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E25: Podcast: Jennifer de St. George on business options for dentists

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Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Welcome. You’re listening to Ascent Dental Radio. My name is Dr. Kevin Coughlin and I’d like to just give a notice of thanks to Mr. Doug Foresta. His company, Stand Out and Be Heard, has been producing and managing this podcast now for several months. I’m proud today to introduce to you Mrs. Jennifer de St. George. I’ve had the pleasure of chatting with Jennifer over the last several months, and in particular, a variety of subjects.

But mostly, the independence and the options that dentists now have. Perhaps one of the most significant changes is the advent of corporate dentistry, or what more properly would be referred to as managed service organizations and dental service organizations.

Anyone who has followed practice management, anyone who has been involved in the field of dentistry will be familiar with Jennifer de St. George’s background and accolades. She is one of the leading practice management speakers. And she is an authority in building teams and providing perhaps most importantly, education, team work and the development of a dental practice to suit the current goals and necessities that are available to today’s dental force.

Without any further ado, I’d like to introduce Jenny de St. George. And as always, these podcast are brought to provide the dental profession with the best in these areas and other areas. And I can’t thank you enough, Jenny, for taking the time to speak to me today about what’s new and what’s going on in the dental profession and how perhaps, between the both of us, we can shade some information to a variety of different topics. Jenny, thank you so much for joining me today.

Jenny: Kevin, it is absolutely my pleasure. I am going to, I’m afraid, date myself a little bit. When I first into dentistry almost four decades ago with my then current husband after he graduated from dental school, we opened our independent practice. And along with about 97 percent of graduating dentists at that time, which would be in the late 60s, about 97 percent of dentists graduating went into solo practice.

They took some money from the bank, in our case it was a whole whooping $25,000, to start four treatment rooms in 770 square feet. About three percent went to the military, postgraduate and once in a while, went into an associateship. So really the decisions that Edmond was making and the dentists at that time was not even a decision they had to make. It was a given.

When we went to crack a bank to get our loan to equip and open and finish the practice because the building was not completely finished, we had to do the last construction, the bank manager as he gave us $25,000 — and by the way, the only collateral we had, two wedding rings, a used VW that Edmond bought going through dental school and a DDS degree. And the bank manager looked at us and said, “We’ve never had a bankrupt dentist yet in the state of California, you will do nothing but succeed.”

Fast forward to today, 2017, and historically I think that has changed to maybe — and I’m going to exaggerate a little bit — perhaps 97 percent of graduating dentists are now looking for some sort of relationship where they don’t have to go out and start what we would call in England a scratch practice. And maybe three percent take that huge leap of faith, put their name on the door, open the door as we did, and just pray that somebody walks through the door.

I know it’s beginning to turn. I was at a meeting recently in San Francisco and I ran into a vendor from Wells Fargo who’s worked in dentistry for actually as long as I’ve been. He remembered me, I didn’t remember him. And we sat and chatted and he said that the market — and I can obviously only talk for California — he said is changing and he’s beginning to see more and more doctors graduating beginning to consider the potential of setting up an independent practice.

Either way, I think that Kevin your goal and my goal is to help in any way we can, the professional make an educated decision. So if they decide to join an organization or they make that commitment to go solo, they do it with, to the best of their ability, all the facts that they can get and not just make a blind emotional decision which I fear that many of them do.

Kevin: I can’t agree with you more, Jenny. I do teach at Tufts School of Dental Medicine in Boston, Massachusetts and the focus of my course is part of a practice management curriculum. Which now is mandated basically through almost all 60 dental schools in the United States to provide a business background and try to improve the business acumen of these young graduates so that they’ve been given the tools to make informed decisions about what works for their particular wants and needs.

So one of the reasons I was interested in bringing Jenny on to our podcast is dentists look for experts. They are looking for information and knowledge. Because unfortunately, most of us have a very strong science background, but we have a very weak background in business. And today, we’re surrounded by significant debt, significant challenges and it’s up to us to provide tools and information to guide these graduates or any particular part of your career whether you’re in mid career or in the twilight of your career, to make informed decisions.

Jenny, in your professional background, what would you consider would be the greatest opportunities, potentially the greatest threats to the profession as you see it? And you’ve traveled all over the world speaking and I believe you’ve been to five continents. What is your feedback from the people who are participating in your programs, reading your books, listening to your CDs? What do you see as their biggest opportunities and threats?

Jenny: I think it’s very important for your listeners to know I do not come from a clinical background. I came into dentistry through marrying Edmond, so I feel like I went through dental school. I feel I graduated as a dentist, but I did not.

When Edmond graduated out of the last year of what was known as P&S in San Francisco, College of Physicians and Surgeons, that was the last year before they moved the school and it became the University of the Pacific. Edmond and his class and the classes before him used to tell me that there was virtually nothing that would walk into their practice on the first day that they did not have the confidence to know how to handle.

Edmond told me he chose to be a GP because he liked the stimulation and the challenge of never knowing what kind of patient was walking through the door. He just didn’t want to go into a specialty practice where he was limited to a specific amount of procedures. So his confidence was so high that he could barely wait for the next patient to come through as an emergency.

Today, and this is just third party feedback, I am wondering if today’s graduating dentists have the same confidence and they have the same skills. I’m going into my memory bank, I think Edmond, I want to say, he made 35 dentures off the top of my head. I do know that when he delivered a new set of dentures, that the patient could not get it out. The fit was so good. He had so much confidence.

And so the most important it would seem to me to say as a non-clinician is to do whatever you need to do to get your clinical expertise to the level that you are confident and comfortable with yourself.

And I think as a number one, therefore, if you have that confidence, the second decision is where to take that confidence and expertise becomes a little easier. I sometimes wonder if the youngest dentists graduating lean towards going into a management service organization because they perceive that perhaps they still need to get more experience or more expertise.

Which in a way, he’s almost made the decisions for him or her. I don’t know how you feel about that comment because you and I have not discussed it and I appreciate I am a non-dentist making it, but it would seem to me that expertise is what the profession is all about.

