| Shaun Keating CDT + Dr. Timothy Test DMD |
Dr. Timothy Test DMD has been practicing family and cosmetic dentistry for the past 25 years in Bethlehem, Pennsylvania. Timothy has built his practice on one simple philosophy: He treats his patients the way he would like to be treated himself. Timothy understands that the dentist’s office is an intimidating place to be for a patient, and he goes to great lengths to provide a positive experience.
Dr. Test is a huge advocate for preventative care and pain management. He takes the time to really analyze why a patient is in his office to try to prevent the issues from re-occurring. Timothy has significantly changed their lives by for salivating their pain. They take notice to the way he cares for them and the online review reflect Dr. Test’s preventative work.
Shaun: This week, we’ll be featuring a dentist who has been committed to outstanding patient care. We will be dissecting the importance of patient experience and how you can provide the best care available. This dentist has practiced family and cosmetic dentistry for the past 25 years in Bethlehem, Pennsylvania. Please welcome, Dr. Timothy Test, DMD. How’s it going, Timmy?
Dr. Test Thank you, Shaun. Hey, it’s going great, man. Great to be here. Sorry for all the snafus finally getting this set up, but here we go. We’re rocking.
Shaun: Dude, that’s so cool, man. I love you. T.T., man.
Dr. Test I love you, too, man.
Shaun: Timothy Test, dude. I remember, shit, a long time ago, we were at a dental meeting, and I think it was in San Francisco, and we actually finally met face-to-face. We went out to dinner, didn’t we?
Dr. Test Indeed.
Shaun: It was like a bar-restaurant. I remember eating a big ol’ Porterhouse and just throwing back beers left and right, and there was a band that was playing, man. Frickin’, I went up and threw a bone to the guys, tipped ’em out. Just frickin’ lovin’ the music. Weren’t they like a Rolling Stones tribute band or something?
Dr. Test They were Rolling Stones cover band, and they were very good.
Shaun: They were really good. I remember the guy calling me out and going, “Dude, thanks for the tip,” and I’m like, “Yeah! Hey, this guy can sing next to me.” You’re like, “What the heck?” And, actually, you went up there and frickin’ sang a song. Dude, what song … ? I got that on video somewhere. What song was it?
Dr. Test I played guitar and I sang “Sympathy for the Devil.”
Shaun: That was it! You were so freakin’ good, and I’m lit in the background going, “Timmay. Timmay. Timmay!” You know, like from South Park because I always did that to you. “Timmay, Timmay.”
Dr. Test It was a good time, for sure. Just completing my world tour of major cities where I perform or something like that.
Shaun: Ah, dude, but you had the biggest balls to freakin’ … I just was like [inaudible 00:02:02], and you just got up and you were like Joe Crocker up there, man. You were twitching and you had such stage presence. I remember the other guitarist and the bass guys just in awe of you when you got up there and they said, “Yeah, we can play that song.” You guys were just jamming it, and they were all in awe of you. The whole place was-
Dr. Test You should’ve been on the drums, though, because I know you’ve got skills yourself.
Shaun: Yeah, you know, but-
Dr. Test The dental world might not realize that in addition to being a world-class lab owner, you’re also a world-class percussionist.
Shaun: Yeah, but, dude, no, I’m not. I’m not that … I don’t know any songs, really. I think I know three songs. I know Kiss “Cold Gin,” I know “TNT” by frickin’-
Dr. Test Hit it on two and four and shut up. That’s all you gotta do.
Shaun: Exactly. I remember, dude, I went to this big Rock ‘n Roll Fantasy Camp in Vegas, like, 5 … 2012 I went. The dude, my counselor, was Rod Morgensteinn from the group Winger. Remember that Winger group?
Dr. Test Sure. Sure.
Shaun: Kip Winger, he was one of the guys, but my guy was the drummer. So, he was so frustrated with me. Three days he was with me, and he was like, “What’s wrong with you? Just one, two, three, four. One …” He kept looking at me and saying, “No. One, two,” like mouthing it during the final show. He said, “Dude, I’m gonna have to go up with you because you’re frickin’ all over the place,” and it’s like, “Ah, man. I suck, dude.”
