Brews and Tiny Teeth, The Unfiltered Pediatric Dentistry Podcast (Casey Goetz)

We are continuing with part 2 of our special on soul-crushing student loans and how to deal with them! Unlike our last episode, the two guests today are pediatric dentists who provide the sole source of income for their families.

Dr. Scott Folkman is a pediatric dentist in Layton, Utah. He started his own practice from scratch right out of residency, and has paid off 450K of student loans in 7 years. Dr. Folkman has utilized multiple rounds of refinancing to drop his interest rates. He is a great example of a pediatric dentist who has been successful with his student loans as the sole income provider for his household, while his wife runs the house with his 5 children. 

Dr. Kevin Brown is a pediatric dentist in Lehi, Utah. He paid off $285K over 4 years while simultaneously starting a scratch practice. He was able to aggressively pay down debt by associating one week per month at a profitable associateship out-of-state, all while taking advantage of the current federal student loan interest freeze to pay down $8000 per month towards principal. 

Sometimes it’s nice to have a podcast without a lot of structure where you can just ramble on unfiltered with your old coresidents. In this episode, myself and three close friends and pediatric dentistry coresidents drink a few beers, talk shop, and share crazy stories from residency. Dr Bryce Evans is the owner of Penguin Pediatric Dentistry in Iowa, Dr Kirsty Gratz is the owner of Good to Grow Dental Center in Indiana, and Dr Nate Green practices as an associate in Denver Colorado.

I love interviewing a good power couple where we can have a drink and talk about teeth! Today we are joined by Dr. Beth Pfohl, a pediatric dentist, and her husband Dr. Chad Pfohl, an oral surgeon. The Pfohls are University of Iowa grads and at AAPD 2022 in San Diego, we had a few drinks at the welcome reception and I decided I needed to have them on the podcast.  Dr. Beth is unique in that she went back to dental school later in life with two kids at home, and continued for the additional two years to complete her pediatric residency. Dr. Chad is a partner at a large group practice and he shares some of his wisdom on how to find good team members and associates to bring into the practice. They come on the podcast to talk about life in the working world, as well as how to find work-life balance between running a full patient load at the office and raising good kids at home. 

As pediatric dentists, we naturally love working with kids and tend to a be a very family-oriented profession. My wife announced that we will be having our first little baby girl in May, so I thought it would make for great conversation to discuss in the upcoming podcasts how having kids influenced or changed the way that pediatric dentists practice dentistry. 

Dr. Richard Baxter is a previous guest on the podcast. He is a young pediatric dentist leading the charge to educate and bring awareness to the tethered-oral-tissue movement. He is the author of the best-selling book Tongue Tied, founder of the Alabama Tongue-Tie Center, and prominent speaker. He has performed over 10,000 lip and tongue ties in his career.

On today's episode, we talk about when it makes sense to scale your practice and expand to create a stand-alone tongue and lip-tie clinic. Richard reviews the business side of the discussion, what the physical space should like look, and when you have sufficient patient-demand to make it feasible. We also spend a little time talking about local anesthesia with a Light Scalpel, and how to release the infamous posterior tongue-tie.

You can find Dr. Baxter's book "Tongue Tied" on Amazon. He also created and teaches the virtual Tongue-Tied Academy Program, and he's giving Brews and Tiny Teeth listeners a $400 discount with a promo code he announces at the end of the podcast.

Recorded live from Bourbon and Baby Teeth in Louisville, Kentucky! Dr. Richard Baxter is a prominent figure leading the pediatric dentistry community in the field of tongue and lip ties (or as he likes to refer to them "oral restrictions"). We sit down for an early morning chat over coffee after the previous long night of partaking in the black tie and bourbon formal evening event. Needless to say, some bourbon was drank and we were still shaking it off the next morning. 

We discuss how Dr. Baxter became so passionate about TOTs, different modalities to perform releases, performing releases on wiggly toddlers or during nitrous oxide sedation, and what current updates are in the literature for supporting these procedures. Dr. Baxter truly is a wealth of information on the topic, and you can tell how passionate he is about it when we speak.

Dr. Baxter's Tongue-Tied Academy Course: https://www.tonguetiedacademy.com/courses/TTA

Link to Dr. Baxter's Tongue-Tied Book on Amazon: https://www.amazon.com/Tongue-Tied-String-Impacts-Nursing-Feeding/dp/1732508208

Conservative treatment, SDF, Hall crowns, parents back during ops... dentistry is rapidly changing to keep pace with the desires of the modern parent. But maybe those who forget history are doomed to repeat it? Dr. Brian Richards is a private practice pediatric dentist who joins us to discuss how he makes his practice successful using old-school techniques that work for him. Brian has posted several of these examples online showing traditional operative work being completed on 2, 3, and 4 year-olds using rubber dam isolation, behavior management, and no laughing gas or sedation.

We discuss parents back during ops, dismissing difficult families, voice control, building an efficient team, and how often sedation is really necessary. We also reflect on the changing of the times with more conservative treatment (SDF, Hall Crowns, ART), and are we using these techniques appropriately? 

Steve Anderson is the owner and founder of Denco Dental Construction. He has helped design and build over 1000 dental offices throughout his 30 year career. He is also the author of the book DentalEase, The Essential Guide to Building the Stress Free and Profitable Dental Practice of Your Dreams. 

Steve discusses his career in the dental construction industry, changes and trends he has seen in the marketplace, and common problems pediatric dentists make when building out their office. We talk about office size, controlling sound, having room for expansion to increase capacity, and designing your office to allow your staff to help operate the practice as efficiently as possible. 

More information about Steve, his company, and his book can be found at https://dencodental.com/

With oral boards coming up next week, I thought it would be a good idea for an episode to go through my notes and pull out 50 random fun facts that could potentially be helpful on the exam. Some of them may be relevant, and some may not. I also included some tips and things to keep in mind during the actual exam itself that could be good to know to help us better prepare.

Good luck to my colleagues taking the test, and here's to having a cold adult beverage next week when everything is over. Happy studying!

Dr. Colin Boswell is a pediatric dentist practicing out of New Hampshire. He has a unique experience as a practice owner and shares some insight on his journey. Dr. Boswell bought an established practice, and ended up later partnering and merging with a former co-resident who had started a nearby scratch-start pedo office. The combination was highly successful and the two offices have grown synergistically. 

Dr. Boswell discusses his journey and talks about the importance of finding the right partner to go into business with. We also review the benefits of partnerships in pediatric dentistry, and why it may be a better choice for some clinicians over a corporate or sole-practitioner route. 

Dr. Benjamin Morgan joins us on the podcast today. He's a pediatric dentist and the owner of Rockwall Pediatric Dentistry in the greater Dallas, Texas area.

Ben comes on to talk about a variety of topics, including his journey to practice ownership, why he dropped Texas Medicaid, creative ways that he increases his revenue, how he structures a 2-doctor practice, and what life is like being a pediatric dentist in a crowded Dallas market. We also discuss his decision NOT to build a 15,000 sq ft facility after buying the land and designing the space.

A couple weeks ago we interviewed a pediatric dentist who had established a busy, successful practice in a small town of 7,000 people. In this episode, we decided to switch things up and talk to a pediatric dentist practicing in New York City, a city with 8 million people! 

Dr. Arielle Faden is a pediatric dentist who associates at multiple practices throughout New York and New Jersey. We discuss what life is like practicing in a competitive urban environment, specifically Manhattan. We talk about patient demographics, general anesthesia, non-competes, associateships, posterior zirconia crowns with esthetically concerned parents, and just how to be successful in general in the big city. This is a great episode for residents looking to practice in a big city or urban environment. 

We have a very special guest for today's episode. Dr. Mike Kanellis has been practicing pediatric dentistry for over 40 years. Following his pediatric training at the University of Iowa, Dr. Kanellis started and operated a private practice in Muscatine, Iowa for 13 years. He then sold his office and made the transition into the world of academics and now acts as the associate dean for patient care at the University of Iowa College of Dentistry. He continues to actively see pediatric patients at the dental school.

Dr. Kanellis shares a wealth of knowledge about his experience in pediatric dentistry. We talk about what it was like seeing 30-40 patients per day out of his original 400 sq/ft office. Dr. Kanellis has always been interested in outside-the-box thinking to manage decay, and he discusses his use of Hall crowns 30 years before it was an established technique. We take a deep dive into treating Medicaid patients, and why everybody needs to do their part to help address this population.

Dr. Kanellis also treats a substantial Amish population, and we have a long conversation about the challenges that exist with this community. Finally, we reflect on the direction that pediatric dentistry is headed in the world of DSOs, student loans, and private practice. Dr. Kanellis also shares his new book, Novocaine, a dark comedy involving a dentist, dental assistant, and the mob.

Link to Novocaine:  https://www.amazon.com/Novocaine-Michael-Kanellis-ebook/dp/B099DXX2XF/ref=sr_1_2?dchild=1&keywords=novocaine+book&qid=1627429645&sr=8-2

Dr. Jay Leung is a pediatric dentist and owner at The Little Tooth Company Pediatric Dentistry. He practices and runs two offices with associates in Connecticut.