Kevin: I can tell you that from my perspective, a number of factors are taking place today. One, many of the young graduates are limited in their exposure and in their clinical skills today, much different than it was 30 and 40 years ago and that’s because of the rise of specialization.

Today, that graduating student, that third or fourth year student is many times taking patients and these patients that require specific clinical care are referred to the post-grad departments, whether that’s endodontics, periodontics, pediatrics, oral and maxillofacial surgery, public health. The list goes on and on and the nine specific areas of specialization.

So unfortunately, and this is a generalization in my part based on 34 years of clinical experience, not only my own business but teaching, that many times these young men and women — and I shouldn’t use the term young, but recent graduates — may be lacking the experience that your husband had three and four decades ago.

I don’t see that changing and my feedback from my students are, “Dr. Coughlin, I just need a couple more years of working anywhere I can to get my skills and confidence levels up,” where your husband’s confidence levels are because of perhaps additional clinical training.

I always tell the students, and perhaps you can comment on this, I always say you would never marry someone just to be married. And I don’t think you should take a job just to take a job. I think you should take a job that you’re passionate about and a location with a support team that you’re enthusiastic about. And it’s up to you to get that additional training.

Because from a purely financial standpoint, since the bulk of our profession is still general dentist, I cannot emphasize what you mentioned earlier in this podcast, you have to get training in the nine areas of specialization.

And although you may not be a complete expert in all areas, with adequate training and mentoring, you should be able to do 80 or 90 percent of the treatment that walk through your doors to improve your bottom line, keep yourself technically and didactically stimulated, and also offer more services for your patients than just simply a radiograph and a referral path. What would be your comments on that, Jen?

Jenny: Number one, I could not agree more because if the graduating dentist does not follow your advice, they will end up by rather being like a traffic cop at an intersection. A patient comes into the GP practice and like the interns doing medical, they pass them on to somebody else. They’re just like the gatekeeper and I wouldn’t have thought most dentists would go to school to become a gatekeeper.

Kevin: I couldn’t agree more. One of the things, Jen, that I’ve actually seen and are part of my presentation, is it’s almost like a dating game. I have them fill out a series of 20 questions and those questions are basically personality questions that determine do you have the entrepreneurialship, do you have the drive and the desire to be a solo practitioner, to be in a group practice or to be guided towards corporate dentistry.

And it’s interesting over the last ten years, typically the groups that I’m speaking to are between 50 and 100 students. And more and more, each year, I see them gravitating towards corporate entities, sometimes because what we touched on is lack of clinical and business skills, but more and more, I see two incomes.

Many times one professional is marrying another professional and they say, “Dr. Coughlin, I’m looking for a different life balance. I’m interested in pursuing other aspirations and goals and I don’t know if I want the trials, the tribulations and the potential stresses of being a small business owner.”

And as I’ve said to you in private, I think our job as educators is not to necessarily put our views on people, but to explain to them the risks, the strengths, the opportunities, the threats and the decision-making process so that they don’t make a mistake.

Because personally, being independent, being in control of your clinical and business, to me is hugely important. But sometimes for other people, they’d rather have other people make those decisions and just focus on the clinical aspect. What would be your thoughts on that?

Jenny: Many years ago, I was interviewed and in fact, interviewed him, a psychologist on entrepreneurship and small businesses. He had worked in the dental field for quite some time and he told me that dentists’ group was the most individualistic of any of the professions. And in his opinion, there were dentists who were brilliant, they could have been heart surgeons or flown to the moon, whatever, but they choose to go into their own practice because they wanted to be in charge. But it takes a personality.

I think that what dentists today who have been practicing for many years, is they realize that 50 or 60 percent of the stress in their practice, maybe more, was not caused by their clinical area, it’s caused by staff and patients.

I joke when I speak from the stage, the ideal dentist if they could wave their magic wand, would let the patient drop off their teeth in the morning, pick up their teeth at the end of the day. The dentist at the dentistry never has to see the patient because it’s the patients and the money and the insurance and the staff that cause the stress, not the dentistry.

So I think that some of the dentists think that by going into a corporation that this stress, as I described it, will disappear, but that is absolutely not true.

And if there’s one practical suggestion I could share with you, Kevin, that I have said from the stage for years, when you are going to interview, whether it’s a DSO, an MSO, to be an associate in a private practice, whatever it is, call up and be a mystery shopper.

Call up and pretend to be a patient and make an appointment for an emergency. Get to the reception room two hours before the interview with the senior doctor or the manager of the group. Watch the staff, watch how they behave to each other, watch how they handle patients.

And if this is a mismanaged rude office where you will do nothing but learn how not to do it, I suggest you make your appointment five minutes and leave. You only want to go where you will be surrounded by the quality in management and communication.

Kevin: Jennifer, how do you feel, what’s the best way for the listeners of this podcast to improve that situation? What are some of the areas if a dentist listening to this podcast says, “You know what, I think I’m doing a good job, but really if I was to be critical of my team, myself, my office, I need improvement,” what would be the best way for them? How do they reach out to get better?

Jenny: The sad thing is we shouldn’t have to ask this question. The sad thing, Kevin, is that in dental schools, patient management, patient-doctor communication and human resources, how to hire and fire and manage, should be part of every program.

In England, a few years ago, they actually took the four-year dental program and made into five years so they could add all this stuff that was not being included in the four-year program.

When I talk to deans of dental schools as I have over the years and I got on my little soapbox about the kind of thing you and I are talking about, the deans tell me that the students are not ready for this kind of information. Yet when you go and talk to the students, they are more than ready and they want it. The deans will say there’s no time in the schedule, the students say you come in at 5:00 in the morning, we will come in.

At the moment, to answer your question, I don’t think there is a structured approach. It’s going to people like me going on to webinars, going to the conventions, but it’s not a systematical approach. I am hoping to get it finished this year, 2017, I would like to start a JdSG Learning Center online where I put up a very basic but the whole program. Because in my opinion, when you learn staff management or you learn how to communicate with patients or how to ask for money, you must always do it in the context of the whole program.