But, dude, that was so fun, man. I remember that totally and, God, hats off to you, man. Timothy Test is very talented. Don’t you have a thing going on in your house, like you have your own Coachella type thing in Pennsylvania?
Dr. Test Oh yeah. We have a yearly house party on Memorial Day weekend, where we have about 250 people come over to the house, and we set up a whole stage, and have live music from, God, noon until when the cops shut us down at night.
Shaun: That is so badass. I mean, even, too, looking at your property around there, it’s just a different world when you’re raised in the kind of city-suburbs or whatever. We know it’s Christmas time here when the lights are put on the house and stuff, and where there, it was like, you got your seasons and it just looks gorgeous, man. Seems like a lot of acreage out there. It’s just wide open, but good fun.
Dr. Test We love it. We absolutely love it, man. That’s where I recharge, man. That’s where I recharge.
Shaun: That’s so cool.
Dr. Test I love people and I love my job, but at the end of the day, just get me out there to the country and let me just bake. Oh yeah.
Shaun: That’s it.
Dr. Test Sitting on the back porch with an acoustic and strumming away and singing to the dogs. Oh yeah. Life is good, man.
Shaun: I know. I seen that, and that’s just so cool, dude. It really is. A lot of talent. You gotta do that annually, I’m sure you do. We gotta build it and I wanna come out next time. Maybe even get out there and-
Dr. Test If you’re ever even close to me on the east coast, man, you let me know.
Shaun: Oh, absolutely. Cool, dude. So, I’d like to start off a little bit with sports. What do you like out there in your area? Obviously, you’re Philadelphia, because you’re pretty close, a couple hours from Philly.
Dr. Test Yeah. I’m sort of a lapsed Eagles fan and Phillies fan. I still do a little bit here and there, but, honestly, between kids and jobs and music and everything else, I kinda lost my mojo for sports a little bit. I’m just not into it the way I used to be. Plus, a golf addiction, too, because that’s bad. I’ve got a 9 iron right in the vein, man. It’s not good.
Shaun: That’s so cool, dude. I know you golf a lot. I’m starting to golf, and I still suck. I broke 100 once.
Dr. Test That’s fine.
Shaun: Yeah, it’s frickin’-
Dr. Test Over 50% of amateur golfers never break 100. Always remember that.
Shaun: Yeah. Really? I’d never heard of that. I feel a little better. I don’t think I truly ever broke 100. I think I took four and five Mulligans or whatever they call them, but I just gotta calm down and just … I try to frickn’ kill it every time. I took a lesson recently, and he goes, “Now, take half that swing away, dude, and just plop it down the center of the frickin’ course instead of just trying to hit for the home run every time.” So …
Dr. Test You gotta play golf with old men. You gotta learn old man golf. These old boys, and they’re 65, 75 years old, they take a simple little swing, they hit the ball in the middle of the club face every time. It goes 170, 180 yards, but it’s in the middle of the fairway.
Dr. Test Then they hit it again, and then they chip it, and they putt it, and they make par every time, and they take all your damn money. It’s a terrible thing.
Shaun: You know what? That is so true, and I’ve had a few people say that. Even if it’s 120 yards or whatever, man, just keep it down the middle, dude. But, it’s fun. I went out and bought the best damn clubs and everything else. People look at me and laugh. They’re like, “You got those good clubs, dude, but you’re horrible,” and I’m like, “Yeah.” I kinda don’t even want … I wanna get a different bag because I’ve got these PXGs, man. That’s Parson’s Xtreme Golf or whatever. That guy’s like some rich dude, and he said, “I’m just gonna make my own clubs,” so I think he hoarded a bunch of the old Ping Engineers. He just designed these things and, heck, if I knew how to play, I’m sure they’re great.
But, I get out there, and from the different 3, 4 … They didn’t give me a 3 iron because they said, “You’ll never be able to hit it.”
Dr. Test No, you don’t want a 3 iron. You don’t even want a 5 iron. You don’t want a 6 iron. You want 7 iron up, and then hybrids and rescue clubs because nobody can hit a 3 iron. You know the old story, right?
