Reinventing your Career Path: A conversation with Dr. Casey Jones, DMD

Announcer: Ladies and gentlemen, this is the Dental Up Podcast brought to you by Keating Dental Lab, a full service award-winning dental laboratory. Each week, you’ll learn tips and techniques from real world dentists, bringing you in depth interviews, motivating stories, current events, and sports. Here’s your special host, the general manager of Keating Dental Lab, Bob Brandon.

Bob Brandon: Hey everyone, Bob Brandon here. Welcome to another episode of the Dental Up Podcast. Our guest this week is a graduate of the Arizona School of Dentistry and Oral Health. She’s a member of the Berkshire District Dental Society and was selected for the Massachusetts Dental Society’s Top 10 Under Ten: Highlighting the Profession awards. She is currently practicing in Lee, Massachusetts. Please welcome Dr. Casey Jones.

Dr. Jones: Thank you so much. Thank you for having me. This is my first podcast ever.

Bob Brandon: Well, this is only about my third or fourth so thanks again. And on behalf of all of us here at Keating Dental Lab, I wanted to thank you for being what I call in our top 10 customers, and it doesn’t have anything to do with volume or sales or anything. These are just our top 10 favorite doctors that we as technicians all really like, appreciate, and look forward to working on your cases. So, thank you. I really appreciate it.

Dr. Jones: Aw, well thank you. That means a lot, and I know it’s been a pleasure to work with your lab, so thank you.

Bob Brandon: Appreciate it, likewise. It is a two-way street and we’re only able to do our job if we receive good quality work from the dentists, and I have to admit that both Dr. Jones and Dr. Wise are in our top 10 because you both put forth the effort and level of detail in the cases to really make them successful the first time. I was wondering if you could explain some of the additional procedures that you, Dr. Jones, and your staff do for us to allow the cases to be so successful.

Dr. Jones: Yeah so I think that part of it comes from my, I guess you could say, luckiness that I have gotten to learn from Dr. Jay Wise as my mentor, because I think coming through dental school there are just so many procedures to learn these days in dental school that lab work isn’t as heavy of a concentration as maybe it used to be. And so we actually had a lab that was on-site throughout dental school so I was able to learn in that way there.

Dr. Jones: But being here with Dr. Jay Wise, he has one of his assistants, Kelly, who has just been amazing in the lab. She kind of knows everything and she pours a lot of our cases and through working with him, there have been times where I will trim my own die for various reasons and he’s shown me how to do that and why I wanna do that, like why I wanna trim it in this certain way to have the right emergence profile so that the lab technician doesn’t have to go in and have their instrument at a weird angle. And I think, like I mentioned to you, that when you trim your own die in spite of every dentist’s probably effort to be a perfectionist and do perfect work every time, you definitely see your imperfections and what you wanna try to do better the next time.

Dr. Jones: So we do that sort of thing. We also will make our own custom trays or maybe our wax rims for our denture cases and I think a lot of that, it helps you to be able to know what it is that you’re looking for from the lab or what you’re trying to achieve moving forward. So I also learn a lot from calling and discussing cases with you guys at the lab and I learn something probably from Kelly, our assistant who works in our lab a lot, almost every day. She’s just a wealth of knowledge and she’s been doing this longer than I have, so that’s fantastic.

Bob Brandon: That is. Now, was Kelly trained as a lab technician before coming into practice with you and Dr. Wise?

Dr. Jones: No. No she wasn’t, and I wish I could remember how many years she’s been with Dr. Wise but it’s a lot. It’s like over 20.

Bob Brandon: Excellent.

Dr. Jones: And so she came in as an assistant and she just … Sometimes people love a certain part of that job and for her, it was the lab work I think. And so he did a lot of training with her and she just took to it and she’s fantastic and gets better as time goes on, so …

Bob Brandon: Excellent. Did she attend the courses at the Dawson Center with you and Dr. Wise?

Dr. Jones: Yes, she has. She has been to the Dawson Center.

Bob Brandon: Excellent.

Dr. Jones: In fact, I think she’s our only assistant so far that has been, but we certainly would love for more to go to that particular training.

Bob Brandon: That’s really important. And we as technicians, we need the continuing education just like the clinicians do, and it’s very important to never stop learning and to always push yourself to do better. There are very few professions in this world where your success is measured in microns, and if you think about it dentistry is definitely one of those.