But dentists graduate from dental school and they maybe go to a convention and in theory they could have three speakers who actually say three opposing views on the very same subject. So it can be confusing. It should be part of the school curriculum and it’s not.

Kevin: I couldn’t have said it better myself. Hopefully, with experts in communication, in teaching, in education like yourself, we’ll see an improvement. And if I could give you a little prod, a little push, I will tell you get that program out running because our profession needs it. The better our business is, the better our communication skills are, the higher level of care and service we’ll perform. And I think understanding the independence and the luxury of being independent — I tell the students be careful what you wish for.

Nothing in this world is for nothing. And when someone tells you they’re going to take away all your stress and all your problems, sometimes you’re left with more stress and more problems.

Our goal out there in the practice management field, in the educational field is to provide data and information so that students, the seasoned practitioner, that practitioner getting ready to transition perhaps into a new area of their life, they need these tools and they need this information to make the most informed decision.

I  want to thank Jennifer de St. George so much for her expertise, her knowledge and her time. She’s been doing this for over two decades, actually over three decades, and it has been an actual honor and a privilege to have you on this podcast.

You’ve been listening to Dr. Kevin Coughlin, Ascent Radio, that’s Ascent Dental Radio. And again, my thanks to Mr. Doug Foresta for producing this podcast and it’s Stand Out and Be Heard. Doug, thank you so much for your expertise and I look forward to our next podcast. Thank you listeners very much.

E24:Podcast: Bob Tremblay on dental practice trends

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Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Good afternoon. You’re listening to Ascent Dental Solutions Radio. This podcast is brought to you by Mr. Doug Foresta. His company is Stand Out and Be Heard and without his expertise in podcasting and production, I would not be able to bring this podcast to you. The podcasts are made for business in general, but dentistry specifically. In this particular podcast, we’re fortunate and lucky to have Mr. Bob Tremblay, who’s been associated with the dental profession for over 35 years.

So often, we as dentists sometimes underestimate the knowledge and information that’s right at our finger tips. Mr. Tremblay has been involved as a growth specialist for Patterson Dental Supply, as I said, for over 35 years. He serves well over 100 dental offices and in my opinion, he’s an expert in the field of dentistry.

His expertise can make your practice grow, make your life better, and most importantly, provide the assets and information to provide the highest level of care and satisfaction to our patient base.

Bob has been featured in full-page articles of Proof, the industries trade magazine. He’s received numerous corporate and national awards for sales and sales training and has consistently been the growth driver of awards and has been in the top ten percent of his specialty with over 1,000 different colleagues for the last 15 years. I consider Mr. Tremblay an expert in the field of dental supplies, dental growth and the general business of dentistry and we’re fortunate to have him take time from his busy schedule to speak to us on a variety of topics that I believe can help your practice and provide some knowledge and insight that sometimes we often forget.

Mr. Tremblay, thank you so much for joining us. I can’t tell you what a privilege it is to speak to you this afternoon. Bob, what can you tell us about the dental profession today as you see it? Since you see hundreds of dental offices, what do you see as some of the trends in dentistry today?

Bob: I think dentistry today is probably the dentistry we’ve seen in quite some time. I think that dentistry is changing very, very rapidly with different procedures and easability of doing the procedures in the dental industry.

Kevin: Bob, sometimes what I found is that the materials, the techniques, change so rapidly. And as a practicing dentist for 35 years, sometimes I get set in my ways, I don’t want to change. I think what I’m doing and what I’m using is the best technique and best procedure.

But with your expertise, you’re able to come into an office, evaluate the supplies, the materials and techniques and you can really add insight to the dental profession because not only do you know these materials and their advantages and potential disadvantages, but you’re seeing them used in hundreds of practices. How do you go about the training and the education of a dental office? What does Patterson have to offer that sets your company apart from the other supply companies?

Bob: First of all, thank you. There is over 84,000 items in the dental industry of what doctors used. And like you say, you’ve used them for years and you become comfortable with what’s going on and what that product does for you. But the evolution of the changing products and what they can do and the strength of certain products, that changes quite frequently. I pride myself in learning and taking numerous classes all the time on the certain products.

But there’s a lot of products that have a lot of similarities and there’s a lot of dentists that enjoy that manufacturer of products or what it does and how it handles. Each office is different of products and I will always provide information on certain products and give them the tools and give them my understanding of what that product does and how it would work in their hands and what the final result is.

But the items out there, each doctor is different and each doctor looks at things different and handles things different.

So I certainly give them the tools to utilize, but it really depends on what they want to use at the end of the day and there are a lot of products out there that can accomplish the same thing. Because it’s comfortable in their hands and they’re using it, I won’t have them changing it unless I know that there’s another product out there that is just far better than what they’re using.

Kevin: Bob, sometimes when I open my closet, I believe I actually have all 84,000 items. I know that’s an exaggeration, but many times I find dentists fall into different categories. There are those dentists who don’t want to try anything, and then there’s that group of dentists who are willing to try almost anything.

And what I found a great asset of Patterson Dental is many times they’ll bring into the office a lunch and learn and allow the dentist and the team members to try different materials, work with those materials before we actually make the investment and time and finances to implement that into their practice. That’s something that I think is not only unique, but very special about Patterson. And what I found working with an excellent sales representative such as yourself, you allow those lunch and learns. Is that correct?

Bob: That is correct and that’s a great topic and something to talk about. That’s one of the things that separates us from the Catalogs and the Uniques out there. There are so many lectures that doctors go to that they tell you that this is a better product and why. So the doctor would go on the internet and try it out and they’ll have a very expensive kit on their hands that they don’t like the handling of it or something like that.

One of the things that gives us the advantage or the value of coming into your office is we have these lunch and learns. Even though the lectures will say that this best, it may not be, like I spoke earlier, it may not be their type of product that they like to use.

