Speaker 1:
Welcome to the Double Your Production Podcast with The Team Training Institute, the one place designed for dentists and their staff who want to grow their practices by following in the footsteps of those that have done it, or in the trenches who know exactly what you're going through. Now your leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs.
Dr. John Meis:
Hey everybody, welcome to this episode of the Double Your Production Podcast. I'm Dr. John Meis here with my partner, Wendy Briggs. How you doing, Wendy?
Wendy Briggs:
I'm great. How are you Dr. John?
Dr. John Meis:
I'm fantastic, I'm fantastic. So, we've got a great topic today. One that there's so much stuff going on in that I think is a ... it's a really great and timely topic, and that is emerging technologies in dentistry. So, we've got some things that we've seen. So we've seen technologies come and go. Something sounded really good, big investments.
I remember the first digital cameras, they came on a cart, they were gigantic, they were super expensive, they didn't work very well. They were clunky, they were really awful. Over time, it got better and now it's an absolute must-have, but there's been others that have come and gone. So, love to start with technology and talk about decision-making around technology and some of the things that we think are emerging and going to be really valuable.
Wendy Briggs:
Yeah, and I think it's such a timely topic, right? I've seen a couple posts over the last two weeks on social media. One was from an X-ray company and their message was, "Despite what you might hear, film is not dead. Film is alive and well," right? So, trying to desperately clinging on to an outdated way of practicing, really.
Another one that I saw was a hygienist that was subbing for a dentist who was older and nearing the end of his career, and therefore didn't want to invest in technology. So the processor was down, there were no digital films or digital technology in the office, and she was having to hand dip her X-rays, something that we did 30, 40 years ago, right? This is in 2022, almost 2023, this is what's happening in some dental practices.
Dr. John, I had an interesting situation over the last few weeks. My husband just bought a new car, and little known fact about me, I literally hate everything about buying a car. I hate the dance, I hate the negotiation, I hate it, I hate all of it. I'm like, "Just give me the price, I'll get the car and let's go," right? So, I make Travis do all of that.
To be honest, it wasn't that difficult for him to talk me into it this time, because the previous vehicle we'd had had problems from day one. There's a lesson here, right? The reason this vehicle had problems was because the battery couldn't handle the amount of technology that was in the car. So we'd park it at the airport, we'd be gone for a few days and we'd come back and the battery was dead, even brand new batteries. So from the very beginning, this car has been a huge headache, so Travis says, "Okay, you know what?-
Dr. John Meis:
[inaudible 00:03:27] cars, but I could be wrong.
Wendy Briggs:
Yes, yes, yes. So there's a lesson there, and that is of course sometimes the technology outpaces the viability of the products they're producing. We've seen that in dentistry, right? We always say the first edition, probably not the best time to invest in whatever it is. So we've seen that, there's a lesson there. So, this time he didn't have to work real hard to convince me to go look at a new car.
However, that didn't change the fact that when actually drove the new car, I was blown away at how much technology has advanced in the past few years. I mean, this vehicle is really remarkable, and it kind of made me stop and think, okay, how many practices are missing out on pieces of technology that they don't even know exist? That they don't know this vehicle has night vision?
So, I'm pulling out of my street last night and in the field across from my home there's a whole herd of deer, and the car alerted me that there's deer in this field with night vision. I'm like, "This is crazy," right?
Dr. John Meis:
Yeah.
Wendy Briggs:
So how many pieces of technology, how many practices are missing the night vision because they don't even know it's possible, right?
Dr. John Meis:
Yeah.
Wendy Briggs:
We see that a lot in dentistry.
Dr. John Meis:
Yeah. So it's absolutely so true, and I've been in tons of practices, and dip tanks, you would think that that would not exist, but it does. Processors, how do you get parts for a processor? I can't imagine anybody's making them, because there's not enough of them in use. So in our profession, the technology gap is very wide from the most technologically advanced to the least. Also, common in our profession is a technology garage somewhere where all the technology goes to die. That never made it into an efficient workflow, and so that's one of the things that we certainly are going to want to talk to.
So, maybe we can start with the three hats on decision-making when it comes to technology. In the book Cracking The Code, it goes into detail on the three hats, and we as dentists are making decisions and dental teams are making decisions using one of three hats.