Dr. Test If you’re ever playing in a lightning storm, always hit your 1 iron. Do you know why?
Dr. Test Because not even God can hit a 1 iron. Ba dum tss.
Shaun: Ah, Timmy. Timmay! You knucklehead.
Dr. Test So, I spent my morning grinding down some enamel and sending some rubber out to Keating Dental Lab, baby.
Shaun: Oh, that is so cool, dude. I thank you for all the work.
Dr. Test My favorite part of the morning.
Shaun: You’re crushing it. You have for years, and I thank you for all the work. You’re across the board. You do implants, you do everything, man. What about-
Dr. Test I try to do everything I can.
Shaun: That’s awesome. You ever gonna get into any digital scanner, maybe, for impressions or what? What do you think about that?
Dr. Test I’ve thought about it, honestly, but talk to your [inaudible 00:08:13] buddy, Eric, there about how long it took me to set up a simple GoToMeeting thing here. That’ll tell you about my relative technology competence. Believe it or not, I’m still film x-rays, man. I’m a little bit old school.
Shaun: Hey, that’s fine.
Dr. Test It’s my 25th year in practice, and I like film and it works for me, and there’s something comforting for an old guy like me to just hold that actual film in my hand and know that it’s there.
Shaun: You’re not alone. Still probably 75% of my guys are still that way. I had a dude last week, Dr. Weinstein. He’s, like, over 50 years, and this guy’s like a dinosaur, but he’s still practicing and doing some quality-ass dentistry, man. Hey, all the new stuff is all nice and shiny bells and whistles, but you can do it old school and get the job done-
Dr. Test We kinda made the point with the discussion on golf clubs. You know, you’ve got the world’s fanciest, most highly technological golf clubs in the world, but Tiger Woods could go out there with a shovel and a rake and beat your ass.
Shaun: Exactly. They say the same thing with frickin’ porcelain and ceramic. You’d have the shittiest porcelain out there but the best ceramic, so you can make that stuff dance and look frickin’ unbelievable. You can have the best porcelains and an average ceramics, and it looks like crap. It’s anything in life like that, I think.
Dr. Test “It’s the Indian, not the arrow,” as they say, my brother.
Shaun: Exactly. “It’s not the sword, it’s the swordsman.” That’s it.
Dr. Test I liked your metaphor better than mine, man.
Shaun: Well, let’s dental up here a little bit.
Dr. Test Sure, baby.
Shaun: So, why did you get into dentistry and at what point did you think, “Man, I’m gonna be a dentist”?
Dr. Test That’s a kind of weird story, but I was one of those kids that just from the time I was very young, I wanted to be a doctor. Don’t know why, but just always wanted to be a doctor. I was fascinated with medical shows and loved biology in high school, and just always wanted to be a doctor. Then, went to college and was not exactly the most stellar student, I guess, and back in the day … this was in the mid 80s … it was really, really tough to get into medical school. And, I had some numbers at the end of college that weren’t exactly med school bound, but my instructor said, “Hey, why don’t you check out dental school? Get you into a real good dental school.” I thought, “Well, I never really thought of that.” He says, “Look, you can play guitar, you paint, you sculpt, you work with wood, you work with your hands all the time.” He says, “Why don’t you think about doing that because right now, it’s real easy to get into dental school. We’ll get you into the best. You’ll have a great time.”
Okay, so I applied and got into Penn and Columbia and Stanford and a couple other schools. And, decided to go to Penn and just loved it, just from day one just really, really loved … I loved fixing stuff. I loved saying, “Okay, I’ve got a patient here in my chair. They’ve got a problem. I’m gonna pick up a tool and I’m gonna fix it. When they leave, they’re gonna be fixed. They’re not gonna leave with a prescription pad with a drug that’s gonna give them 50 side effects. They’re gonna need another drug to take care of that side effect. I’m gonna fix them.” That’s still what really, really draws me to this profession, makes me proud to do what I do.
Shaun: Yeah, you’re like a MacGyver, totally. I mean, I can see you doing … You know, fixing and all your woodwork and all that you do, you really are very talented.