So what does that do? That does what many offices that sits in the storage shelf and it’s never used and it becomes outdated. But it’s very important to have the value of somebody like myself to come in to explain the product, for them to utilize the product and try it out even in hand.

And we certainly — I know I do and Patterson stands by this — we give you 100 percent guarantee. So if you use it and it’s not what you want or it’s not what you thought it would be, we certainly take it back and give you a full credit if it’s in a kit’s form. Because it’s something that we can’t guarantee that you like and it’s important that you utilize what you have.

Kevin: If I could just make an inside comment, my personal opinion is sometimes we as dentists we’ll only give something a try once or twice and then that’s it, we’ve given up on it. And like most things in this world, sometimes it takes a little additional training, some patience, to make sure that these products are used properly, not only by us, but the dental team that supports it.

If you were to comment on the restorative part of dentistry, which is still a large portion in dental health care. I noticed a phenomenal company like VOCO has the ceramic composite restorations. How are those products being represented and is the dental community and the patient base receptive to them and are you getting good to excellent feedback on the products such as those?

Bob: Yes, and VOCO does have a new ceramic-based resin composite and it seems to be really taking off quite well. There’s a lot of manufacturers out there, that name brand product: the 3Ms, the Dental Supply Cox of the world, that have that name or that brand, if you will, so doctors will utilize theirs before. VOCO is from Germany and they’ve really stepped up and have really come up with some great products. They’ve really come a long way with their resins and their ceramic resins and other products along the way.

But there’s many, many manufacturers; Ivoclar has some great ceramic products as well, but it really depends on how the doctors like it to feel. As Gordon Christensen says, there’s three things you really look at when you do; how it handles and what the end result is and obviously, the cost. We want to look at those three things. And if those three things work in a dental office, it’s worth utilizing.

Kevin: Bob, if you were to comment on the actual instrumentation. I know through personal experience Patterson has an excellent association with Hu-Friedy and the cassettes and the instrumentation that goes along with that. I’ve just been blown away by the incredible hands-on service to prepare these kits. These kits can sometimes have 20, 30 instruments in it and the organization and the implementation which is just phenomenal. That association with Hu-Friedy, how long has that been going on for?

Bob: That’s really a great statement there. Hu-Friedy is one of the finest instrument manufacturers in all of dentistry. You look at their dollars and so many people are so short-sighted looking at instruments because it’s very price difference from one instrument manufacturer to another. And it’s definitely a quality product and you can have instruments that are a very weak metal versus a strong metal. Plus the Hu-Friedy company really prides themselves in an organization of IMS cassettes. It’s not just instruments being put into a cassette, it’s a very well-built cassette, very organize-driven to make your job more efficient and better organized.

And that’s what helps the dental offices get better and grow, is the organization of their protocol and procedures and what they do. And Hu-Friedy certainly adds to that with their IMS cassettes. Their instruments are far better than any other instrument I know and I’ve dealt with. They’re constantly designing new instruments for different procedures. They never stop. They’ve really taken the time and every single…

Kevin: I can tell you when I had an instrument fractured, and in almost all cases, it’s because I was using that instrument improperly, I took it beyond what it should have been done, I’ve never had an issue with Hu-Friedy replacing that instrument free of charge.

But for those listening who may be just beginning their career or thinking about improving their overall practice, the ability to organize your cassettes for orthodontics, endodontics, periodontics, restorative, whether that be amalgams or composites, the whole gamut of the cassette organization and the instruments in those cassettes I cannot emphasize how incredibly effective and efficient it can be when you allow a company like Patterson and Hu-Friedy to set this up for your office. And again, that over the top service and care will pay you back in dividends.

I’d like to change topics and brag a little bit that I had the fortunate time to go to a Sirona meeting in the Connecticut area recently. I know the relationship with Patterson and Sirona is quite strong and I was just amazed at the new technology. And for someone who, I believe, keeps up-to-date and usually has the latest and greatest, what can you tell me about their 3D imaging that really stands out with Sirona?

Bob: I just want to say, Kevin, you’re absolutely right. Sirona is, yet again, another German company that Patterson is really connected to and has really worked well with. They have not only CAD/CAM, but their latest CT scan that really helps them and dentistry and actually has changed dentistry from where it was even two or three years ago where it is today.

Dentistry is changing and the technology that is out there. Sirona provides some huge high-end technology from CAD/CAM to CT scans to take better care of the patients, easier, faster, less trauma. With their 3D scans, it allows you to do implants without flaps. It gives you the tools that you need to pretty much do everything in the dental office that wasn’t able to be done two years ago.

Kevin: What particularly for me took me back at that wonderful weekend was the integration of CEREC with Galileo; the ability to have this technology, whether it’d be the intraoral cameras, that whole integration of the technology so that it’s user friendly. As an early CEREC user, I remember some of trials and tribulations, not only with the hardware, but the software.

And sure enough, a company like Patterson and Sirona team up and they understand some of the disadvantages that new technology can present and they proceed with research, technology and it’s just amazing how everything is married together today. Can you give us an example of what you see in the near future, what’s on the agenda that Patterson has that makes your company continue to stand apart from other companies?

Bob: I think that Sirona will always be a major part of what we do and what we have seen. You had mentioned the CAD/CAM and the capability of how they marry each other into the CT scan. And it really keeps everything into the general dental office where you can scan the mouth, do a CT scan that will allow you to do a surgical guide by milling it with the CEREC to place the implants.

Kevin: I can tell you, Mr. Tremblay, that I’ve been a practicing dentist for the last 35 years and in my opinion, like most businesses, most businesses revolve around relationships, what I call the BLT. You want to deal with people you believe in, you like and you trust.

And for the listeners out here, I cannot emphasize the importance of creating that relationship with your sales representative who’s actually a part of your team. Use them, use their knowledge, use their information, their technology and it may be one of the best relationships you’ll foster in your professional dental career. I’m so happy that you were able to take time and I can’t tell you enough how much I have been appreciative of your expertise and your company’s backing and just your ability to teach our team members and our office how to get better. Mr. Tremblay, thank you so much.