One is the clinician. So, the clinician also often wants somewhat bright shiny object, "Oh, this looks cool, let's go invest in this." There's a manager hat. The manager hat is really, okay, how do we make this work in a business sense? Then there's an investor hat, and that is, all right, if I'm going to put money into this technology, what is going to be my return? How do I get a return from this investment?
Wendy, what you and I will joke about and have frequently observed is that people will make an investor decision with their clinician hat on, right?
Wendy Briggs:
Right.
Dr. John Meis:
So making sure that when you're making a decision, that you might use all three hats, but when it comes down to writing the check for an investment, that you at least have your investor hat on for a little bit, so that you can make sure that when you do make the investment, that it's going to have a return. We can define return, and maybe that would be a good topic as well, is what are the different returns that we can have?
Wendy Briggs:
Right. We've seen this time and time again where we'll hear from doctors who are struggling to pay the bills in the first place, that they're looking at a new cone beam or something like that. I'm like, "Whoa, hang on, hang on. Let's get the ship in order first." Because sometimes adding that expensive piece of technology can take the whole ship down, and so we do have to balance those three.
Sadly, there's so many practices out there that don't understand that and don't have fail safes or systems in place to protect them from that bright shiny object syndrome, or from that super aggressive sales person or the special deal at the conference, or whatever it may be that makes it sound so attractive, right?
Dr. John Meis:
Yep. No, that's exactly right. I think when we look at technology, a pretty simple filter to use is, whatever technology that you're looking at, is it going to make your practice in some way better? Is it going to make the work go faster? Is it going to make the work easier? Or is it going to reduce some cost, so some factor of making the expenses lower?
So those are the four things, better, faster, easier, cheaper that I use and I think is a pretty simple way of looking at it. You mentioned a cone beam, so let's apply that filter to a cone beam. Okay, does it make the treatment and the patient experience better?
Wendy Briggs:
I would say absolutely it does.
Dr. John Meis:
I would argue that, yep.
Wendy Briggs:
I've seen same tooth, same day, PA versus the cone beam image. It's radically different and tells a completely different story, right?
Dr. John Meis:
Yeah.
Wendy Briggs:
I'm sure you've seen many of those cases as well.
Dr. John Meis:
Absolutely. With the cone beam, find that the tooth is un-restorable, vertical root fracture, whatever, but you can't tell on the PA, and so you could then invest in trying to repair a tooth that's unrepairable. Then of course that injures the trust between a patient when you have to go back and say, "Oh gosh, this isn't going to fix it. We're going to have to go to plan B."
Wendy Briggs:
Yeah. I think from the patient experience as well too, Dr. John. Being able to see their own skull in 3D, that's a huge wow factor for people, and the comments they make prove that, right? So if you have any doubt whether or not it's impactful to the patient experience, just listen to what patients are saying when they initially see that image, it's really shocking to them, right? Just like my new car, there's technology that they didn't know exist, and now that they've seen it, they're super impressed and wowed by it.
Dr. John Meis:
Yeah, for sure. Faster, I would argue probably not faster.
Wendy Briggs:
Right. Not initially for sure.
Dr. John Meis:
Yep. Easier, I would argue definitely that. Being able to visualize the canal morphology when you're doing root canals, to be able to identify bone, to be able to make a implant surgical guide so that your placement is faster. So it does help faster there, doesn't it? Because implant placement is much faster if you have a guide and much safer and much better. So easier, yeah, I think it definitely qualifies for that. How about cheaper?
Wendy Briggs:
Well, I guess it depends on what you're looking at, right? The cost of a failed procedure, as you mentioned, with damage of trust and I guess maybe reputation of the community, right? There's all those things that you can factor into as a lost opportunity cost, but certainly it does require a much more significant investment than a new processor, for example, right?
Dr. John Meis:
Right.
Wendy Briggs:
I mean, it's considerably more costly.
Dr. John Meis:
Yeah. Yeah, and I would say the fact that we have ... when I was first starting to do implant surgery, cone beams were just coming on the market and they were twice or three times as expensive as they are now. So over time the technology has reduced in cost, as technology always does. You and I have talked about the three generations, that the third generation has kind of the point in time where the usability is good and the cost has come down.