Dr. Jay comes on the show to share his experience of being audited by Medicaid. After receiving a daunting letter in the mail and being threatened with some hefty penalties, Dr. Jay was able to use legal help and great documentation to defend and protect himself. He gives listeners some pointers and advice in the event an audit ever happens to them.

Dr. Cyrus Safizadeh is a pediatric dentist who opened a practice with his wife, a general dentist, shortly before COVID. They grew this practice together throughout the pandemic challenges to come out thriving on the other side.

Dr. Cyrus talks about the benefits of working closely with a general dentist and utilizing the skillsets and technology that his wife brings to the practice. He shares how they have balanced Medicaid patients to keep a healthy new patient flow on both the pediatric and adult side. He is kind of enough to open up and talk freely about his practice numbers and how he plans for growth. 

We also discuss how they made a 150k investment in a CAD-CAM unit, and Dr. Cyrus has ended up using it extensively in pediatric dentistry. After being exposed to so much general dentistry, he also talks about why he no longer starts sweating at the site of extensive permanent tooth decay and treatment plans. 

Dr. LaRee Johnson is an accomplished pediatric dentist, speaker, and private practice owner from Raleigh, North Carolina. She is very active on the ABPD, and keeps a busy schedule with professional lectures, speaking events, and running ultra marathons. Dr. Johnson joins us on the podcast to tell us a bit about her busy private practice, along with answering some listener Q&A's. Some of the topics we discuss: - Should parents be allowed back during procedures? - Tips on talking to the parent when he/she is surrounded by their own crying kids - How do you handle parents that expect treatment be done the same day as the consultation - What do you say to a parent who denies x-rays? - How do you handle GA/sedations where you find more work then originally anticipated on the treatment plan?  

Our final episode from Bourbon and Baby Teeth 2021!

Our last guest from BABT 2021 is Scott Childress of Magnify Dental Marketing. Magnify is a full-service digital marketing agency for dentists. Their services include startup branding and logo design, website re-builds, SEO, social media content development, and reputation management.

Scott and I discuss how young, tech-savvy pediatric dentists can harness the power of the digital age to increase brand awareness and new patient flow. We talk about targeting the correct demographics, the power and affordability of Facebook marketing, creating organic content, how Google reviews (and Google business account) influence SEO, and hacks that dentists can use to easily improve SEO and ranking without breaking the bank.

Link to learn more about Magnify Digital Marketing: https://askmagnify.com/

This is our first episode of the Pedo Pearls Power Hour! A chance to throw a beer back and talk about pediatric dentistry just like the good ol' days of residency. We break down listener questions, clinical pearls, and even share a few humble flexes of successes we have in our profession.

Dr. Nate Green and Dr. Casey Goetz read three different listener questions/comments regarding the following topics:

1: Pediatric dentist associateships

2: Business plans to secure practice loans

3: When can you consider a permanent crown on a hypoplastic molar

If you have any questions, comments, or humble brags to share on the next Pedo Pearls Power Hour, send us an email to cgoetz@troypediatricdentist.com.

Dr. Kris Hendricks is a pediatric dentist and practice owner from New Mexico. I came across his viral TikTok video showing models of how different styles of pacifiers affect occlusion in kids.

Kris talks about how he was essentially gifted an orthodontic practice in New Mexico. He shares his take on social media, going viral, and what he currently recommends to parents asking about pacifiers. We break down what the research says for pacifier recommendations, and if "orthodontic" pacifiers are all they are cracked up to be.

Dr. Elizabeth (Liz) Wilkinson is a coresident and close friend of mine who I finally convinced to hop on a podcast episode with me. She practices as an associate in Kansas, where she lives with her husband and two young children. Her husband, Paul, is an orthodontist at a busy ortho practice.

Dr. Liz and I catch up for a bit before she shares her practice journey about how she found the right fit as an associate. We talk about treatment planning, hall crowns, glass ionomer, class IIs, the challenges of being a new parent and running a dental practice... all sorts of good stuff. ***Shoutout to all young moms who own a busy pediatric practice, you are all superwomen.***

We also spend a lot of time discussing the value of establishing early care with patients, and how it makes sense from an oral health, patient behavior, and also a profitability standpoint.

Sedations are a huge part of what we do as pediatric dentists. In the era of alternative techniques to manage caries, it's important to keep our sedation skill set sharp to provide the highest level of care possible. Dr. David Bailey joins us to break down how he makes it work in his busy Wyoming office. Dr. Bailey has a wealth of sedation experience that he shares with us, with a hats-off to the great Stephen Wilson and his effective triple-cocktail method. We debate open vs closed airways, in-office vs surgery centers, effective oral sedation strategies, and how to have highly profitable days using oral sedations. 

*** Don't forget to submit any questions, comments, or interesting clinical cases you may have for our monthly Pedo Pearls Power Hour. Emails can be sent to Casey Goetz at cgoetz@troypediatricdentist.com

Ok the title might be a bit click-baitey, but today we are talking all things IV sedation. Dr. Casey Rhoads is a pediatric dentist and owner of Honey Bee Pediatric Dental Co. with two practices in the Kansas City area. Her and her fellow practice partner, Dr. Rebecca Ferns, do 6-7 days of in-office IV sedation cases (open airway) per month. She shares her practice journey with us and how they have structured sedations in their busy new practice. We talk about what verbiage to use, treatment plan presentation, and things to say/not say when trying educate nervous parents who might be hesitant about sedating their child for dental care.

This is a short, live episode with Dr. Arik Amin. Dr. Arik graduated from dental school in 2020 and has spent the application year working in public health. He matched and will be an incoming resident at the NYU pediatric dentistry program in Columbia, Missouri. Dr. Amin came to the office today to shadow and watch a little live-action. We went to lunch and logged a quick podcast talking about what new updates are happening in the world of applying to pediatric dentistry residencies. The audio is a little rough, just because we recorded in a BBQ joint, but it was a still a great, short conversation on topics that are often overlooked during the application process.

Dr. David Stanley is a pediatric dentist and partner at Wild About Smiles Pediatric Dentistry and Orthodontics in Murfreesboro, Tennessee. He joins us on the podcast to discuss his career, and how things have changed since being diagnosed and treated for prostate cancer. We talk about trying to find balance between working hard to build a practice and pay off loans, while at the same time finding enjoyment in life, spending time with family, and learning how to sleep well at night after a hard day at the office. We also talk about how beneficial talking to a therapist or counselor can be to keep your mental well-being in check.

Dr. Stanley and I also have a brief discussion about how his office was recently embezzled from by a trusted employee, so he reflects on things he could have done differently and gives advice to young practice owners on preventing this from happening to them. 

Dr. Bobby is a pediatric dentist, speaker, and authority on oral sedations. After 8 years as a pediatric dentist in the air force, he transitioned to an academic roll at Ohio State and now Cincinnati Children's Hospital. He frequently lectures for the AAPD at their sedation courses.

Dr. Bobby cracks a beer with me and we talk about some great topics, including life in academics, changing parent expectations that make our job difficult, and how he uses oral conscious sedation to manage those kids that fall in between the spectrum of full mouth rehab and minimally invasive dentistry.

The infamous Dr. Evan Hershkowitz joins us today for a Pedo Pearls Power Hour session. Some of you may know Evan as the guy who screams profanities about first primary molars on iPedo, or maybe as the guy who tells parents to get the f* out of my office (ok he actually doesn't say that, but we all wish we could to those helicopter moms). 

Dr. Evan and I break down listener questions today, including:

- How many ops is ideal for a solo pediatric dentist?

- What do pedo full mouth extractions end up looking like years later?

- When does it make sense to bring an orthodontist into your practice?

Evan also shares some info for the upcoming Bourbon and Baby Teeth CE course, held this September in Louisville, Kentucky. What started as an excuse to drink whiskey has turned into a fantastic pediatric dentistry conference with some amazing speakers. You can find more info at https://bourbonandbabyteeth.com/

Dr. Bryce Evans joins us to discuss parent communication strategies to build trust and strengthen relationships. We touch on Covid issues, presenting treatment plans, cell phones in the office, allowing parents back during treatment, social media, and how parent demands in pediatric dentistry have evolved to the present.

Dr. Matt Griffith is a pediatric dentist on the big island in Kona, Hawaii. Dr. Matt is the first and only pediatric dentist I have ever interviewed from Hawaii!

Dr. Matt talks about his crazy backstory of opening his own practice in Kona. His style is one of providing a high level of patient care, and not being forced to see more kids a day than he's comfortable with. We talk about what the culture is like with his patient population, and some of the challenges of being a pediatric dentist in a rural spot in the middle of the Pacific.