Ladies and gentlemen, you’ve been listening to Ascent-Dental-Solutions. It’s a company that focuses for dentists on dentists. I hope you’ve enjoyed today’s podcast. I want to give a shout out again to Stand Out and Be Heard, Mr. Doug Foresta, who’s produced over 40 of these podcasts for me over the last year and without his expertise, this couldn’t be done. Mr. Tremblay, thank you so much for your time and expertise and we’ll be talking soon.

Bob: Kevin, my pleasure. Thank you so much.

E23: Podcast: What dentists need to know about sleep medicine

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Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Welcome. You’re listening to Ascent Radio. This is Dr. Kevin Coughlin. You can hear this podcast on Ascent-Dental-Solutions, where the focus is on knowledge, development, training and education. Today’s podcast is for dentists and for the lay public that is interested in learning more about sleep medicine. I want to first, before I get started, give a congratulations and a big thank you to Mr. Doug Foresta. His company, Stand Out and Be Heard, has produced over 30 of these dental podcasts for me and the production and the effort is tremendous. Thank you so much, Doug.

My name is Dr. Kevin Coughlin and this is Ascent Radio. Today, the topic is sleep medicine. Sleep medicine started back in 1895. So it is not new, but it is new to the dental profession. And it appears to me that each year sleep medicine is becoming more and more important, not only for the dental facilities to provide care and service in this area, but for the public to be informed.

Some statistics that may shock us; number one, sleep disorders are more common than asthma and diabetes combined. This means that it is affecting tens of millions of people. You may not be aware of it, but 20 percent of all motor vehicle accidents are associated because of sleep deprivation. The driver is tired, they’re not alert and there’s a motor vehicle accident.

Some notable issues that were associated with sleep deprivation were the Three Mile Island plant that almost blew up, the Challenger, which did blow up. All of these events and in particular motor vehicle and truck accidents, occur between the hours of 1:00 am and 7:00 am. And this is because tens of millions of people are not getting the proper amount of sleep.

Some systemic issues that are associated with sleep deprivation are hypertension or high blood pressure, stroke, dementia, loss of memory, loss of alertness, a decrease in memory, a decrease in alertness. All of these factors have an effect on our ability to perform at a high level and feel good about our overall health.

How does this relate to dentistry? First of all, the American Association of Sleep Medicine is considered the governing body. It provides guidelines and the standard of care for dentists and physicians to follow to provide the public with the highest level of education and with the proper processes and procedures to help our population address this chronic, severe problem of sleep deprivation.

In lay terms, most people consider going to a dentist for snoring. Their significant other is disturbed and irritated because the individual snores and that snoring creates a situation which is uncomfortable and embarrassing.

In reality, the proper process and procedures to provide excellent care in sleep medicine is the following; first and foremost, you should seek out a dentist that either has certification, designation or a minimum of 25 hours of training in the appropriate sleep medicine courses.

Many dentists provide sleep medicine care and treatment, but most do not have the designation, the certification or the minimum requirements and as a lay person, you may want to seek out those qualifications. This certainly doesn’t mean that a dentist that doesn’t have these qualifications can’t provide adequate care and service, but first and foremost, you may want to consider those three options in choosing a dentist to provide this care.

The next thing to look at is how is sleep dentistry provided today in the United States. Many times, there’s confusion and the lack of ideal care and service. Step one, according to the American Academy of Sleep Medicine is the patient must have what is called a PSG, or a polysomnogram. This is a level one sleep study done in an area hospital where the individual stays overnight and their eye movement, muscle movement and cardiac evaluation is constantly monitored along with their blood pressure, their inspiration, expiration and a combination of all these factors will determine whether the correct diagnosis of obstructive sleep apnea is present or not present.

By definition, obstructive sleep apnea is determined by the number of times an individual stops breathing during their nighttime sleep. As a general rule, between zero and five is considered normal, between five and 15 is considered mild obstructive sleep apnea, between 15 and 30 is considered moderate obstructive sleep apnea and above 30 to 60 episodes is considered severe. It’s critical that this proper diagnosis be made.

In most cases, this is going to be done by a physician in a sleep facility and in most cases, it will be covered by your medical insurance and in most cases, the gold standard of treatment at present time is called CPAP, which stands for Continuous Positive Airway Pressure. In 2017, the C has been dropped and now the correct verbiage would be PAP or Positive Airway Pressure because some of the newer CPAP machines do not provide continuous positive airway pressure, but it comes intermittently and some patients respond better.

It is critical for the lay and professional individuals to make a proper diagnosis of obstructive sleep apnea. If in actuality you do have this condition, this condition can be life-threatening. It can increase your chances of stroke, hypertension, diabetes, memory loss, physical activity, concentration and alertness along with a decrease in your autoimmune or your ability to fight diseases. I bring this up because many times we as dentists will simply treat the patient for a snoring disorder. In order to follow the appropriate guidelines by the American Association of Sleep Medicine, you shouldn’t be taking that course of action, in my opinion, and in many others in this field.

Step one is make sure the PSG study is done. Once you’ve been diagnosed, the gold standard, as discussed earlier, is the CPAP unit. However, 80 to 85 percent of the public are unable to tolerate the CPAP unit. They find it constrictive, some people feel claustrophobic, people find it difficult to sleep. Generally, most people have the most difficult time during their first seven to 14 days. If you can get by those seven to 14 days, usually, most people adapt and they’re quite comfortable with the CPAP unit. However, the vast majority of patients don’t make it those 14 days and are looking for alternatives. And those alternatives from a dental standpoint, in most cases, are what we call Intraoral Devices or Mandibular Advancement Devices. Mandible standing for the lower jaw.

There are an entire slew of perhaps 75 intraoral appliances and they all have advantages and disadvantages. But in sum and substance, the major driving force is the appliances should be comfortable. They should fit well. They should be able to advance your lower jaw in increments of one millimeter or more. They should be easily adapted and changed based on your particular needs.