With some of the cloud technologies that are coming into their own now, I think they're on generation three already because of the bedding and the betas and how easy it is to do that with computer technology. Yeah, so you could argue the cheaper either way. So when it comes to cone beam, when we look at the most sophisticated practices, when we look at the doctors that have the biggest tool belts, which is the thing that drives productivity per hour.
If we're living in a PPO environment, our efficiency, our productivity per hour is very, very important, because if we're taking discounted fees, we have to make up for that in some way, and efficiency is probably the most significant way to do that. So the cone beam kind of checks off not everything on the list, nor does any technology or any investment at all need to check off all four, but it checks off three of the four, and so for us, it's a winner.
Wendy Briggs:
Yeah, I would agree with that, Dr. John. I would also agree with, oftentimes I've heard you share with doctors about how to calculate when it's time, right? If we are buying a cone beam because we want to do more implants, that's probably not the best way to think about it, right? We really should ramp up our implants to justify the investment of the cone beam.
Dr. John Meis:
Yeah.
Wendy Briggs:
I remember the days when we would send patients off for radiology, right? There was a central clinic, and certainly that was more cost-effective for many dentists, but it wasn't the best thing for patient experience. So certainly we love the fact that if it makes sense having the cone beam in-house, being able to use it on more of our patients, that makes really good sense. But if you've done 10 implants period in your career, you probably should rethink the strategy. I think sometimes we fall victim to thinking, if I had the cone beam, I would do more implants, right?
Dr. John Meis:
Yeah, right. The cone beam's not going to drive more implants. It won't drive more implants in total. It may drive more implants in your office, because you may feel more comfortable taking on clinical situations that are a little more complex when you have the confidence with the cone beam and with planning technology and a surgical guide. You have all of that put in place, you may do some more. But I think you're absolutely right. The skill has to be there, the desire has to be there, the diagnostics have to be there, right?
Wendy Briggs:
Right.
Dr. John Meis:
Does your entire team believe in implants and believe in the benefit of that? So that work all has to be done first, and that may be the harder work. It's often easy to write a check and all this other work on execution is much tougher. So if you have much of that in place first, it makes the investment a lot safer, right?
Wendy Briggs:
Yeah, I would agree.
Dr. John Meis:
[inaudible 00:14:18].
Wendy Briggs:
I would agree, absolutely. I would say there needs to be some thought and effort put into building a system for implementation before the equipment arrives, right? Because too often we see the team notice this new piece of equipment's arrived and they're a little bit panicked, they didn't even know it was coming, and they don't know what their role is in that. So, that we also see helps drive a higher level of confidence and actual utilization of whatever the technology is.
Dr. John Meis:
Yeah, for sure. For sure. All right, so we talked about cone beam. There's another one that I just spent the better part of a day playing with it in our own offices, and that is the use of artificial intelligence in diagnostics and radiology interpretation. So, the product that I just spent a bunch of time with is Overjet. So Wendy, do you want to explain what that technology does?
Wendy Briggs:
Yeah, for a long, long time, we've talked about a concept that we label diagnostic assertiveness, right? You say if we have one patient examined by 10 doctors, they're all going to come up with typically a different treatment plan. There's range. One is going to have the most treatment, one's going to have the least amount of treatment, and there'll be a whole bunch of things scattered in between.
Well, what I think is most exciting about artificial intelligence is that now we actually have technology or a tool that can help us level set that diagnostic assertiveness amongst multiple providers under the same roof. In small group practices, we can establish a standard of care far more easily. This was really one of the major advantages of using Caries Detection technology when that first came out.
Dr. John Meis:
Yeah.
Wendy Briggs:
The DIAGNOdent or the CariVu and some of these things that could really help us provide proof that there's a problem to the patient. That's what I think artificial intelligence on the radiographs does at an even higher level, at a level that finally provides value to the clinician.
Dr. John Meis:
Yeah.
Wendy Briggs:
The previous technology provided value to the patient, as does artificial intelligence in this way, but it can also provide a high-level of value to the clinician. What I love about it obviously being hygiene-focused is the capability that we have to show the patient, show other providers there is perio in your practice that you're not actually treating, right?
Dr. John Meis:
Yeah.
Wendy Briggs:
For me, I think that's a game changer for many practices, because we've never had the capability of doing that before.