Dr. Test I love working with my hands. I really, really do. To be able to take that terrified patient that sits down, and they’re shaking in their shoes, and you sneak the Novocain in and they’re like, “Are you gonna get me numb?” I’m like, “Yeah, I already did.” Oh.
Shaun: That’s so cool.
Dr. Test Yeah, you sneak that elevator up in there, you wiggle it around a little bit, and you kinda palm number one. You put it in your hand, you put it down on the table, then you have them bite down on gauze. Then, you snap the gloves off, and they look at you and go, “Why’d you take the gloves off?” “Well, because I’m done.” Then you show them the tooth, then their eyes bug out their head.
Shaun: That’s so cool. That’s awesome how you do that. You need to.
Dr. Test It’s a good feeling. It really is. It really, really is.
Shaun: You gotta have that bedside manner, for sure, man.
Dr. Test Well, you know, my assistant and I have been working together for 19 years now.
Shaun: That’s sweet.
Dr. Test She’s a dear friend, for sure, and my other assistant and I have been together for 11 years, and we keep it light. We keep it real. We keep it focused on the patient, but we keep them laughing. We keep them happy. We don’t take ourselves too seriously. We take our work seriously, of course, but we don’t take ourselves seriously. We’re not going in there with a starched white coat and a stiff upper lip and all that. We’re going in there and we’re being real people, and we’re doing real work, and it’s a great feeling. It really, really is.
We have a very prevention-centered practice as well. There’s no question about it. I’m the kinda guy that a new patient comes in, and I’ll sit there for sometimes 45 minutes to an hour just talking to them about why they’re here. Why have they been in the dental chair so much? You’re 35 years old, you’re very healthy, you take good care of yourself. Why is it you’ve already gotten $20,000 worth of dentistry. What’s going on? We talk about those things. We talk about everything from diet to home care to, God knows, we talk about para-function, clenching and grinding. That’s a big thing. We change a lot of minds, and we change the patient.
I think it was Spear that said, “Before you try to change the teeth, change the mind.”
Shaun: No kidding.
Dr. Test That’s what we try to do. If I could empower Mrs. Smith to be her own best dentist, her own best hygienist, I don’t gotta do as much work. Neither does my hygienist. That’s what we try to do every single day. We share things with patients. New patients kinda first look at us sideways and say, “I grind my teeth? What are you talking about?” We show them, we pick up a mirror, we pick up an intra-oral camera, we show them the where, we let them understand things. You probably know this, but I do a tremendous amount of pain management dentistry as well. Jim Boyd and Barry Glassman taught me all their magic, or some of their magic anyway, almost 13, 14 years ago now, and we’ve delivered probably somewhere in the neighborhood of 2500 NTIs in the last 14 years. Big, big part of our practice, and makes me real proud. Makes me real happy to know that we got patients who had been through how many years of pain and suffering, how many years of unlimited specialists and medications, dear Lord, and we got our hands on them and their pain stops, and their dental problems stop. That’s a good thing.
Shaun: Is that a TMJ thing mostly with the pain?
Dr. Test It’s everything from TMD patients, patients with pain from the jaw, to migraine patients, tension headache patients. We do a tremendous amount of work with sleep apnea and snoring prevention as well, and there’s a lot of overlap in those two things. We have a lot of patients who suffer from apnea and also morning headaches and migraines, and it’s always a big challenge to figure out exactly what appliance is right for that person. But, we do a lot of NTIs, we do a lot of TAP appliances. It’s a wonderful thing. Knowing that I can keep the patients’ teeth happy and also have way more impact, in many cases, on their overall health and well being than their physician, it makes me feel real good.
There are times when I’ll never regret the decision to become a dentist, but I always had that thing where, yeah, I wanted to be a quote-unquote real doctor back in the day. The things that we do with pain management and TMD and TMJ patients give me that feeling a little bit, a lot.
Shaun: That’s frickin’ awesome, dude.
Dr. Test It’s pretty cool. As I like to joke sometimes, it’s kind of a crappy business model. When all of your focus is on prevention, you certainly do a lot less dentistry than you might, but-
Shaun: But you sleep good at night, and-
Dr. Test Oh, that head hits the pillow really good every night, I promise you, bro.