I’m not going to waste time and energy going through each individual device, but suffice it to say that the intraoral appliance many times could act and provide as much success in obstructive sleep apnea as the CPAP unit when it comes to mild and moderate cases of obstructive sleep apnea.

For those individuals who have severe obstructive sleep apnea, the gold standard is still the CPAP unit. However, for those patients who can’t tolerate it or refuse to use it, they’re still much better off with an intraoral appliance. Keep in mind that these intraoral appliances should last at least three years or longer. In most cases, the fees will range anywhere from $800 to $2,200. The reason for the vast variety of fees depends on the type of appliance and whether the adjustment visits are associated with the overall cost of the appliance.

In most cases, the correct process and procedure is the dentist will deliver the intraoral appliance. It’s first constructed by impressions of the top and bottom jaw. Those impressions are done in the dental office and then a construction bite is taken with the lower jaw in a protrusive or forward position. Generally, the upper and lower teeth are separated between two and five millimeters. And generally within seven to 14 days, the appliance is fabricated either in the dental office or at a professional dental laboratory.

The device is then delivered to the patient, and in most cases, the patient should be seen within seven to ten days to make any additional adjustments to make sure that the patient is comfortable.

Common complaints with the intraoral appliance are that patients will state that their teeth are a little sore in the morning. Their temporomandibular joints may be a little uncomfortable from the protrusive force placed on by the appliances. Overall, the results tend to be good to excellent, but keep in mind the subjective findings are not good enough according to meet the standard of care.

After the adjustments to the appliance have been made and the patient feels more rested, more comfortable and their significant other states that they hear less snoring or no snoring at all, the correct process and procedure is to have a follow-up PSG examination so that we can look at the objective studies and determine ocular movement, which is an EOG, muscular movement which is an EMG, and brain waves and cardiac issues which are an ECG or an EKG. The reason for this is we’re looking for objective evaluations to determine that the intraoral appliance is providing the high level of care and service to improve your overall health.

Keep in mind that there’s nothing that will make you feel better than a good night sleep. We’ve been providing intraoral appliances for sleep disorders for many years now and it is amazing to me how much better patients state they feel, how much better and more alert they are after the use of an intraoral appliance or a CPAP unit.

Keep in mind that there are some specific things that can be done to reduce your need for each of these devices. Number one for a female, you should try to keep the diameter of your neck less than 14 inches. For a male, less than 17 inches. Your base body mass index should be less than 30.

Losing five to ten percent of your body weight will significantly improve or reduce the need for an intraoral device or an extra-oral device. These are things that really can not only improve your overall health, but reduce or eliminate the snoring.

Keep in mind that all patients that are diagnosed with obstructive sleep apnea they all snore, but all people who snore do not have obstructive sleep apnea. By definition, apnea simply means the sensation and lack of breathing for a duration of five to ten seconds or longer. They are significantly different than a snoring event and that’s why the correct diagnosis is imperative.

Keep in mind that this information, along with other information, will be brought to you in future podcasts. For those individuals that are suffering from snoring, in summary, get the proper diagnosis first and then if the CPAP is effective, go forward and if it is not, consider seeing your dentist who has certification, designation or a minimum requirement of 25 hours or more in continuing education devoted strictly to sleep medicine.

A simple trick for our listeners to determine whether an intraoral device would be effective at eliminating or reducing snoring is as follows; make the snore sound. Just sitting in your car right now or sitting at home, make that snore sound [snores] now take your lower jaw and move it forward as far as you can and attempt to make that same sound and you’ll find that if you can, then more than likely, the intraoral appliance is the root to go and you will have an effective and successful result and save yourself thousands of dollars and hours of time. I</span

t’s a simple trick that most of us can us at home. And the reason I explain it this way is sometimes snoring and sleep apnea is caused by an upper airway or nasal passage obstruction. When that’s the case, an intraoral appliance would be much less effective or not effective at all.

Another cause of sleep apnea or snoring is some kind of central nervous system disorder. And again, in most cases, an intraoral appliance will not be effective. However, overall, over 90 percent of all sleep apnea or obstructive sleep apnea is caused by occlusion of the oral cavity or back of the throat by the tongue. By bringing the lower jaw or mandible forward, the tongue is advanced forward and the airway is open.

I hope you’ve enjoyed today’s podcast. You’ve been listening to Dr. Kevin Coughlin and this is Ascent Radio and you could get more information on my website www.ascent-dental-solutions.com.

And again, my thanks to Stand Out and Be Heard, Mr. Doug Foresta, who’s produced this podcast. Thanks again and I look forward to talking to you soon.

E22: Podcast: Doug Foresta on how podcasting can help your dental practice

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Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: This is Dr. Kevin Coughlin, owner and creator of Ascent-Dental-Solutions, with a focus on education, development, training and coaching. I’m excited today to bring to you a guest, Mr. Doug Foresta, who specializes in podcasting for businesses.

In full disclosure, I created Ascent Dental Solutions sometime ago and noticed that it was spattering. And after meeting Mr. Foresta, he introduced me to the concept of podcasting and what it could do for my business. And I cannot explain how it has rocketed to a more successful level that I never dreamed possible. With no further ado, I’d like to introduce Mr. Doug Foresta. Doug, thanks so much for taking time with this podcast. Can you just give me a little background about yourself and the business, please?

Doug: Thank you so much, Kevin, and thanks for having me on. When I first started podcasting, I didn’t even know what podcasting was. I moved here to Massachusetts from New York in my late 20s and went back to school, became a therapist and I wanted to get the word out about what I was doing and the work I was doing and thought I would go into radio.

At the time, I was working with a business coach and I said, “Why don’t I go into radio?” And she said to me, “Do you know anything about radio?” And I said no. She said, “Do you have any connections in radio?” And I said no, and she said, “Why don’t you try podcasting?” And I said, “What is podcasting?”