In this solo episode, I wanted to review a scoring system I created that allows pediatric dentists to reflect and compare their own attributes. Some pediatric dentists are great at running a business, some are excellent clinicians, some have great behavior management with the kids, and some are extremely efficient with their time.  But often times as dentists we fail in other categories where we should be trying to improve. For example, just because somebody can see 80 patients a day and produces 2 million dollars a year doesn’t mean that they are truly improving oral hygiene in their community, that they are actually doing good dentistry, or that they have a staff that is proud to work with them.  The scoring system includes the 10 categories relevant to a good pediatric dentist, with a 1-10 score for each (100 total possible points). The idea is to go through and reflect on these categories with minimal bias to determine how good of a pediatric dentist you are. The 10 scoring categories of a good pediatric dentist are broken down in this podcast and include: Clinical skills and outcomes

Behavior management

Impact on community oral health

Parent perceptions

Involvement in organized dentistry

Office staff scores

Doctor mental health

Office technology and improvements

Office production

Office overhead

Two oral surgeons join us for this week's episode. Dr. Chip Abraham is a fourth-year OMS resident at Indiana University, and Dr. Doug Orzel is a private practice OMS and practice owner in Grand Rapids, Michigan. These two oral surgery studs come on the podcast to talk all things oral surgery involving pediatric dentistry. We go through different tough clinical situations, as well as review a few listener Q & A's. Some of the topics we discuss:

Should pediatric dentists be extracting permanent teeth?

How do oral surgeons decide on a sedation modality? What agents and what doses?

Do oral surgeons ever elect NOT to sedate?

How do you suture a small extra-oral laceration?

Can a tough teenager have thirds taken out with just local anesthetic?

Dr. Alex Otto and her husband, Tim, are previous guests on the podcast. Dr. Alex is a pediatric dentist, they own and operate four offices in the Austin, Texas area. Tim has an MBA and a strong business background working with fortune 500 companies. They join me on the podcast to discuss their latest project, Alcan Dental Cooperative. Alcan is a cooperative model in which pediatric dentists can join in exchange for a minority equity position. Unlike DSO/PE buyouts, a dental cooperative works by helping dentists systemize and grow their practice without being forced to sell out to a majority shareholder. The dentist keeps the practice but gets the benefit of outsourcing A/R, marketing, HR, etc. using scalable systems. This also increases practice valuation in the both companies as well. Tim and Alex explain this model to me and describe the benefits that it offers to pediatric dentists who are stuck somewhere in between the grind of solo practice ownership, and selling out the entire practice to a DSO. You can learn more at www.alcandentalcooperative.com

Recorded in-person at the AAPD meeting in San Diego, Dr. Corey Hastings and I sit down at a hotel over a couple cold craft beers and talk shop. Dr. Corey has been a guest on the podcast before, and is a wealth of knowledge regarding the business side of dentistry. He has an MBA, and has built 5, 6?... 7? A lot of offices in the Missouri area in a very short amount of time.

In this episode, we discuss:

- What's a healthy overhead for a pediatric practice?
- When making the jump to multi-doctor ownership, how do you structure compensation?
- How are capital expenditures accounted for?
- Cash flow and growth topics.

Dr. Ted Beauchamp is an endodontist and the owner of Beacon Endodontics in Wentzville, Missouri. Dr. Ted served in the Army after dental school, where he completed a one-year Advanced Education in General Dentistry (AEGD) residency program, then received his certificate in Endodontics after an additional two-year residency. Dr. Beauchamp continued to serve his country, practicing in South Korea, and then at Fort Campbell, Kentucky, as Chief of Endodontics. He mentored and taught endodontics to new general dentists and oversaw twelve dentists and forty support staff on base.

Leaving the Army, he entered into private practice with a well-respected endodontics office in St. Louis, then started Beacon Endodontics in 2020. He and Dr. Casey grab a beer at a local brewery and talk about some of the tough endo decisions that pediatric dentists face. 

We discuss using MTA, permanent tooth pulpotomies vs pulp caps, when to leave decay, long-term outcomes of apexogenesis as definitive treatment, when to initiate root canal therapy after trauma, and a host of other topics. 

Dr. Tim Richardson is a pediatric dentist and the owner of Acorn Dentistry for Children in the greater Portland, Oregon area. After residency, Dr. Richardson bought and grew three offices in a five year period. After feeling the stresses of burnout coming on, he decided to sell these offices and start over with both a goal and team-oriented mindset. He has since started six pediatric offices in a five year period, and leads a team of nine pediatric dentists as partners and associates. In this episode, we discuss:

- Where is the line drawn between "corporate" dentistry and large group practices
- How to reinvest equity into growth to make other people's money work for you
- Why Dr. Richardson went with a growth and volume model over being a sole practitioner
- How to use real estate to minimize taxes
- Why he doesn't put money into traditional investments like the stock market, and instead invests that money into his practice

Dr. Reza Ardalan is a pediatric dentist from Port St. Lucie, Florida and the owner of Ardalan Pediatric Dentistry. He joins us on the podcast today to tell us about his practice story and his journey to become a well-known personality on TikTok as a pediatric dentist. Some of the things we discuss in this episode:

- How Dr. Reza managed his $470k in student loan debt
- The importance of CE and expanding your skillset
- Growth of a pediatric office and when it's time to buy real estate, build, and bring on an associate.
- The benefits of owning your physical office as a pediatric dentist
- Why more pediatric dentists should take advantage of the power of social media

Dr. Reza is optimistic about the future of our profession, and he encourages any listeners to contact him via any of his social media platforms. 

Dr. Casey Goetz is a pediatric dentist who opened a scratch startup practice in rural Missouri in October of 2020. He discusses his personal journey to ownership, setting aggressive goals, and developing strategies for implementing growth in today’s competitive marketplace.

Dr. Kevin Kennedy is a pediatric dentist and practice owner from Clarksville, Tennessee. He fostered and adopted three kids during his pediatric residency before having biological children of his own. This experience really opened his eyes to the complexities and challenges of kids who have experienced loss, or as Kevin defines it "kids from hard places."

Dr. Kennedy shares his story and gives listeners some advice on how to care for these kids and communicate better with their parents.

It's been 12 full months since we opened the doors of my startup practice here in Missouri, and we had a fantastic (but challenging) first year. I wanted to take the opportunity to do a bonus podcast and review some of the things I've learned after one full year of starting and running a busy pediatric dental practice.

Cuivre Creek Pediatric Dentistry opened last October during the COVID-19 era, and in that time our team has a built a practice that has rapidly expanded to averaging 160+ new patients per month. We've had a lot of growing pains with such a high demand for our services, and I'd like to share some of the mistakes and lessons learned that might be able to help out young practice owners.

On this episode, I review 5 key lessons that I've learned as my first year as a private practice owner. These topics include:

1. Managing the work stressors that keep a dentist up at night

2. Pushing yourself to set goals and tracking your KPI's

3. Hiring and managing staff, treating them well while balancing a healthy overhead

4. Understanding your patient population

5. Why branding and social media is so important

Lots of exciting things to come on future episodes of the Brews and Tiny Teeth Podcast. Feel free to reach me with any questions at cgoetz@troypediatricdentist.com, or hit me up on Facebook messenger at Casey Goetz.

On this solo episode, I review 5 new tools/materials/pieces of equipment that I've purchased in my practice over the last year. I break down the good and the bad of these products, and how listeners can consider using them in their practice. We should always be trying new products and technologies to constantly try to deliver dentistry better, faster, and cheaper. The products I review are: 

1. Dukal throat packs

2. Optrasculpt composite sponge

3. Mosquito diamond bur

4. Zyris anterior isolite system

5. Denovo extraction forceps

Lilly Cortes-Pona is a dental practice consultant and coach who specializes in pediatric practices. Her company writes the practice management newsletter for the AAPD, and she works with practice owners all over the country to help them lead, connect, and profit. In our discussion, we go through common barriers and issues that pediatric dentists face at each stepping stone in their career, from early practice owner all the way to multi-doc, multi-office practices. 

In this podcast we discuss:

- Challenges that early career dentists and startups face
- The importance of considering utilizing a therapist for your mental well-being
- When to bring on an associate and why associates are in such demand
- How to get multiple doctors to agree on what direction to take the practice.
- How a dental coach works and how they can work with a practice to improve outcomes

LCP coaching website: www.lcpcoaching.com

Lilly has also provided our listeners with a free link to her "checklist for success": https://lcpcoaching.formstack.com/forms/checklist_for_success

Dr. Gabe Ross, a pediatric dentist out of South Carolina joins the podcast to talk about the changes seen in pediatric dentistry between now and 20 years ago. We discuss the challenges of a starting a scratch pedo practice, financial strategies with parents, generating reviews, DSOs, and things you can do to appeal to parents in the modern age of social media in the dental world.

As the two year anniversary of opening my practice approaches, I thought it would be a fun exercise to go over my profit-and-loss statement from the last 12 months and breakdown my expenses. The average overhead in pediatric dentistry is around 50%, but I think we can do better. 