Shaun: That’s so cool. Now, do you do anything like … Like, my wife had a clicking in her jaw, and they actually did a Botox into the joint or something, and it frickin’ [crosstalk 00:16:31], and it eliminated it. What’s the reasoning behind that? Have you ever used the Botox or no?
Dr. Test I do not. I have a couple very good friends who are local surgeons that do that for me in some situations. But, at the end of the day, what I found is that almost every quote-unquote TMJ patient, more preferably TMD patient, has some degree of para-function, has some degree of grinding and clenching. When the jaw starts to go bad, it goes bad simply because you’re putting too much pressure on it. My analogy that I’ve shared before is, if I were an orthopedic surgeon and a patient came into my office, and I saw them standing around in my waiting room bouncing up and down on one knee, and they came back and said, “Doc, I got a problem with my knee,” the first thing I’d probably say is, “You know what? Do me a favor: stop bouncing up and down on that knee.”
Dr. Test “Doctor, it hurts when I do this?” “Well, stop dong that.”
Shaun: Exactly. I’ve been told that before. “It hurts my thumb when I do this dislocating the joint,” and the doctor goes, “Well, stop doing that.”
Dr. Test Don’t do that. Right.
Shaun: And I stopped doing it years ago, and it doesn’t hurt anymore. It’s like the easiest advice.
Dr. Test The level of … And I use the term para-function to loosely describe everything from clenching, grinding, biting your nails, biting your cheek, anything you do with your teeth you’re not supposed to be doing with them. It is so prevalent, it is so common. It is absolutely ubiquitous, but it’s completely underdiagnosed in dentistry, without a doubt, and God knows almost unheard of in medicine. With our pain management stuff that we do with migraines and tension headaches, I spent a lot of time many years ago lecturing to neurologists and headache clinics and all these places presenting our data in how much of an impact we’ve had on these patients, and got almost zero referrals from any of these places because there’s just this kind of disconnect of, “Oh, it can’t just be from your teeth. Teeth don’t cause headaches.” Well, teeth don’t cause headaches, but clenching with unbelievable force day and night certainly do cause problems.
You can think grinding and clenching for your business because, let’s face it, why do people need to have crowns put on their teeth?
Shaun: Because they grind those little bastards down all the way, and we gotta cap ’em.
Dr. Test They grind ’em to the bejeezus.
Shaun: We gotta cap ’em and send ’em to Keating.
Dr. Test Sure. Sure. One of my favorite moments in dentistry was in 2003, I believe, in San Diego at Jim Boyd and Barry Glassman’s lecture on NTI and pain management. In front of a room of 35 or so dentists, Jim Boyd stood up there and said, “Guys, let me ask you a question. How does this wear occur?” And she showed a slide of someone with severely worn teeth, and you got a variety of responses. “Well, maybe he ate sunflower seeds. Maybe he chews ice. Maybe he does this.” Then, Jim just said, “Well, how hard is a sunflower seed compared to enamel? How hard is ice compared to enamel?” We all just kind of looked at it, and he said, “Let me ask you another question.” He says, “Do your teeth touch when you eat?” It’s all a bunch of kinda confused faces around the room, and then a chorus of “well, hell no, of course they don’t” and a bunch of light bulbs all went on. That’s when I just … This was 2003 or so, and I’d already been a dentist for 10 years at this point, but it just all of a sudden clicked, realizing that all of that wear that I see. It’s not from this or that. It’s because people grind their teeth incessantly.
I remember Jim said … We’re about to go on a lunch break. He says, “Do me a favor.” He says, “I want you all to chew your sandwiches in group function,” and, boy, did that really strike a chord with me and I thought, “Wait a second. It’s not group function. It’s group para-function. That’s what’s going on. That’s what we’re doing this for.” All these theories of nathology and guidance and all of these things, they don’t have anything to do with function. They have to do with para-function. That’s been the biggest battle, in terms of dentistry, of the different camps with occlusion that … Well, malocclusion doesn’t cause grinding and clenching, but if you have grinding and clenching, let’s make sure you’re quote-unquote occlusion is designed as best as it can to protect whether it be your natural teeth or that beautiful porcelain crown I just put in your mouth. Let’s make sure it’s good for that.