Dr. Jones: Yes, definitely.

Bob Brandon: And if you become complacent and just wanna stop learning, you definitely reach your ceiling. And all of us here at Keating, we continually strive to push ourselves to keep learning and keep up with the new materials and techniques and everything digital. And I know your practice, you guys have recently delved into the digital world. Can you tell me a little bit more about that?

Dr. Jones: We have. Yes, it’s been very exciting. So we did purchase the iTero and so we have the ability to do digital impressions, and most patients love that and it has this wow factor to it because they can see it happening and see this 3D image that you can sort of manipulate and blow up, and it’s just really cool to them. And I’d say that it’s great. It definitely has a learning curve to it, and the result is really only as good as the information that’s put in there. So if you don’t take the time to learn how to do the scanning or make sure that the scan that you’re sending is as great as the …

Dr. Jones: You get used to looking at those impressions that you take, and you see that bubble on the margin or you see whatever it is, and you have to start to look at that digital scan in that same way because you guys aren’t … I wish you were magicians, and sometimes maybe I ask you to be a little bit, but you can’t make something if you can’t see the whole perforation of the tooth or any of that stuff.

Bob Brandon: Correct.

Dr. Jones: So it’s been exciting, but I don’t know that it’s made us faster at things yet, just different.

Bob Brandon: I think that’ll come, as you guys get more and more cases under your belt.

Dr. Jones: Sure.

Bob Brandon: And it’s like anything new, there is a learning curve. And the whole goal of digital technology is to improve all aspects. It’s gonna be faster, better, and cheaper for you guys as time goes along, and the wow factor for the patients is great. You mentioned being a magician, and sometimes we can blow up the finish lines on a prep and sometimes we can see them and sometimes we can extrapolate and play connect the dots on the computer screen. Other times, we might say, “Okay, well is the margin this line that’s way down apical into the sulcus or is the finish line here?” But it’s great because we can take a screenshot of that image and we can email it to you and then you can then tell us, “No, I need you to move the margin line up. That’s just cementum and it’s kind of rough down there and I didn’t put my bur all the way down there into the sulcus.” You know, that’s …

Dr. Jones: Yeah, I think it’s great. I think it’s really where dentistry is headed and I think that it’s really exciting and even the ability to take a scan of your pre approved provisionals, for example, and then you can scan the preps and it’s really exciting how you can see it all put together in that digital world.

Bob Brandon: Absolutely. It eliminates a lot of the guesswork, what you just mentioned there in terms of a patient approved provisional and taking a scan of that and then submitting that to us, so that’s our blueprint for the final restoration. Technically for us, it’s a very simple procedure for us to combine that scan data in the design of the final restoration.

Bob Brandon: Can you tell me, did you guys consider other types of scanners, different systems, different manufacturers, or what was some of the thought process?

Dr. Jones: Yeah we did, and I think that there are a lot of great options out there. iTero’s just one of them. But for us, the deciding factor was that both of us are certified in Invisalign.

Bob Brandon: Excellent.

Dr. Jones: And I had pretty not long before we got that completed my certification, and so it seemed like one of those things that made sense since we had that piece of it. Why not be able to submit our information to Invisalign that way and so that’s what we went with.

Bob Brandon: Absolutely, great decision and iTero is probably … When customers call in and ask us, iTero is definitely in the top three. And these one, two, or three, it just makes sense really on what fits with your personal practice and your patient and your demographics of what you’re treating. So I applaud you and Dr. Wise for taking this step. It’s phenomenal and it really is gonna pay a lot of dividends for you guys. On the training, how much information did you guys receive in terms of crown and bridge or implant fabrication, implant based restorations?

Dr. Jones: With our iTero training, you mean?

Bob Brandon: Correct.

Dr. Jones: So we had a couple trainings and there was someone that was able to actually see us through a camera that was on the iTero, and so she could see in real time what we were doing and was coaching us. So it was sort of virtual in that way and we were a little skeptical, but it was great. And we did have one of those trainings where Dr. Wise prepared a crown just before, and so she walked us through scanning that in real time.