I've been able to run a very low overhead, lean office by keeping my expenses in check and doing many services myself. In this episode, I review some of the following that allow me to keep a sub-30% overhead:

- How to calculate a true overhead (what do I include and what do I take out).
- How being rural keeps my rent, staff salaries, and advertising budgets low
- Bringing in more revenue is an easy way to lower overhead that doesn't involve cutting costs
- Save money by doing your own bookkeeping, website, marketing, payroll, etc.
- Where to shop for dental supplies, and why the big suppliers can eat into your profits.

I hope you enjoy this deep dive into practice numbers. Cheers!

Dr. Mitch Kramer is a pediatric dentist, partner, and soon to be 100% owner of a busy pediatric practice in central Minnesota. Dr. Kramer comes on the podcast to share his story about how he structured his initial buy-in in 2016. After helping grow the practice to four-locations, an associate, and 12,000 active patients, Dr. Kramer will be transitioning towards buying out the remaining practice equity from his partner Dr. Dennis Carreras this year. 

It was great catching up with Dr. Kramer, as this was the office that I associated with between residency and the start of the COVID pandemic. We were able to reflect on our opportunity to work together, along with the challenges of finding and retaining both good staff members as well as associate pediatric dentists. We talk about the financial practice opportunities that can be found outside of the urban setting, how to keep team members motivated, when can you afford another dental assistant, and batting clean-up for restorative work from previous associates that doesn't go as planned. 

McDonalds knows the cost of a sesame seed on every bun they sell, yet when you ask a dentist what their case acceptance rate/monthly breakeven amount/recall retention rate of their practice is, most have no clue. With 2021 having come to a close, now is a great time to sit down over a cold beer or a stiff whiskey and start making some spreadsheets to understand the numbers in the business you are running. 

Dr. Eric Hans is a private practice pediatric dentist with nearly 25 years of business experience. We have a great conversation about important KPIs (key performance indicators) that dentists should be watching in their practice. Dr. Hans really emphasized in our discussion that building a strong relationship with both your team and the patients in your practice is the foundation to why we need KPIs in the first place. 

This was a challenging topic to cover because it can be so broad, but we did a nice job touching on most aspects of it. Everybody knows that a practice owner should monitor production, collection, new patient numbers, overhead, A/R, etc. But many KPIs go a lot deeper than these numbers and are critical for keeping a pulse on how things are going in your practice. 

Some of the things we talk about in our conversation:
- Tracking your hygiene department, daily hygiene numbers, and restorative to hygiene ratios
- Breakeven costs and when are you losing money to do dentistry
- Production on GA/sedation days vs clinic days
- Setting goals and how often to track them
- Monitoring new patient flow, age of your patient population, and knowing how to expand your capacity
- Watching your P&L, and when is it ok for your overhead to be higher

Dr. Richard Marn is a dual board-certified physician in anesthesiology and pediatric anesthesiology. He trained at NYU and Johns Hopkins Hospital, and was on Mt. Sinai Hospital faculty as one of their pediatric anesthesiologists for 11 years. He works in New York providing pediatric in-office sedations for pediatric dentists and oral surgeons through his company New York Medical Anesthesia.

Dr. Marn is also unique because his wife Dr. Jessica Marn is a fellow pediatric dentist! 

Drs. Richard and Jessica Marn recognized that medical education for dentists and oral surgeons is fragmented and incomplete. They co-founded an education company, Blue Pacific Medical Simulation, that teaches dental offices how to properly respond to medical emergencies in their office.

In this episode, we review why pediatric dentists and their teams often aren't well trained or equipped to handle in-office anesthesia emergencies when things go wrong. We discuss common problems, review a recent pediatric dental anesthesia death in the news, and talk about how Dr. Marn's company runs simulations to train dentists on how to be better prepared. More info on Dr. Marn and his services can be found at the website below. 

 www.bpmedsim.com

www.nymedicalanesthesia.com

Dr. Nick Luke is a pediatric dentist, originally from Iowa but now practicing at a busy office in Wisconsin. Dr. Nick is a big fan of finding creative ways to follow the guidelines and literature while also creating a fun experience for his patients.

In this episode, we discuss:

- Why Wisconsin is awesome

- Hall crown philosophy and techniques

- MTA usage in pulpotomies

- Caries removal and biofilm control

- How being a dad and work-life balance go together

Dr. Corey Hastings joins us on the podcast for this week's episode. Corey is a pediatric dentist in Missouri and recently opened his third pediatric office. He has an MBA and a passion for developing systems to optimize the delivery of quality pediatric dental care.

This was a live episode we did in-person over a couple of craft beers. The initial conversation was supposed to focus on demographics to support a pediatric dental office, and we ended spending almost an a hour and a half going deep into conversations on pediatric dental hot-button topics. This podcast is raw, unfiltered, and unscripted. It's a good one, even though we don't stick to an agenda! Some of things we talk about:

- Demographics for a pediatric dental office

- Rural vs urban pediatric dentistry

- Solo vs group practice, single-location vs multi-location

- Prophy palace vs restorative heavy practices

- How do you convince an associate to buy in? And are associates more likely to start their own practice?

- How pediatric dentistry can be an isolating profession

This week's episode is a special feature that should appeal to many of our dental listeners. We are talking about soul-crushing student loans and how to deal with them! Most of us leveraged some degree of student loans throughout our extensive education process, and these loans influence the financial decisions we make every day.

This two-part episode series features multiple short interviews with pediatric dentists who have opened up about their career paths, and how they tackled large amounts of student loans. The three guests in this episode are:

Dr. Megan Charowski is a pediatric dentist who works as an associate at Holly Tree Pediatric Dentistry in South Carolina. She used a simple strategy of keeping personal expenses low and living off spousal income to pay off 380K in student loans in 3.5 years. 

Dr. Phil Chung is a pediatric dentist practicing out of New Jersey. He has paid off around 400K of his 550K total in student loans, while also simultaneously investing for retirement. 

Dr. Beth Winans is a pediatric dentist in Reading, Pennsylvania. She started a practice from scratch 5 years ago, while her OMS husband bought into an existing practice. Together they have paid off 530K in student loans, paid off her husband's million dollar buy-in, paid off her 500K practice loan, and invested 270K in equity into a surgery center, all using a debt-snowball technique as they became successful practice owners. 

Dr. Arielle Faden is a pediatric dentist and practice owner out of Jersey City, which is a large metro area near New York City. She was a guest on the podcast almost two years ago when she talked about practicing as an associate in a large city like New York. Since that time, she has gone through the journey of partnering with her boss to become a 50/50 practice owner.

We discuss how there's a lack of podcast content for dentists in these situations, but that partnerships are a great opportunity for dentists who aren't interested in either associating or going through the stresses of a scratch start. Some of the things Dr. Faden talks about:

- How she knew that this office was the right fit for ownership

- How they determined the value of the practice and purchase price

- What did lending look like for this transaction

- How did her income increase to cover the debt payment

- How they structured the operating agreement to know who can buy what with company money, and how profits are split

You can reach Arielle at ariellebethany@gmail.com

Dr. Kaitlin Hoogeveen is a pediatric dentist in a small town in Iowa with just 7,000 people, yet she has grown exponentially and reached her current office capacity within 3 years of starting her practice. We discuss what life is like being the only pediatric dentist in an expansive rural setting, both the advantages and the challenges. We also talk about practice logo design, marketing in a small town, avoiding burnout, and also alternative techniques to conventional drill-and-fill dentistry. Casey and Kaitlin also share their thoughts on a recent online hot topic of how to respond if a parent flat-out refuses your proposed treatment. 

Dr. Robbie Matthews is a pediatric dentist and the owner of Happy Campers Pediatric Dentistry in Peoria, Arizona. His young practice has exploded in growth over a very short period of time, even in a competitive area. Dr. Casey and Robbie sit down with a beer to go over strategies for growing a pediatric dental practice. We review how to post authentic Facebook content, TikTok, giveaways, and other social media pearls. The main strategy we discuss is simple... you have to "run for mayor" and become part of the community. Being involved and getting your name out there, along with treating patients right and presenting treatment plans properly, will generate internal referrals via the bulletproof word-of-mouth referral method. This is a fantastic discussion with a lot of great wisdom packed into an hour episode. 

Dr. David Bailey is a private practice pediatric dentist in Sheridan, Wyoming. He has been using SDF in his practice for years, and was an early advocate for using it as a caries-arresting medication. While still an important component of his practice, he has since limited SDF to specific patient situations. 

Dr. Bailey and I have a discussion about the potential issues with widespread SDF use in our profession, in light of recent issues regarding non-coverage by insurance companies for restorations placed on teeth previously treated with SDF. We discuss the pros and cons of its use, along with how the esthetic drawbacks can be perceived by the public.

We go over six different unique patient situations in which SDF may or may not be appropriate compared to more traditional means. This was a great exercise for identifying situations in which SDF would be the perfect first-line treatment option, while in others it may do more harm than good. 