I started off podcasting as a way to get my own messaging out and overtime people started asking me how do you do that, how do you do podcasting, can you help me with podcasting? I never thought when I started doing it that I would be helping anyone else. It was never my intention to do that. But as I found it to be very effective, other people wanted help with it and so here I am.

Kevin: We’re glad you’re here and we’re excited about not only what you’ve done for my business, but what you can do for other businesses. Could you briefly explain the diverse clients that you’re currently dealing with?

Doug: Sure. One of the nice things about podcasting is it works for such a wide range of people and organizations. I can tell you that I currently have a large portfolio of clients in government and nonprofit, probably because of my social work background. But I produce podcasts for the National Association of Workforce boards, California National Association, San Diego Metro Career Centers as well as lots of speakers and coaches and authors.

I’ve trained literally hundreds of speakers and coaches from all over the world to do podcasting. And I produce podcasts for people including speakers, including Jennifer Brown who is a inclusion and diversity expert and many other coaches, speakers, authors.

I think that the common thread between all of the different organizations and people that I help is a desire to create some type of positive change in the world. So that probably would be the common thread.

But that’s what’s so cool about podcasting is that whether you’re a nonprofit organization, a profit, I also produce podcasts for Insurance Licensing Services of America, so truly quite a wide range of people and organizations. But again, I think the common thread being a theme of creating positive change in the world and the desire to use podcasting as a way to get the message out in a larger way.

Kevin: I know most of our listeners are in the healthcare industry, and in particular with an emphasis on oral health and dentistry. But one of the things that I found that was so amazing with the podcast is the diversity of the listeners and the contacts that I’ve been able to make with your expertise and your knowledge.

Just briefly, I was able to do a podcast with Ms. Debra Rowe who has just a phenomenon background and expertise in communication and health care, along with several other individuals. In particular, I’m now talking to the Kellogg Foundation on oral health and how to improve it for children.

Recently, we did a podcast with Judith Brown who coaches, teaches and consults on inclusion in the office for Fortune 500 companies. All of this would not have occurred without the expertise of your business, your contacts and podcasting in particular. Is that common or have I just been exceptionally lucky?

Doug: One of the things that I think people don’t realize about podcasting, people ask me what’s the difference between podcasting and radio, I think one of the ways of looking at podcasting is absolutely it’s a broadcasting tool, but it’s also an amazing networking tool.

I’ll tell you when I realized this was, I remember I was sitting in Barnes & Noble — we live in western Massachusetts — I was in a Barnes & Noble in Holyoke, Massachusetts and I was reading a book called Imagination First by Scott Noppe-Brandon and this book was talking about the power of imagination and education and workforce. And I thought to myself boy, I’d love to get involved with the work that they’re doing and I thought I’d love to interview the author.

The thing is that the author of that book, Scott, was at the time the executive director of the Lincoln Center Institute for the Arts and I thought well, there’s no way that they’re going to come on my podcast. But I reached out and almost immediately I heard back from them. And it was really funny because I thought why would they do this?

We did the interview, it went really well and afterwards I thought I’d like to run one of these imagination conversations that they have. At the time, they were doing these conversations all across the United States in every state and so I reached out, they said, “Well, we already did one with the governor of Massachusetts.” And I thought, well I’m not the governor but I thought what about doing one in the western part of the state.

From that, I was able to facilitate an imagination conversation. From that, I was then invited to something called America’s Imagination Summit and there were all of these amazing people there. There were NASA astronauts, the people from IDEO, all these amazing companies and organizations, Deepak Chopra was there, Sir Ken Robinson whose TED Talk has been watched more than any other TED Talk.

When I went there, I said, “Hi, my name is Doug Foresta,” and they said, “Oh, we recognize you from your podcast,” and that’s when I realized the power that podcasting has in terms of being able to get the word out and connect with other people.

So yes, podcasting is a great broadcast tool, but it’s also a great way to get access and to meet people that you would just never meet otherwise. And for that reason alone, I think podcasting is such a powerful tool.

Kevin: I would say I’m 100 percent convinced of that analogy. I’ve seen it in my own business, Ascent Dental Solutions. Let me ask you another question, Doug. Is there particular metrics that someone new to podcasting like myself and people listening if they wanted to go in it, do you expect 50 people to listen to the podcast, 50 million people? Is there a way or a metric system to determine how powerful this is and is it working for you as an individual or a group?

Doug: That’s a really great question and I could tell you that the average number of downloads, according to Libsyn, which is a leading podcast hosting service, the average number of downloads for a podcast episode over 30 days is 160 downloads. So that gives you some kind of idea of a metric of if you’re doing better than that, you’re doing better than average. But it really is a good question because one of the first things that I ask clients to think about when they start a podcast is what does success mean for you.

For me when I first started with podcasting, I wasn’t really worried about making money from it. I wanted to get my message out in a bigger way, I wanted to build up thought leadership. But for other people, it might be podcasting is a way to get more opens for your email list, which might ultimately mean that you’re trying to sell more products and services, get more clients.

So it really depends. You have to decide for yourself. Some of the organizations that I work with that are nonprofits, definitely their goal isn’t necessarily the goal of making more money, but it might be getting more people to utilize their services or staying top of mind with clients.

So you really have to decide for yourself what does success look like for you. And actually my number one piece of advice before you start a podcast is to really think about it and make sure that you know what success looks like for you. Because otherwise, let’s say if you don’t know where you’re going, you’ll probably end up somewhere else.

So it’s really important to decide for yourself what that metric of success is, but certainly you can watch the downloads and see if you’re growing your listener base and audience base. That should certainly be at least one part of that metric of success.

Kevin: For some of the listeners here that may not be familiar with podcast, this podcast, how does the vast majority of people download it? What are the actual steps and systems to download a podcast so that the listeners have access?

Doug: That’s another great question, Kevin. What I can tell you is that iTunes is definitely the primary way. From what we know from watching the statistics is that iTunes is the king of podcasting. People are accessing iTunes via their iPhones and now we have, as well, iHeartRadio, Google Play, Stitcher Radio which are allowing people to listen from their android phones.