Dr. John Meis:
Yeah. Yeah, I think that you could position it as a second look, or you could position it as a first look that gives you a more focused view on how to look at diagnostics. So with Overjet, what it does is it reads X-rays and looks at M documentation and it looks for missing documentation. For instance, do we have the appropriate films in the past? Do we have periodontal charting readings? So, it looks to see that if you have the documentation and if you've done the diagnostics.
Second is it looks at X-rays and points out areas that are showing signs of disease. So it will show at places where there is bone loss, it'll show places where there's calc spurs, and it highlights them in color so you can see them very, very easily. Most importantly, the patient can see them very, very easily.
Wendy Briggs:
Yeah. Yeah, for years, we've actually advised against showing patients X-rays in most circumstances, because we feel that it can add to the level of confusion a patient experiences. It takes us a long time to be able to see what we can see in X-rays. So assuming that the patient can see what we see, even if we carefully point it out, sometimes they nod their head and go along with you, because they don't want to feel stupid or silly, but they really can't see it.
There's a scene in Friends when one of the characters is pregnant and this ultrasound tech has just shown her the baby in the ultrasound, and the ultrasound tech leaves the room and she's like, "I can't see the baby. I don't see anything, I can't see the baby." I feel like in some ways that's us when we're showing the patients X-rays. We assume that they can see it and they really can't see it, right?
Dr. John Meis:
Yeah.
Wendy Briggs:
So I think in many instances this is a tool that because it's in color, the patient can follow along far more readily, and I view it as almost an instant second opinion.
Dr. John Meis:
Yeah, yep. So we actually had a representative of Overjet come to the last CEO mastermind group, which is a group that we run that helps practices go from single location, sometimes single doctor to multiple doctor, multiple location, even to the point of outside investors and things like that. So, this helps people go through that process and it's really being handheld as they go through that process.
So they came and showed it to us, and I think every single person bought it. So we had the next CEO meeting last weekend, and so about half of them had it in their office and implemented. It was absolutely fascinating to hear the discussion about it, because it was pointing out just what you talked about, Wendy, in that diagnostic assertiveness. So some of them were saying, "I'm seeing things it didn't see." Most of them were saying, "Oh, it saw things I didn't see, and then when I looked further, it was like, oh yeah, I could tell."
So one of our fantastic members, and really we think of him as a part of our team, that's Dr. Nate Lester, always the first to implement. His execution is absolutely incredible. So he was describing how he uses it, where he'll have the X-rays up and he'll say, "Well, this can see better than I can see because of the technology."
He clicks the button in front of the patient and all the color comes up. He said it's just so fantastic. It's such a wow factor for the patients, and it makes it visual for them, which is one of our keys that we've taught in our case acceptance courses for a long time, that if you can make it visual, the patient can understand it better. So, it is really fantastic technology.
So I spent the better part of a day working with it in our offices, and we're still working on getting the workflow to where it's having the maximum impact. It's taken us a little while to dial that in, but it's having a really nice effect.
Wendy Briggs:
Yeah. Well, I love it. Like I said, it's exciting to see technology. I think dentistry's come so far in technology in a variety of ways, certainly since I began. I'm not going to say you've been in the trenches longer than me, but for those that have, probably seen even more gains and improvements since that time, right? So this is one area that I think is really exciting, and I can only imagine how it's going to continue to improve as the technology continues to improve.
Dr. John Meis:
Yeah, yeah. So when I look at these artificial intelligence diagnostic tools and put it back through our filter, is it better? Oh, it's definitely better. When you have multiple doctors, it helps you to level set so that people are diagnosing in a similar way, which helps the team support the diagnosis with our team case acceptance process. So, is it better? Absolutely better.
Is it faster? It's really fast. I mean, speed is not an issue with this. So, the speed here is getting patients to the point of understanding what's going on in their mouth so they can make a decision about how they want to move forward, right? So, it makes it really clear for the patient. So, we definitely pick up speed.
Is it easier? Yeah, it is fast, easy. I think when you have it and you see it and then you're doing your diagnosis, that it burns less mental energy, right? Already it's in your brain that your brain didn't have to compute it, and so I think it's easier and cheaper. There is an investment in it, but when you relate the cost of the technology compared to the increase in case acceptance, it is definitely worth it.