Let’s be honest, 99% of our patient encounters are awesome and end with happy kids and happy parents. But then there’s that 1% of the time when things don’t go as planned and you end up with angry parents. We've all gotten those unwarranted one-star reviews, so now it’s time to share them to remind each other that you just can’t make everybody happy. This episode took a lot of time to put together, so thank you to all the anonymous pediatric dentists who took the time to share their stories!

Dr. Shane Harpham is a pediatric dentist and the owner of Sea Smiles Pediatric Dentistry in Bluffton, South Carolina. Dr. Shane and I open a couple craft beers and talk about how to do the perfect class II composite restoration on a primary tooth. Some of the topics we discuss are:

- Creating a team and environment to set you up for success

- Treatment planning and case selection (composites vs SSCs)

- Isolation techniques

- Prep design, bonds, and finishing

- Glass ionomers and Equia Forte

- Areas that Class II restorations frequently fail

- The importance of learning from your failures and always trying to improve

Dr. Peter Nguyen is a pediatric dentist who started First Bite Pediatric Dentistry in Henderson, Nevada. Dr. Nguyen grew up as the child of Vietnamese war refugees. He did his pediatric residency at UCLA, before moving to the Las Vegas area and associating for a number of practices prior to doing his start-up.

Dr. Nguyen has a great sense of humor and as he puts it, "I'm not the smartest guy on iPedo so I have to make up for it with my sense of humor." I loved this podcast, I thought it was awesome to just laugh out loud and tell stories about ridiculous things that happen in our practice. We talk about Dr. Nguyen's start-up journey, then discuss crazy and ridiculous things parents and kids have done in our offices. 

We also talk about "verbal judo" and the art of communicating with parents when it comes to tough treatment plans or difficult situations. 

Today's episode is all about general anesthesia. Dr. Geoff Ping discusses his techniques for doing 8-10 GA cases on his surgery days. This episode is loaded with good content and clinical pearls. We talk about order of operations during full-mouth rehab cases, how to decrease turnover time, tricks for cementing crowns, limiting wasted movements, and so much more. If you're a pediatric dentist and you do GA cases, you need to listen to this episode.

Dr. Juan Yepes is a man who needs no introduction. He is a pediatric dentist, radiologist, physician, masters of public health... I'm sure I'm forgetting something. Let's just say he's smarter than I am. Dr. Yepes joins us on the podcast to talk about radiation safety in pediatric dentistry. 

We had a great conversation highlighting the importance of being responsible with how much radiation we are prescribing in the office. Some topics we discuss:

- Modern digital sensors vs traditional film x-rays, and why digital has its drawbacks
- Rectangular beam collimation and why we need to consider it
- Updates to wearing a lead apron, and how to change public perception
- Background radiation doses and how we practically apply it

This was a great conversation that made me stop and think about how many times my staff hits that x-ray button in the office on a daily basis, and it definitely stimulated some critical thinking. Dr. Yepes can be reached at jfyepes@iupui.edu.

Dr. Robert Elliott is a pediatric dentist and the owner of Cary Pediatric Dentistry in Cary, North Carolina. "Bobby" is an active leader within the AAPD, a pediatric dental consultant, and also the founder and owner of a very successful private practice pediatric office. He frequently lectures at the AAPD annual session to young doctors on practice management topics and leadership skills. We sit down to chat about young pediatric dental practices and the common struggles they face. 

Dr. Elliott owns two pediatric dentistry consulting companies. Pedo Springboard is a one-on-one consultation service for young pediatric dentists interested in doing a startup. His second company, Pediatric Dental Directions, is a consulting company more tailored to improving systems, numbers, and KPIs in more established practices. Dr. Elliott also runs Pedo Boot Camp, a CE course designed to help practice owners improve the efficiency of their systems in their practices.

We discuss some fantastic topics in today's episode, including:

- What is the best way to name a pediatric practice?

- Who would benefit from a dental consultant, and how does it work?

- Is a dental consultant worth the expense? (How will I get my money back?)

- What are common mistakes young practice owners make that get them into trouble?

- How practical is it to be a completely fee-for-service pediatric dentist, and how does dental insurance influence today's young dentists?

Dr. Elliott can be reached at info@pedospringboard.com

https://www.pedospringboard.com/#about-pedo-springboard

Thad Harker is a project advisor at Primus Dental, a design and build full-service construction company that has built close to a 1000 dental offices across the Midwest.

Thad and I have a great conversation about dental office design and construction. He emphasizes that the construction process is all about managing people. We talk about how things have changed with higher interest rates and construction costs, but that it still makes financial sense to not lose opportunity cost and get yourself a "golden hammer."

Some topics we discuss in this episode:

- Why are construction costs high, and will they come back down?

- Why does location matter?

- Does it make sense to price shop a build-out?

- How have pediatric office designs changed post-COVID?

- Is it still worth it to do a start-up and be a practice owner?

Dr. Ben Popple is pediatric dentist in Georgia who started a scratch practice out of residency for $250k. Six years later, he is building his third office with 18 chairs in a ground-up build. The theme of this episode is minimizing the expenses of your start-up. We identify what things you need to do to keep your costs down, including choosing a contractor, dealing with equipment reps, knowing how to find affordable/used equipment, and reinvesting practice income during the growing years. If you're currently trying to start a dental practice, or have any interest in doing so, this is a great episode to check out!

Don't forget to send in your questions, comments, clinical scenarios, and humble brags in for our Pedo Pearls Power Hour. Send us a voice message or email to cgoetz@troypediatricdentist.com and we will break it down on our next episode. 

Dr. Aaron Bumann is a pediatric dentist practicing in the Kansas City, Missouri area. He's is an active member of the Missouri Academy of Pediatric Dentistry and has been the leading voice advocating for improvements to our state Medicaid to provide better access to dental care for kids.

Dr. Bumann and I talk about his background and what his practice is like in the Kansas City area. We talk about the benefits of being an associate dentist, and how you can create a healthy professional work environment when you find the right office and surround yourself with good team members.

The focus of our conversation deals with the recent Medicaid fee increases that have been approved in Missouri. The governor recently approved a budget increase that will nearly double the current fees for dental services. To give context, a typical pediatric recall appointment that historically reimbursed around $90 will increase to around $180. This historic increase will allow more kids to have access to quality dental care in our state. Dr. Bumann discusses his role in making these fee increases happen, and gives some insight on what actions providers can do to advocate for changes in their own states. 

Dr. Donny Qafleshi is a pediatric dentist in Indiana. He comes on to share some of his personal and professional experiences as an immigrant, a dad, and a pediatric dentist. Some of the things we discuss:

-Dr. Donny's journey to the United States as a child to escape war

- How to know when a practice partnership is the right choice

- How many kids a day is a sustainable amount to see without burning out?

- Internalizing emotions as a pediatric dentist and a new parent

- Working on mindfulness and techniques to prevent work anxiety

Live from AAPD 2022, this episode features short power interviews with 6 pediatric dentists (2 residents and 4 private practice). We learn more about their practice backgrounds, pearls that they’ve learned, new technology that changes the way they practice, and advice for other pediatric dentists.

Dr. Kristine "Love Peace" Grazioso is a pediatric dentist with a large practice in Massachusetts. She practiced for years as contracted provider with Delta, Blue Cross Blue Shield, and Medicaid. In 2020, she made the decision to drop all insurances and go completely FFS, in order to provide better care for her patients. Even though she practices in a competitive area, her practice is busy and thriving.

Dr. Grazioso shares her story about how she made this transition. She gives pointers and advice to other pediatric dentists who are interested in going OON with dental insurance plans. Dr. Grazioso has used her experience as a springboard to provide consulting and coaching services to other pediatric dentists who want to fight against being handcuffed to dental insurance companies.

Dr. Christopher Chance is a pediatric dentist and the owner of Oaks Point Pediatric Dentistry in Houston, Texas. He joins the podcast to tell us more about his start-up journey to create a boutique practice in an edgy, modern office in the growing Houston area. 

We drink a few cold beers and talk about some of the following start-up topics: 

- Using corporate associateships as a practice run for a start-up 

- Challenges with securing lending for a large or expensive practice space

- Using local resources and professionals in the community to create and design a modern practice space

- Marketing using word-of-mouth and social media

- Understanding how start-ups have a young patient base that matures over time, and how the demand for dental services evolve

Happy Holidays to all listeners and hard working pediatric dentists out there. I hope you all take some much deserved time to relax with your families. Don't forget that any listener questions, concerns, or ideas for future topics can be sent to cgoetz@troypediatricdentist.com.

Howard Farran is an icon in the world of dentistry, and a guest that I've wanted to interview for a long time. He's the founder of Dental Town, an international speaker who has lectured in over 50 countries, author, host of the Dentistry uncensored Podcast, and just an all around cool personality.

Dr. Farran joins Dr. Casey Goetz for a discussion of all things pediatric dentistry. We talk about how pediatric dentistry has changed as a profession, practice ownership, DSOs, student loans, and the future of dentistry. Howards shares his words of wisdom to the young upcoming work force of pediatric dentists.