Podcasting is definitely mobile. I would say that that’s one of the nice things about podcasting is you can download it to your mobile device and listen to it on your tablet, your iPad, your iPhone or your android phone whenever you want.

Having said that, one of the things I hear people say is what if I have an audience that isn’t really mobile savvy? What I have found is that we can get people to listen to your podcast in a variety of ways. You can send it out as a link in an email, I definitely recommend doing this, putting it as a player on your website.

So even for people who, let’s say, aren’t that savvy with getting a podcast off of iTunes and don’t normally listen to podcast, if you put that podcast on your website, put that player there, that gives you an opportunity for people to very easily just click on a player and be able to listen to a podcast, even if they don’t go to iTunes. So really depending on your audience you can tailor the ways that people do listen to your podcast.

Kevin: That’s a nice segue because almost every dentist and health care provider that I’m aware of they have a website. So you strongly recommend that the podcast be downloaded to the website so that there’s access to it, not only along with iTunes and iHeart, but also on their particular website?

Doug: Absolutely. I definitely recommend putting the podcast on your website. Because again, some people are going to find you on iTunes and Google Play and these other ways, but if you’re getting traffic to your website, you’ve got a built-in audience of people that are already going to your website. Just make it clear, make it easy for them to find and click on and that’s a great way to just get a head-start in building that listener base.

Kevin: I suppose my business with 14 dental practices, practicing dentistry full time for the last 30 somewhat years, most of the dental offices that I’m associated with, we have some kind of marketing in the reception room.

We have flat screen TVs which promote products, services and care and we promote this podcast on those flat screen TVs so when people are sitting in the reception room, they have the ability to hear different topics. Would you recommend that also?

Doug: Right. The bottom line is go where people are. If you know that that’s where your audience is, go where they are. That’s just a great marketing principle in general. Absolutely.

Kevin: Some short facts about podcasting. I know when you were coaching me, introducing me into the strength of podcasting, generally you want to keep the podcast at what timeframe for an average listener?

Doug: What the data tells us from medicine research is that there’s a drop-off after about 22 minutes of podcast listenership which really correlates to the average American commute. My recommendation is good average podcast like this, 22 minutes. People can then subscribe on Stitcher Radio, soon to be an iHeartRadio, Google Play, et cetera. If people are listening and they want to go to do that.

Kevin: And we’re trying to expose the health care profession in general, but dentistry in particular, the power and the strength of promoting a message that’s interesting to the general public and to our peers. And I can tell you with 14 dental practices, 150 employees and practicing dentistry full time for the last 34 years, there’s very few things that I found that has created the reach and the power of podcasting.

And I have to give a plug and full disclosure. I could tell you until I met Mr. Foresta, I met Doug, he coached me, we talked about it, we came up with a strategy, it’s been a tremendous shot in the arm for my personal self-satisfaction and the business. And I have no one to thank, but you. And I say that publicly and I say it in private. How can people get in touch with you, Doug, if they need additional information or perhaps your expertise developing their podcast?

Doug: They can go to www.dougforesta.net and if they go there, they can actually get a free gift there. So they can go to, again, www.dougforesta.net. They can also email me at dougforesta@gmail.com.

Kevin: I don’t want to put you on the spot, but as we get ready to close today’s podcast, can you give the listeners a general cost? What kind of investment would someone have to make to start this podcast and get things rolling? Do you mind answering that question?

Doug: I can tell you that you can certainly learn this yourself, but it is something that you have to think about your time and whether it’s worth it for you. If you’re a dentist and your job is your business, do you want to stop what you’re doing to learn podcasting? In the beginning, I used to teach people podcasting, but it was really clear that people didn’t want to learn how to do the technical aspects of podcasting. They just wanted it done. So primarily, now that’s how I work with people, is we handle all the backend, me and my team handle the backend of things so you don’t have to take time out of your business to learn podcasting.

The other thing I would tell you is, first of all, I tell people not to look at it as an additive cost, but rather to think of it as how could I switch over some of my marketing dollars from things that I’m doing in more traditional marketing to podcasting which has a longer shelf life than a flier or a brochure. And I could also tell you that it really is very cost-effective when you think about comparing it to having a professional video done.

You could literally have a year of podcasting for what it would cost you maybe to produce one or two professional videos. So very cost-effective. And like I said, one of the things that I do is help you so that, if you really decide podcasting is right for you, you don’t have to waste your time, which is money, learning podcasting, learning the technical aspects of podcasting.

Kevin: Just one last point I’d like to make; what I’ve personally learned is the frequency of the podcasts are also important. And as I’m doing my own research and getting more familiar with the podcast system, someone who does a podcast once every other year isn’t as effective and yet some people do ten podcasts a day, that also may not be effective. In your expertise, what’s perhaps the best rate to promote a podcast, the number of times it should be done in a week, a month or year?

Doug: I often say that podcasting is like exercise. If you go to the gym once, you say I tried that, it didn’t work. Podcasting is not one of those things that you can do once or twice and then walk away from it. The most important thing is consistency. I have organizations that do podcasting once a month, but they do it consistently and they do well with it. I would recommend at least once a month, ideally twice a month. And what I tell people is try it twice a month, see if you like it, and then you could move to weekly if you think that it’s something that you really want to do.

But even if you do it once a month, you’ve just got to be consistent about releasing it at the same time every month. And when you do, you’re definitely going to see more results with two podcasts a month than one podcast a month. So consistency and don’t overwhelm yourself, but give it some time and allow yourself to see what the results are.

Kevin: Doug, I want to thank you so much for your expertise. I want to thank you personally for what you’ve done for me and my company, Ascent-Dental-Solutions. I hope our listeners have enjoyed tonight’s podcast and I look forward to talking to you in the future.

If you have any questions or comments about how you can be helped by Ascent-Dental-Solutions, don’t hesitate to reach out to me and my contacts. Thank you again, Doug, for a wonderful evening and I appreciate your expertise.

Doug: Thank you so much.