Dr. Jones: We didn’t have anyone that did the training with us for the implant part of things, so that I mostly watched the training videos that you can access online, and they’re pretty straight forward but I will say that was definitely a learning curve for me. I had a couple redos and I’m not really sure what went wrong, but you go back to that just traditional take the impression and get that one done for the patient so you don’t have to redo it a couple times and then you …

Bob Brandon: I remember, yeah.

Dr. Jones: Yeah, and then you just pull up your bootstraps and try it again because you know you gotta figure it out on the next patient. So I don’t know that we got a lot of that, but I feel like we got enough training. It just takes some practice too, because some of it you can certainly delegate to your assistants who sometimes are better at us than doing it. So they really have a knack at picking that up and I think they enjoy it, and we even use the scans for our new patient exams so that we have a baseline of that and it’s amazing how much you can see. You can see how their occlusion fits together. You can record multiple bite positions so that you can see if they have a first contact before all their teeth touch together. You can monitor their wear and their recession over time. So there’s a bunch of exciting things that we’ve still yet to start to implement, but there’s so much potential in there. I think it’s fantastic.

Bob Brandon: Oh, absolutely. That is so well said. The value of taking a scan on a new patient or an existing patient and monitoring the things you just mentioned, occlusal disfunction, tooth wear. It’s just so important because you can go back five, 10 years in time and tell Mr. Smith here that, “Look, your central incisors, 10 years ago they measured at 10.5 millimeters, and now unfortunately you’re at 9.5 only ten years later. There is some active problem going on here.”

Dr. Jones: Right.

Bob Brandon: Yeah, it’s a great way to record that baseline data.

Dr. Jones: Definitely.

Bob Brandon: So now, has your product or material selection changed since you’ve gone digital in terms of crown and bridge restoration?

Dr. Jones: No, I don’t think that that’s really changed. Dr. Wise and I still like to do gold work and things and we’re part of the Tucker Gold Study Club.

Bob Brandon: Excellent.

Dr. Jones: So that’s a little different realm, or at least they say in the Tucker realm, that we’re still doing traditional impressions for things like that. So we don’t use the iTero for everything but I don’t think there really is any thing that you use for every application. You just have to know when it’s appropriate to use it and know that things will change over time, and you just have to stay up with the new technology as it comes out and keep learning. Like you say, lifelong learner.

Bob Brandon: I mean, that’s absolutely true and it’s great that you’re not forcing the issue with the scanner and forcing it to become everything for you. I applaud your decision on maintaining the tried and true techniques for gold work. It’s beautiful and I know that gold is on the decline, but I applaud you for, you and Dr. Wise both, for maintaining the commitment and the integrity to prescribe gold where it’s needed.

Dr. Jones: Mm-hmm (affirmative), yeah. Thanks.

Bob Brandon: What we do now with some of these digital scans is we’re able to produce restorations without models. And I know your recent cases, you’re getting back almost like a little solid model with the preparation and the crown. In terms of the lab work, we’re able to produce restorations directly from your digital scan, and the way we do it is we first isolate the margin and then we articulate the two arches together, and based on that we can design a monolithic restoration. And I know you guys are a little bit more traditional and there’s nothing wrong with that, but we have three different types of monolithic restorations that we’re able to offer you guys faster, so it’s a standard three day lab turnaround.

Dr. Jones: Oh, wow.

Bob Brandon: And we can save you $20 on each restoration because we’re bypassing shipping, we’re bypassing our …

Dr. Jones: Making.

Bob Brandon: … our model room, we’re bypassing your Kelly essentially in the production stage here. So we do these restorations for probably about 40 or 50 customers on a daily basis and we’re able to produce modelless e.max, modelless KDZ Bruxer which is our traditional high strength material, and our KDZ Bruxer aesthetic which is our high translucent and it’s actually one of our more popular products. It’s growing in popularity every year. The nice things about KDZ Bruxer Aesthetic is it looks more like e.max than any other zirconia that’s out there. And for some of your posterior single units, I’d like to extend this offer to you and just to try it on a case where maybe you have a patient that is a little bit heavier on their occlusion or you’re maybe on a case where you’re not able to get as much occlusal reduction as you would have hoped for, either in terms of an exposure or just a very short clinical tooth. These are very popular restorations and I think that we can save you guys some money too.