Dr. Josh Solomon is a pediatric dentist and the owner of Pediatric Dentistry and Orthodontics of Livermore in Livermore, California. Over his 20 year career he has developed a reputation for being a leader and educator in advanced restorative techniques related to pediatric dentistry. He frequently hosts online and in-person CE courses and specializes in using the Bioclear matrix system. Dr. Josh is currently building a brand new office that includes a teaching center where he can host his courses.

We have a fantastic discussion related to all things composite resins. We talk about magnification, isolation, light curing, injection molding, heating composite, using flowable, air abrasion, disclosing solution, bulk-filled resins.... the list goes on and on. We pack a ton of pearls and content into an hour long conversation. You can reach Dr. Josh on social media or his email for questions on upcoming CE events.

We all know the struggle of placing posterior pre-fabbed zirconia crowns on primary molars. Sometimes they fit like a glove, and sometimes they become a hot dumpster fire where you try 5 different crowns and none of them fit. Dr. Chad Davis, a pediatric dentist out of Arizona, and Dr. Andrew Johnson, a prosthodontist out of Arkansas, have worked together to develop Alphabyte. Alphabyte is a scanning system that allows you to quickly scan a primary molar and determine the correct crown size along with reduction discrepancies via a heat map to improve speed and efficiency with placing posterior crowns.

Chad and Andrew come on the podcast to discuss how they developed this system, and how Alphabyte has practical applications beyond zirconia crowns. They will be at AAPD at the Kinder Crown booth where attendees can get a hands-on demo to see how the product works. You can learn more at https://alphabytedental.com/

A lot of money is wasted in our profession on marketing that doesn't produce a high return on investment. Practice owners need to learn to market smarter, not harder. 

In today's episode, Minal Sampat joins us to discuss creative and affordable ways to market and grow a pediatric dental practice. Minal is an RDH and worked for 10 years in a pediatric dental office. She is a national speaker and marketing strategist, along with author of Why Your Marketing is Killing Your Business.  

Some of the topics we discuss:
- Making your website better than your competition
- Better dentist bios
- Internal referrals and community outreach
- Facebook vs Instagram and how the algorithms have changed
- Hiring help to develop Tiktok videos

Minal's website and more information about her can be found at https://minalsampat.com/

Dr. Art Nowak has been practicing pediatric dentistry since the mid 1960's, back when there were only seven residency programs. He taught pediatric dentistry at the University of Iowa for almost 50 years, during which he published "Infancy Through Adolescence." This textbook is a staple in our profession, and Dr. Nowak literally "wrote the book" on comprehensive pediatric dentistry.

We have a great discussion on how pediatric dentistry has changed through the years. Dr. Nowak expresses his concerns that we have commercialized pediatric dentistry and moved away from focusing on prevention and treating the whole patient. Dr. Nowak continues to stay busy and he is excited to release his newest edition of the textbook sometime next year.

Joe Sparacino is a general dentist who joins me for what may be one of the most interesting conversations I've had yet on the podcast. Dr. Joe started a large practice out of dental school down at the southern Texas border providing care to underserved kids with Medicaid. He built two large practices before selling and putting his practice proceeds into bitcoin back in 2019. He since has bought and sold four other practices and has walked away from clinical dentistry (at least for now). He has spent early retirement pursuing a passion for music, along with casually starting the company Membersy. Membersy is a dental membership technology service that has rapidly grown and is now used by many of the large DSOs.

Dr. Joe is a risk-taker, a free-thinker, and very obviously driven to create and grow his ideas into something special. He currently lives in Colorado and is working on his next idea, the Happy Patient Company. This would be a service to streamline resources and remove barriers to grow practices for dentist who are looking to achieve their goals.

Dr. Kirsten Frazier is an orthodontist who recently started her own practice in South Carolina. She practiced in Chicago for several years out of residency before determining that she needed to be her own boss, and made the decision to move to a new city and plant roots in her dream practice. I wanted to bring Kirsten on to discuss and compare her start up journey to my own, to get a better sense of what challenges orthodontists face. Many pediatric dentists have spouses and significant others who are orthodontists, so this should be a great podcast for those listeners as well!

In this episode, we discuss:
- Growth expectations of a new ortho office
- Dealing with competition and saturation
- Collection systems, cash flow, and payment plans in an ortho office
- The importance of social media in orthodontics, and how it differs from pediatric dentistry
- What things Dr. Frazier would do different in her startup, and what advice she has for other dentists

You see it all the time on iPedo... "I'm tired of my associate job and I want to start my own practice, but I'm not sure where to start." It's no surprise that a large void exists for knowledge and content relevant specifically for pediatric dentists who want to start their own practice.

Well we have some huge news to share on the podcast today. For the last 6 months, Dr. Corey Hastings and I have been working tirelessly on building a comprehensive course specifically for pediatric dentists who want to start their own practice. We are super excited to roll out Little Smiles Practice Mastery, an online video lecture series that walks you step-by-step through the startup journey. This "power pediatric dental MBA" has almost 15 hours of lecture material, along with all needed spreadsheets, forms, attachments, and paperwork you need to jump-start a practice. All of this in a low-cost subscription platform that is available on-demand whenever you need it.

On today's episode, Corey and discuss the benefits of practice ownership over a cold beer. We review why we made this course, what all is included, and why we believe most pediatric dentists can build an awesome practice without spending a fortune on a consulting company.

Make sure to stop by our booth at AAPD to get on our mailing list, or visit www.pediatricdentalmba.com. We anticipate the course to go live early this summer and we are so excited to give other dentists the tools they need to achieve their practice goals.

Dr. Eric teDuits is a pediatric dentist and a private practice owner in Madison, Wisconsin. He has been growing and expanding his practice for nearly 30 years, and he joins us today for a great discussion on how to maximize efficiency and productivity in the hygiene department. 

Dr. teDuits discusses how he expanded and structured his business from one pediatric dentist to six partners with three different locations. We discuss how he brings on associates in his practice, structures buyouts, and involves the real estate. We transition into the focus of our conversation to learn more about how Dr. teDuits is able to see 60-70 recall patients in a day, with a focus on providing quality oral hygiene instruction while implementing good systems and a high-performance team to deliver the care. 

We wrap up our conversation by getting Dr. teDuit's thoughts on the future of private equity and the influence of DSOs in the pediatric dental space. This was a dense and very fluid conversation, and we touch on a lot of different topics besides just improving practice recare. 

It doesn't take long reading iPedo posts and talking to other dentists to realize that burnout, stress, and difficulty finding work-life balance is a common problem among pediatric dentists. In this episode, Dr. Natalie Datien joins us to discuss her story about why she walked away from a busy practice.

Dr. Natalie bought a practice shortly out of residency with her husband, a general dentist in the Detroit area of Michigan. Together they grew the practice from an old-school, low-production office into a multi-doctor GP practice with Dr. Natalie running the pediatric side of things. They were seeing over 100+ new patients a month and booking out for weeks. After three years of sleepless nights, staffing issues, worrying about cash flow, and dealing with difficult families, Dr. Natalie and her husband set down the handpiece and sold the practice. She is now retired at 33 and happily spending time with her young family.

We have a really interesting conversation about what life is like after dentistry, reflections on what could have made things easier as a practice owner, advice for young start-up docs, and just in general what type of things burn us out as practice owners.

PODCAST NEWS:

If you are a pediatric dentist attending AAPD in San Diego, look for me (Casey Goetz) at the convention. I'd like to do some speed-dating style interviews with other pediatric dentists, maybe 10 minutes long, asking for pearls, tips, advice, and lessons learned. Keep an eye out for me and flag me down if you are interested in being part of this episode idea!

Dr. Ann Bynum is a pediatric dentist and the owner of Holly Tree Pediatric Dentistry in Simpsonville, South Carolina. She has been in private practice pediatric dentistry for over 20 years, and maintains an active roll in the AAPD while also acting as a board examiner for the ABPD. She comes on the podcast to help us answer some long overdue listener questions and answers that have built up over the months. On this version of our Pedo Pearls Power Hour, we answer questions regarding:

- What's the best way to warranty restorative work that has failed?
- What metrics can you track that lets you know it's time to hire an associate?
- How soon in a new pediatric office should you start providing general anesthesia?
- How do you control the flow of Medicaid in your practice to keep it at a healthy level?

Any future questions, comments, or topics for discussion can be sent to cgoetz@troypediatricdentist.com, or DM me on facebook or instagram Casey Goetz. 

Dr. Alex Otto is a pediatric dentist who with her husband, Tim, have opened three pediatric dentistry practices since 2020. They have offices in Buda, Kyle, and Austin Texas with plans to continue expansion while providing a 5-star patient experience.

Dr. Alex was a GP and an associate who worked at multiple practices before going back and completing her pediatric residency in Alaska. Her husband, Tim, worked in the corporate business world with multi-million dollar companies after obtaining his international MBA with degrees in finance and management. During residency, Tim spent two years learning everything he could about the business side of pediatric dentistry. He and Dr. Alex developed their systems and created the framework for their practice vision so that they could immediately start their practice ownership journey after residency.