I think we’re starting to see that shift. Thanks to the tireless efforts of Barry and certainly Jim as well, we’ve seen that shift a little bit. We’re starting to wake up to it a little bit. I still participate on Dental Town and a whole bunch on Facebook with other dentists. At least a couple of times daily, we share cases, we share thoughts, and I think it’s starting to-
Shaun: To resonate.
Dr. Test … to make the turn that it should, where the emphasis is not on changing the occlusion to stop the para-function, but on stopping the para-function and making sure your occlusion is designed to withstand what para-function happens.
I think the next big thing, really, that dentistry needs to look at, too, and have the discussion about is daytime para-function. That’s the conversation that I have so often with my patients these days. With the number of night guards that we have out there, we know we have patients who are religious with their right guards. They wear them every single night because if they don’t, they wake up with an 8 out of 10 migraine every morning. So, I know I have these patients wearing their night guards just religiously. But, yet still, some of them are still wearing and breaking teeth and breaking restorations. It’s a daily conversation. “Well, let’s talk about your daytime grinding,” and every single day, I get patients looking at me as if I had seven heads sprouting from my neck. They think no way in hell they grind and clench their teeth during the day, that’s it’s somehow a weird that or that they would never do that.
Shaun: Yeah, you wouldn’t think they would. You would think they were making a natural freeway space, like you got that resting butt face all day, you know. “Who’s sitting there grinding their teeth?” But, I guess, maybe people do.
Dr. Test Oh my gosh. Invariably, I’ll have these same patients come back a week or a month later, and they’ll look at me and say, “Dammit. Dammit.”
Shaun: “You’re right. I do grind them in the daytime.”
Dr. Test Right. “I grind them all the time.” I think sort of opening up that connection, somehow getting people to have that awareness, however we might do it … I’ve done things as silly as I’ll take one of the cheap-ass giveaway rings that we give the five-year-olds after the cleaning, and I’ll put it on the patient’s finger, and I’ll say, “Okay, every time you look at this ring, check where your jaw is.” Or, I’ll them, “Put a little Post-it note on the dash of your car,” because God knows … You’re in California out there where you sit in traffic for four hours a day. Next time you’re stuck in traffic on the 401 or whatever number you might be on, take a look around, see what their jaws look like, see what those folks are doing.
Shaun: That’s a trip. Even, too, you got me thinking, well, you know, I don’t think about it when I eat, but do my teeth really touch? I don’t think so, unless I’m really trying to rip or something.
Dr. Test Oh, when you’re eating? No. If you’re gnawing on a rib here … Think about this: think about a time you’re really hungry, you’re really digging into a meal, and you’re chewing, and all of a sudden your teeth kinda grip together. You get that kinda nails on a chalkboard feeling.
Shaun: Ugh, I hate that. Yeah.
Dr. Test It doesn’t happen often, and when it does happen, we’re very aware of it. But, that force that happens with an inadvertent tooth contact when we’re eating is still minimal compared to the force of especially nocturnal bruxism. It has to be addressed, and I wish it were addressed so much more.
Shaun: That’s great, great info, man. I don’t think about it a whole lot other than working on curve of Spee, curve of Wilson, compensating curves. We have stone models, you know. They feel no pain, but what you guys go through and that is just amazing, though.
So, let me talk about bit about on your practice now … So, you’ve been 17 years in Bethlehem there.
Dr. Test 17 years [inaudible 00:24:46] Bethlehem, yep.
Shaun: When you first started up, did you work for a doctor? Tell me a little bit on when you started out and how you started your practice.
Dr. Test I had two associateships here in the area. One was right out of school in ’93. That lasted for four years, and then the owner decided to sell the place right out from under everybody. Then, I had another associateship for three years, and after about three years, I said, “No. This isn’t for me. It’s time to get my own place.” In 1999, I started looking around, found a great building in a great location, and scratch started out of nothing. Now, I’d had seven years in the area, and I’d had, thankfully, a good reputation and a good following, but there’s obviously the limits with contracts, et cetera. But, we sort of got the word out through advertising and a little bit of marketing, and grew every year, and we love it. We just love it.