Dr. Jones: Okay, great. Thanks for that information. That’s exciting.

Bob Brandon: And in terms of your implant work, again the digital realm ties in beautifully with implant work and scan bodies and we have a way that on your next implant case, just give me a call ahead of time and let me know which implant manufacturer style and size it is, and I’ll order you a scan body and have it shipped directly to your office and all you do is …

Bob Brandon: It’s a digital impression coping, if you will. So instead of unscrewing the healing cap and putting the impression coping in and then taking your physical impression, the scan bodies are tied into a digital library for each manufacturer and implant style. And we take your scan with the scan body and then we just select the manufacturer and essentially the library of the implant, and we drop that implant analog in virtually on the computer screen and we’re able to design a titanium abutment, particularly with the new Keating Custom Abutments and then we can design or fabricate by hand any type of restoration. So this is, again, it’s a very important topic in dentistry. It open up implant treatment to a larger number of patients because we’re able to offer these things at a more cost effective rate for you.

Dr. Jones: That’s great, excellent.

Bob Brandon: So I’d like to go back in your history a little bit, and you have some very interesting experiences that I’d like you to share with our listening audience.

Dr. Jones: Sure.

Bob Brandon: In particular, your move from the Arizona School of Dentistry up to the Arctic Circle.

Dr. Jones: Sure. So let’s see, the Arctic Circle part of things actually hit while I was still in dental school, which it was amazing. So what ended up happening is that our dental school was smaller and newer and was one of those things where they wanted to offer opportunities for research but they didn’t have them on site. So I had had, because I was a professional dancer before I was a dentist, I had lived in New York City, and before I was a professional dancer and then I was in college, I had done some research on sleep apnea.

Bob Brandon: Oh, wow.

Dr. Jones: So before … I know, a lot of befores. So before I ended up going to dental school, I had thought that I wanted to do research and so I went back to doing some research at NYU and was looking at sleep apnea and I was teaching the computer how to score the breaths for sleep apnea, and I found it really dreadful. Just boring because I had no person interaction and I hated getting up and going into work and for me that was weird, because I’d always loved school and I’m kind of a workaholic which is not a great thing. So I realized that that was just not the right way for me to go.

Dr. Jones: So I ended up taking some time and went on some cruise ships with my husband and we traveled the world and figured out what I wanted to do from there, but ended up going to dental school at the Arizona School of Dentistry and Oral Health when I figured out that that’s the direction I wanted to go. And they offered this opportunity to do research and I thought, “Well, I’m just gonna ask if I can go to NYU.” So I contacted the pediatric department there because I love working with kids, I love all ages, so I ended up getting to do some research in their department and it was on various things like nutrition for compromised … What would you call it? I guess nutrition for kids who have health challenges and how you can keep them healthy through dental stuff and all of that, because it’s just one other thing to think about.

Dr. Jones: Also using fluoride in early prevention in kids. Not just prevention but if they’re just not quite … We called it pre cooperative. There’s just not quite ready for that dental treatment, how you can use this regimen of bringing them in for fluoride varnish treatment, and this was even before silver diamine fluoride, but looking at that.

Dr. Jones: So I got these opportunities from there and then while I was there, the dean of the pediatric dental department asked if I wanted to go to Alaska with him on an outreach. I was like, “Um, sure. That sound amazing.” So that was the plan and they just wanted a couple people from ASDOH, or Arizona School of Dentistry and Oral Health, to go. So one of the instructors, Dr. [Maurine Romer 00:23:12], said, “Yeah, I’ll go.” So she went and actually the first time we tried to go we got stopped by a volcano erupting.

Bob Brandon: Oh no.

Dr. Jones: So it got rescheduled. Yeah, but it got rescheduled and we got to go. Then I got to go twice. The second time they actually let … The first time they let other undergrads, people from NYU go, and that was the first time that they had done that, so that was exciting. And then it was just me from ASDOH, but the second time we got to bring other students from my school with NYU. And then for years after that, they partnered together and they got to do these outreaches and it was amazing.

Bob Brandon: That’s fantastic.

Dr. Jones: What a great opportunity.

Bob Brandon: So where did you live? What were your living conditions like up there?