Some of the topics we discuss:

- How they did a detailed demographic analysis and landed on Austin, Texas

- The importance of controlling overhead

- How high interest rates can create opportunities for smart practice owners

- The future of pediatric dentistry and how corporate dentistry will change the field

Dr. Yoshita Patel is a pediatric dentist and the owner of Viera Pediatric Dentistry on the east coast of Florida. She has grown a relationship-based FFS practice and has had a ton of success in her community. Her 700+ 5 star reviews speak to that. You can tell by the way she talks about her practice that Dr. Patel emphasizes the patient experience and relationships she has with her patients and families. In this episode we review:

- How a FFS office can grow just as quickly as a PPO office
- Giving back to your community can accelerate a FFS office
- Dental insurance challenges and how to overcome them in a FFS office
- Focus on the relationships, and the numbers/money will come
- When looking at a start-up, determine your goals and what YOU want, and then structure the practice and your mission statement around that
- Implementing tongue and lip ties into your practice, and understanding the struggles that new mothers face

This episode is a boards-review style solo episode, where I take some time to review the AAPD guidelines, current literature, and throw in a little personal opinion on key topics in pediatric dentistry. In today's episode, I review:

- Amides vs esthers,
- Is septo really better?
- When to give an IAN block and when to infiltrate
- Buffering and computerized delivery
- How to manage a local anesthetic overdose
- Pharmacokinetics and contraindications to N20
- MTHFR, should we avoid N20 in these patients?

Shawn Johnson is the vice president of business development at Treloar and Heisel, a premier provider of financial and insurance services to dental and medical professionals. He joins us to discuss topics relating to protecting both your practice and yourself. We walk through different stages in the career path of a typical pediatric dentist and review what systems and insurances should be in place to protect yourself from all of the curveballs life throws at us. Some of the topics include:

- What to look for in a disability policy, and how much coverage should you have?
- When is a term life policy appropriate compared to a whole life?
- Why pediatric dentists need a higher level of coverage with the trend for in-office general anesthesia.
- What are the components of a business owner's protection policy?
- Finding a balance between keeping an emergency fund vs having business interruption and overhead coverage.

Dr. Roger Lucas is a pediatric dentist and practice owner in the state of Washington. He is a trained biochemist and is passionate about advocating for dietary modification to help his patients. Seven years ago he wrote a book titled "More Chocolate, No Cavities." Dr. Lucas and I discuss the key concepts in the book, and the importance of educating our parents on the harmful effects of sticky processed carbohydrates.

Ever since the big announcement earlier this year, NuSmile's Bioflex crowns have created quite the buzz among pediatric dentists. NuSmile revealed the crowns to the general public at AAPD 2022. These white, flexible resin polymer crowns could be a game changer to provide a flexible and esthetic improvement to traditional stainless steel crowns. As a millennial techie pediatric dentist, I wanted to learn more.

Mike Loessberg is the Vice President of sales at NuSmile, a whiskey connoisseur, and a founding member of Bourbon and Baby Teeth. He joins us on the podcast to sip some whiskey and talk more about this new product, including some frequently asked questions he's received about the product. These crowns should be available and released for sale sometime this fall, likely at Bourbon and Baby Teeth in Louisville, Kentucky.  Mike also gives us some updates on BABT and what we can expect this year. 

Mike can be reached via Facebook or at https://bourbonandbabyteeth.com/ 

We spend a lot of time talking on the podcast about rural pediatric dentistry, start-ups, and high caries risk populations. Let's shake it up and learn more about what practice is like out on the west coast of California. Dr. Evan Chang joins us to tell us more about what practice is like in San Fransisco. Dr. Change splits his time between practicing in a high-end FFS practice and a community health Medicaid clinic.

Some of the topics we discuss:

Challenges of the unique affluent community of San Fransisco

Utilizing a therapy dog in the office

Spending time developing relationships with patients early, and how sometimes watching decay lets you do better dentistry in the long-run 

Working closely with referral sources and how they can help you think outside the box

Keeping your treatment planning skills sharp while working in a FFS practice

Did Covid kill the future of study-clubs? Are we forever doomed to zoom calls and virtual dental meetings?

Stay tuned for future episodes from the Bourbon and Baby Teeth Conference in Louisville, Kentucky. We have a lineup of exciting guests to bring on, you wont wan to miss it!

Danny Cammarosano is a regional director of practice finance for Provide. Provide is a tech company that has entered the dental practice lending space and has grown to be one of the top players for financing dental practices. Provide sets itself apart from the other big players like BOA and WF by offering better customer service and a more practical approach to lending. Danny shares updates to what's been changing in the practice lending space in this new era of high build-out costs, inflation, and elevated interest rates. Some of the topics that Danny covers:

- What are the higher loan amounts that new practices are qualifying for?

- What makes for a good borrower, and are business plans necessary?

- How are repayments being structured, and how can you avoid prepayment penalties?

- What is the lending forecast and what's expected to change over the coming 1-2 years?

- What should a dentist consider if looking to purchase real estate or do a ground-up buildout?

- How does lending change if the borrow has an established first practice and wants to open a second location?

- How much will a bank lend for a partnership buyout, and is there a limit for a high production/expensive practice?

Dr. Reed Faldet is a young dentist and entrepreneur who has built an 8-figure commercial real estate portfolio. He has transitioned out of full time dentistry to focus on real estate. We have a great discussion all about real estate, including the following topics:

- How has the market for commercial real estate changed?

- When does it make sense to lease a practice space compared to buying and building?

- What options are there if you don't have the cash for a down payment?

- How does lending work for practice loans?

- What are the tax benefits to owning real estate, and how does depreciation work to lower taxable income?

Dr. Faldet also helps partner and mentor with dentists looking to purchase their real estate but who need help along the way. His email is info@dentalrepartners.com

Ok the title is a bit of a click-bait, but I did have the pleasure of interviewing Dr. Staci Whitman on the podcast. Dr. Whitman is a practicing pediatric dentist in Portland, Oregon. She is a "functional" pediatric dentist who practices in a demographic that caters to more natural and holistic modalities. Her practice is heavy in dietary guidance, vitamin supplementation, ozone therapy, tie/lip tie release, myofunctional therapy, hard tissue lasers, and also traditional SSCs and general anesthesia.

I wanted to have this conversation to widen my horizons and provide me with more context to educate and converse with my own patients who have concerns about fluoride, toxins, and materials. I was surprised to find that I agreed with the majority of points that Dr. Whitman discussed. You can tell that she's passionate about educating her patients, promoting a healthy diet, and focusing on prevention rather than picking up a handpiece to fix the world's problems. I think this will be a great episode for stimulating some critical thinking skills about the way we discuss treatment options with our crunchier families that we all know and love!

Dr.  Kathleen Schultz is a dual-specialized pediatric dentist and oral pathologist. She teaches and practices at Long Island Jewish Medical Center in New York. Dr. Schultz and I talk about a grab bag of oral path situations we sometimes encounter as pediatric dentists. Some of the topics we hit on:

- Dentigerous cysts in the mixed dentition
- Gun to the head, which is worse? Chewing tobacco or cigarettes?
- Nutritional deficiencies and the increase in scurvy in food insecure or special needs patients
- Magic mouthwash, prescribed topical agents, and geographic tongue
- HPV vaccination updates
- Primary failure of eruption cases

Check at Dr. Schultz on her Instagram @drkathleenschultz where she posts unique and interesting peds-oral path cases. 

Dr. Justin Stevens is a pediatric dentist and practice owner in Bozeman, Montana. His wife, Joni, is also a pediatric dentist. Together they acquired a practice and have grown it to the point of constructing a brand new 10-op building. I invited Dr. Stevens to be on the podcast after spending some time in Bozeman after my annual September elk hunt. Montana is a beautiful state and I wanted to learn more about what the pediatric dentistry scene is like out there.

Dr. Stevens is also an advocate for using a Solea hard tissue laser. He and his wife have two of them in their practice. We discuss the efficiency of lasers, reducing chair time with less local anesthesia, how to complete specific preps such as class II's and SSC preps, and also how the cost breakdown is more achievable than you may think. This was a great discussion for any pediatric dentist interested in practicing in Montana, building a practice from ground-up construction, or anyone interested in investing in a hard-tissue laser. 

https://gvpediatricdentistry.com/

Are you a well-rounded pediatric dentist? You might not be as much as you think.

If I've learned anything about dentists, it's that they are resistant to change and easily get stuck in doing things the way they've always done them. A good dentist recognizes his or her own shortcomings, and isn't afraid to try new procedures and materials, and step beyond the edge of the comfort zone. 