The time that it saves. We sometimes spend a lot of time on things and not realize how much that adds up. Wendy, you do a great job of one more procedure per day and what the value is for that over the course of a year. So every minute we can save, if we save an extra five or 10 minutes a day, and that can equate to another procedure, the way it adds up is incredible.
Wendy Briggs:
Right. I think that really is the perfect segue into our last piece of technology. We wanted to talk about three key pieces of technology here today, so the last one I would talk about is one that that's probably the most pushback we get from providers is how long it takes initially to use and implement, and that is digital scans.
Dr. John Meis:
Yeah.
Wendy Briggs:
Again, I think you and I, we've worked on this quite a bit. We have one of the largest group practices in the country come to us, and this is one of the key initiatives that they were trying to implement, right? So we held a series of events all across the country with this group, and we're helping them help the providers see the value in digital scans, and the results have been really quite remarkable.
I would say initially using an iTero or some type of equivalent scanner can seem intimidating, but again, the wow factor for the patient is really incredible. The fact that we don't have to have putty or goop in the patient's mouth to take an impression anymore is a tremendous win for everyone involved.
Dr. John Meis:
It's a better patient experience-
Wendy Briggs:
Yeah, yeah.
Dr. John Meis:
For sure.
Wendy Briggs:
We can see so much more, right? We can see so much more from that. It's really the depth of impact. What it can actually do is far better than our intraoral cameras or any of those other technologies that we've had in the past. So once we see a practice embrace and utilize this technology, at first it takes a little bit of time. It can take six to eight minutes for a scan, but we've seen hygienists get it down to below two minutes.
Once you get there, again, the impact that it has on the patient experience is really remarkable, patients are blown away by it. All of the advantages that we have now with the latest scanners, you can zero in and do an intraoral camera view on the whole arch, you can do an intraoral camera view on just one tooth. You can highlight it, you can turn it different colors and different shades. You can take that image and view it as if it's a stone model.
All of these are really incredible wow factors for the patient, but it gives us as their clinicians so much more valuable solid information to utilize to improve all of our service offerings, right? So again, initially it's challenging, but once we learn how to do it well, our speed picks up tremendously.
Dr. John Meis:
The ability to compare scans over a period of time, so now we can see tooth wear, we can see gingival recession, we can see things that were really hard to ... is that much different than the last time? I'm not sure. This is a way that increases the certainty and confidence of the clinician, allows a way, again, for you to demonstrate things to the patients. Seeing is believing. When patients see what you see and when you explain it to them, it makes a big difference on how they think about accepting care.
Wendy Briggs:
Right.
Dr. John Meis:
So, those are three really great technologies. Some of them not particularly new, because cone beam's been around for what, 30, 40 years, probably. But now we're multiple generations, the ease of use, the interconnectedness between the technologies is way better, cost has come way down. So these are three things that we think are winners, and I hope that the three hats and the four filters is helpful as well for everybody.
Wendy Briggs:
I would think so, Dr. John. As we were sitting and trying to decide, I think we need to do a part two to this podcast and come up with three more, because there are more that we discussed. These are certainly not ranked in order of importance or efficacy or any of that, these are just three things that we believe are having a tremendous impact in the practices who have embraced them and are utilizing them to the fullest.
Dr. John Meis:
Yeah, yeah, yeah. Awesome. Well, thanks everybody for being on this episode of the Double Your Production Podcast. Thanks, Wendy, for your great insights as always.
Wendy Briggs:
Absolutely. One last note, Dr. John. For those that are listening fairly quickly to this, I believe we have a webinar coming up soon where we will be talking about a year-end strategy, right? So if you are coming to the end of your 2022 and you want to take a look at what you can do differently or do better on 2023, we have a webinar coming up. So, we will put that information in the show notes so that those who would like to join us for that can get access. It should be amazing. I believe it's going to be happening on, did I get it right? Is it December 29th?
Dr. John Meis:
I believe that's right.
Wendy Briggs:
Okay, yay, I got that right. So December 29th, we hope you can join us for those that are listening to this podcast here fairly soon. We'll have a great session, strategic planning for 2023.
Dr. John Meis:
All right, thanks everybody for being with us today. We'll see you on the next episode of the Double Your Production Podcast. Bye-bye.
Wendy Briggs:
Bye-bye now.