Dr. Jones: Well, we had an air mattress. A single air mattress, and we had a sleeping bag, and we had one of them had bunk beds that we had that could go on top of that. There was nothing fancy. In Fort Yukon, there was a really nice dental facility but it was just one dentist and he just could not keep up with the demand of the work that was there. So once a year he had all these people to come and help with the dentistry that was needed, so that was exciting.

Dr. Jones: And then when we went to I think it was maybe Arctic City, I’m forgetting now, but the other really remote town that we went to. We did not have any warm water for showers, but I will tell you that those were the most refreshing cold showers that I have ever taken. It was so nice to do that at the end of a day. You’re standing up. In that case, we were more or less in like a gym and we had chairs set up for the patient and then we had all the portable dental equipment, and we would use just boxes of gloves for them to lean their head back onto in order to have it be their headrest. So those were the conditions that we were working in and it was fantastic. I learned a ton.

Bob Brandon: That’s excellent. It’s whatever it takes to get the job done up there and providing care to patients and human beings that don’t have access to it in a traditional setting. That’s phenomenal. We had a customer, and he’s now since retired, but he practiced on Nantucket Island and his first job out of dental school was with the Native American Health Services, and he was up near the Arctic Circle for two years after dental school. And hearing you talk about some of these things brings back some of the stories that Dr. Roy Davis used to tell me and it’s not all practicing in a nice, shiny office with high tech equipment. There are people out there that you have to go to and reach and make it happen for them. So that’s phenomenal. Great story. Thank you for sharing.

Dr. Jones: Thanks, thanks. One of the things that I loved about the Arizona School of Dentistry and Oral Health is that we all got our Certificate in Public Health while we were there. So in our third and fourth year of our education, we got to rotate throughout community health centers throughout the US really, and so I got to go to Maine and to Washington and wherever to have training within a community health center, so we were helping meet the need for access to care along with getting our education. And those people were calibrated to be able to continue to teach us and score us and all that sort of thing, but I thought it was a great model.

Bob Brandon: Oh, absolutely. The more patients you can get exposed to and everything while you’re in school and learning, that pays dividends down the road. Absolutely. What were some of the other either challenging or fun procedures that you got to do in dental school that you remember and are taking into practice with you now?

Dr. Jones: Challenging or fun? Well, I think that one of the things that I found most fun or challenging in dental school were the pediatric procedures and getting to work with children. And I was one of those lucky ones that I got to do a ton of stainless steel crowns in my rotation through the pediatric [inaudible 00:27:50], and we just had a great staff. I loved everyone that taught at ASDOH but those were ones that always stuck out in my mind because we would always do …

Dr. Jones: We were sort of forced to volunteer. We had to come up with actual projects that we would do, like plan the Give Kids A Smile or do other outreaches too, but those were always fun. And then also, I’ve always had this two loves. And I think that always happens in my life it seems, like dance and science. And then it’s kids stuff and this high end almost pros like stuff, where I thought about specializing in prosthodontics along the way but I also thought about specializing in pediatric dentistry. And I just have so many loves that it was hard to pinpoint and that’s the cool thing about general dentistry is that you can pick and choose and kind of do it all, if you want, in a way. So that’s where I am.

Bob Brandon: Do you guys treat a lot of children in your practice?

Dr. Jones: I see children. I don’t think that we see a lot of children, but we definitely see more children here since I’ve been here and even if I’m not seeing kids in the office, I love … I go into the schools every year. I think February was Children’s Dental Health Month so I was one of the Massachusetts Dental Ambassadors, and I got to go into the schools and go on the radio and record tips and share stuff on Facebook and just try to get the education out there for the parents of how to take care of these teeth and how to prevent problems. And that’s one of the things that’s so exciting to me being general dentist and getting to see what happens if you don’t do X, Y, and Z while they’re young, with all this stuff about sleep apnea and growing the airway in kids while they’re young versus having to wear a CPAP when they get older. It’s interesting how all of that is coming into the dental world too, since I’ve seen sleep apnea from other perspectives too.