Dr. Sean Whalen is a seasoned pediatric dentist and practice owner from Westminster, Colorado. We discuss different techniques, procedures, materials, and ideologies that a well-rounded pediatric dentist should be offering. Dr. Whalen is passionate about providing a full range of services to best serve our patients, including interceptive ortho, oral conscious sedation, oral surgery, posterior zirconia, advanced behavior management and many others. We discuss that if we do not distinguish ourselves with our skill sets as specialists, corporate dentistry may push us out of the marketplace. 

Charles Loretto is a partner at Cain Watters and Associates, a firm which needs no introduction in the world of dentistry. Charles oversees the practice transition department for CWA, and is founder of affiliate company, National Dental Placements, that assists doctors in the buying, transitioning and valuation of a practice. He and his team help hundreds of clients and non-clients with their transition goals annually.

This week's episode is a podcast swap! Dr. Casey Goetz joins Michael Arias on The Dental Marketer Podcast. Michael's podcast focuses on marketing topics, campaigns, and strategies to help dentists grow their business. They sit down and discuss the startup process and talk about a range of topics including:

- Choosing the right practice location

- Practice lending

- Using social media to increase patient flow

- Cash flow in a start up

And so much more! Check out Michael's marketing business and podcast at:

https://thedentalmarketer.site/

https://podcasts.apple.com/us/podcast/the-dental-marketer/id1153836877

Dr. Julia Richman is a pediatric dentist and private practice owner in Washington. She joins us on the podcast to talk about a variety of topics, including her journey from being a long-term (10+ year) associate to starting her own practice and the challenges that go with it. Dr. Richman has an interest in forensic odontology that we discuss. She also is an avid diver, and we talk about how cold water therapy and just being outside in general can be a remedy for the stresses of being a pediatric dentist. 

Dr. Brandon Schwindt is a pediatric dentist who practices in Portland, Oregon. He started Kona Kids Dentistry from scratch in 2003, and practiced for 6 years in a leased space before making the investment and buying land to build a new office. He discusses the conversations he had with his financial team to determine if building a large office was the right move from a growth and tax perspective.

In 2011, he completed the building with 3800 sq ft and 8 op chairs plus a hygiene bay. He practices in the location with his wife, who works as a GP seeing adolescent patients, along with an additional new associate.

Dr. Schwindt and I spend a lot of time discussing the process of transitioning from a leased space into a ground-up build, and the lending and tax consequences that go along with it. We review how deductible rent expenses from the practice can go towards paying the mortgage on the building. He explains how depreciating components of the building and smart accounting work helped to lower his tax liability while building equity that he can use to boost his retirement. He also gives advice to new pediatric dentists who are trying to decide if building or leasing is the right choice for their practice.

Dr. Jon Lindblom is a pediatric dentist and practice owner from Bartlesville, Oklahoma. He's been a practice owner for 10+ years in his small hometown in Oklahoma, and enjoys the benefits of practicing in a busy and uncompetitive environment that a small town has to offer. He's a firm believer in reinvesting and becoming involved in your local community (he donated $50,000 to sponsor and build a disk golf course for his practice). We discuss what his practice is like, and also how he uses oral sedations with chloral hydrate to overcome the access barriers to traditional GA in a small town.

Dr. Lindblom tells us about why he decided to sell his practice to MB2. For those that aren't aware, MB2 is a dental partnership company that purchases equity and buys out dental practices. In some ways it's similar to a DSO, but in many ways different. Dr. Lindblom really did his due diligence, and he tells us about the benefits of his partnership and why it was a good choice for him and his practice. 

Dr. Marc Soelberg is a pediatric dentist who recently did a scratch start in Post Falls, Idaho. After several years of associating without a partnership offer, Dr. Soelberg decided to open his practice in a growing rural town in northern Idaho.

In this episode, we talk all about what opening a practice in 2024 looks like. He shares his challenges with obtaining a loan big enough to cover the cost of an office that's a functional size. We also discuss what marketing strategies worked best to obtain new patients, along with sharing some mistakes he made along the way.

Dr. Gerardo Martinez is a pediatric dentist who practices out of Milford, Delaware. After spending time in California, Florida, and Texas, Dr. Martinez decided to start a practice in rural Delaware. We discuss a whole range of topics on this podcast, including the differences in patient populations he has treated throughout the country. He believes the future of pediatric dentistry is bright, and he discusses how much need still exists in the more remote areas like Delaware.

Dr. Martinez has a unique practice philosophy. We talk about how he is okay with tougher/crying appointments and being aggressive with extractions while at the same time using SDF, Hall crowns, and glass ionomer products to manage decay. 

I had heard that Dr. Martinez invested in and uses a scanner to take digital impressions for his space maintenance. I hate fitting bands and taking impressions, so we took a dive into the costs and benefits of purchasing and using an intra-oral scanner in a pediatric office. It definitely changed my perspective and is likely something I will purchase in the near future. 

Dr. Johnny Johnson is a pediatric dentist from Florida who joins us on the podcast today. Dr. Johnson practiced full time as a pediatric dentist until a bicycle accident in 2002. Over the next 6-7 years he continued to practice while undergoing multiple surgeries on his wrist. He eventually hung up the handpiece when his wrist needed to be totally fused. We spend some time talking about disability insurance and what that journey looked like for Dr. Johnson.

Dr. Johnson now spends his time advocating for public water fluoridation. He is a leader in the American Fluoridation Society and fights every day all around the country and world to promote the benefits of community water fluoridation.

I try to challenge Dr. Johnson with the current evidence of fluoride, and some of the conspiracy theories and claims that anti-fluoride parents present to us. Dr. Johnson gives us the evidence and rebuttals to counter these claims. 

He encourages any listener to reach out to him at drjohnnyjohnson@gmail.com for personal help in advocating for community water fluoridation in their own community, as he is very passionate about his work. 

Thad Harker is the Project Advisor for Primus Dental, a design-build medical construction company that has built hundreds of dental offices across the midwest and beyond. Thad advises dentists on projects ranging from building out small existing lease spaces, all the way up to ground-up, multi-million dollar stand-alone buildings. His 20 years in business to business, bio-medical, and construction consulting allows him to help his dental clients design and build the office of their dreams.

We have a great conversation on creating a vision and working with a contractor to build out the ideal pediatric dental office. We review current changes in the building sector with COVID and material costs, trends seen in pediatric dental offices, common mistakes that dentists make, keeping building costs under control, and a variety of other pearls involving pediatric dental build-outs. 

We have a lot of exciting episodes coming up! Don't forgot to continue to send in listener questions, comments, and tough clinical situations to cgoetz@troypediatricdentist.com. 

Where does a pediatric dentist put money in 2021? Let's talk a little about the personal finance and wealth-building side of pediatric dentistry. 

Evan Koch is a Certified Public Accountant holding the Personal Financial Specialist designation of the American Institute of CPAs. Evan's extensive tax planning experience allows him to incorporate individual and business tax strategies into comprehensive financial plans that include pension planning, wealth management, and business structuring. His practice centers around tax planning and financial consulting for dentists and dental specialists, including many pediatric dentists. He joins us today to talk about the current state of the stock market, inflation, savings rates, paying off student loans, and general steps towards reaching financial freedom. Evan also shares his #1 common attribute that he sees in his most financially successful dental clients.

Today's episode is all about taxes. As pediatric dentists, we have tax issues, and dental school doesn't give us the foundational knowledge we need to understand how taxes work and how to play the game. 

Scott Clynch is a CPA and personal financial planner at Cain Watters. He joins us today to talk about how taxes work. We start big picture with basic concepts and definitions, and then walk through how taxes work at each career stage that a typical pediatric dentist goes through. Some things we talk about:

- Marginalized vs effective tax rate, differences between deductions and credits
- W2 vs 1099 employees
- What can an employee dentist do to lower his/her tax bill?
- What is an S-corp and how does it work?
- What expenses should be run through a practice? What areas are grey and what's on the black list?
- When does it make sense to implement a 401k plan for tax purposes?
- What is a capital gains tax, and how does it work when a pediatric dentist finally sells his/her practice?

Dr. Roy Shelburne joins us on this episode to tell his incredible story about being arrested for Medicaid fraud. After years of running a busy and successful practice in Virginia, Dr. Shelburne received a phone call that the FBI had raided his office. All of his personal assets were seized, and he was tried and found guilty of medicaid fraud. He served 19 months in prison, and now spends his time consulting dentists on how to prevent this from happening to them.

This was an eye-opening conversation. As pediatric dentists, many of us see medicaid. You may think that if there were an error or mistake with an office's Medicaid billing, penalties and fines could occur and simply be paid as long as the mistake was innocent. Dr. Shelburne's story demonstrates that this isn't always true. 

For anybody looking for more information on Dr. Shelburne, his website is: http://royshelburne.com/

Link to registration for Dr. Shelburne's Dental Billing Bootcamp: https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fform.123formbuilder.com%2F6180041%2Fform&data=05%7C01%7C%7Ce22febb87d32459cfd8708da54595fb1%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637915040111326747%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=CBiK8%2FzfZ8Dp0LZGJpdrBQ3Nlsi2URYTti%2BOh60O%2BVI%3D&reserved=0