, you know, develop this platform, you never know who's listening.
1617
02:07:55.999 --> 02:07:59.243
You never know what they hear and you never know when they hear it.
1618
02:07:59.904 --> 02:08:03.150
Your content is so valuable and so powerful.
1619
02:08:04.112 --> 02:08:05.514
And I'm glad you're doing it.
1620
02:08:05.534 --> 02:08:15.390
And I admire the fact that you're asking, you know, this wide swath of people around the profession to really, you know, encourage people to live their best life.
1621
02:08:15.431 --> 02:08:16.673
So kudos to you, my friend.
1622
02:08:16.853 --> 02:08:17.434
I appreciate that.
1623
02:08:17.654 --> 02:08:18.215
Thanks a lot, Brett.
1624
02:08:18.275 --> 02:08:18.636
Thank you.