Bob Brandon: Oh, absolutely. Yeah, I mean it’s such an underdiagnosed and undertreated problem, especially in kids with, like you said, growing the airway and making sure that the arches are wide enough and compatible so that nighttime breathing so that they’re not mouth breathers and everything. It is a hugely underdiagnosed …

Bob Brandon: I’ve seen it in my own children, and they’ve both been through orthodontics. And now my, I think you used the word precooprative, 17 year old is finally starting to understand some of these things. So yeah, it’s all fun stuff. And you mentioned your other love was the prosthodontics side and again, I can’t thank you enough, but you and Dr. Wise, your work level and quality is truly it is prosthodontic quality and exceeds even some of our customers and dentists that we’ve had the great fortune to work with that are true prosthodontists. So again, I want to thank you for your level of work and dedication to the craft here. It’s amazing.

Dr. Jones: Oh, well thank you. We definitely try. It’s hard work every day, that’s for sure. There’s a lot of time that goes into it that isn’t face to face with the patients. There’s a lot of behind the scenes stuff, and I think a lot of people don’t realize that, but there’s certainly nothing more rewarding than being able to give someone their smile back. That really, I feel like, can change someone’s life, which is a pretty exciting … That’s kind of like having a super power. You can …

Bob Brandon: It absolutely is.

Dr. Jones: How cool is that?

Bob Brandon: I can’t agree more and I think that’s why we’re all in this, is to help people smile and restore their function, restore their health …

Dr. Jones: Absolutely.

Bob Brandon: … and to give them more pride and a better sense of self being, really.

Dr. Jones: Yep.

Bob Brandon: I’d like to end if you don’t mind, and I thank you and I know we’ve gotten a little bit off topic, but I think all the stories were phenomenal. I’d like to end though by, if you could pass on one or two pieces of advice to the younger audience, those that may be considering going to dental school or are currently in dental school or trying to find their way immediately after dental school, what advice would you like to share with some of the newer dental professionals?

Dr. Jones: Yeah. Well, I think one that I tend to say is fake it until you make it. And that sometimes sounds bad, but what it really means is that you’re gonna be outside of your comfort zone at times and that’s really the only way that you’re gonna learn new procedures and move forward in your career, and it’s always with the best interest of the patient at heart and you’re gonna learn everything you can, but there’s realistically gonna be that time when it’s your first time ever doing something and you’re maybe freaking out in your head, but you don’t want the patient to know that, because they don’t wanna know it. So fake it til you make it.

Dr. Jones: And then I also think never stop learning. It’s so important to be a lifelong learner and to realize that you definitely are never gonna know everything, and use the people that are experts in what they do for what they do well because it’s important to try to quarterback all of that stuff and be an advocate for the patient. And there’s just so many new exciting things that are coming out in so many different directions that you can take a dental profession that it’s great. So do it, if that’s what you wanna do.

Bob Brandon: Absolutely. Thank you so much. I know time is money. I thank you so much for your time and all your expertise and wisdom that you’ve passed along to the dental community. And remember if you have a case next week that you wanna try out one of these modelless restorations or on your next implant case, just give me a call ahead of time and I’ll get everything straight and ordered and just sent directly to your office so we can make these procedures faster and smoother for you.

Dr. Jones: That sounds wonderful. Thank you so much, and thank you for all that your lab does. It’s wonderful to have consistent results that you know that you can count on and if there ever is the occasional whatever is the issue, we know that you will be able to fix it. So that’s just a great relationship to have. So thank you from both of us, from Dr. Wise and from myself.

Bob Brandon: And on behalf of all the employees here at Keating Dental Lab, I can’t thank you and Dr. Wise enough for your dedication and quality that you put forth to let us do our jobs properly. So thank you.

Dr. Jones: Thank you. Alright, that sounds great. Thank you so much. I appreciate it.

Bob Brandon: Okay, take care. Thank you.

Dr. Jones: Okay.

Bob Brandon: Okay.

Dr. Jones: Take care.

Bob Brandon: Bye-bye.

Dr. Jones: Alright, bye-bye.

Announcer: Thanks for joining us on the Dental Up Podcast show this week. Make sure to follow us on Facebook, Instagram, and Twitter or search the Dental Up Podcast on iTunes for our weekly feed. Don’t forget to visit keatingdentallab.com/promo for exclusive offers. Keating Dental Lab is a full service dental laboratory and we’re nationwide. We’d love for you to send us a case so we can show you the Keating difference. If you dig what you heard, please leave a review on iTunes and we’ll be back next week.