Shaun: That is so cool. That’s ballsy to start your own place from scratch, man.
Dr. Test Oh, terrifying. Absolutely terrifying. Absolutely beyond terrifying.
Shaun: Me, too. When I started this, frickin’ I just built it, you know? It was like, “Fuck. Build it, they will come.” I remember saying that, but I don’t think I could do it to this day. To start over, it would scare the hell out of me. Same with you. I bet if you were gonna try to start a practice from scratch in this economy and just the way that everything is going, it’s tough.
Dr. Test Mind you, the economy is different. It was 2000 when we first opened, the economy was still booming, people were still spending money left and right. When we started out, we had two [inaudible 00:26:22] grinding it out full time. We took every insurance known to man at the time, just to keep the chairs full. But, I’ll tell you what, 2008, 2009, the whole industry felt it, and the whole industry, I think, is still coming back from it. We certainly are.
Shaun: I see it because I’ve got so many doctors in all different states, and it’s never gonna come back, the hay day. When I first started off 2002, those were boom years. My first four years, I grew so much, and then ’06 and ’06, and it started to … All those practices limited to cosmetics because everyone had that real estate, you know, extra discretionary income that … Houses went up, and they’re spending left and right. “Let’s get my teeth done.” Everyone wanted their teeth done, then it dropped out the bottom.
Dr. Test Absolutely. I’ve definitely seen a comeback the last couple years, there’s no doubt about it. But, yeah, it’s not over. I don’t think it will ever come back to where it was, and that’s okay. We have a fairly modest practice. We have four operatories, I have a front desk girl, my wife is the office manager, which is lots of fun always, and I have two hygienists and two assistants. Pretty lean operation, fairly modest building. I never wanted to build a big dental Shangri La, never wanted to be strapped to anything like that. We watched our debt, we didn’t get too many toys. I don’t own a Cerec, I don’t own anything majorly fancy. I never wanted to. I think every toy that you buy as a dentist, you have to feed it. If that toy is a Cerec machine, you’re gonna tend to see things looking like a crown more than maybe they should. Keep the toys to a minimum there, you young dentists out there that might be listening to this nonsense.
Shaun: That’s good advice, man. I tell you, most of my guys that are successful say the same thing, man. Just get in there lean and mean, first five, ten years. Don’t buy nothing you don’t need, but just get your chops in there and get your seals down, and don’t expect to make any money. The money will come. Just concentrate on the patient, do the best dentistry you can, and everything will follow. I see you got a diode laser. At least you broke out that. What kind of laser you got?
Dr. Test I got a laser. I got a little handheld … I like it. I don’t think it’s indispensable, and I like it. I use it. But, soft tissue management, for me, begins with patient compliance and home care, for sure, the appropriate use of chemotherapeutics, and laser when needed. It’s not a core of my practice, by any means, and I don’t think it ever will be. Remember, here’s my dirty secret, Shaun: I still do amalgam. Don’t tell anybody.
Shaun: Dude, last week, Weinstein’s like, “Shaun, I probably done a million amalgams. I still do ’em. It’s a great service.” You know what, dude? Be proud of that.
Dr. Test They will take away my amalgams when they pry them from my cold, dead hands.
Shaun: That’s awesome, dude.
Dr. Test There was a Facebook debate last week between … Well, it wasn’t a debate, I guess … But, an unnamed dentist in Florida, shall we say, who has a bit of an interesting reputation put a quote up on Facebook saying that, “Amalgams are fine for poor people, but in my practice …” His full quote was, “They’re fine for poor people and inferior dentists.”
Shaun: That’s so messed up. Hopefully that wasn’t Billy Boy Strupp, was it?
Dr. Test It went over kind of like a led … Oh, I wouldn’t name any names, no no. But, there was a dentist from California, dentist to the stars in Beverly Hills who I think is one of the most gifted guys ever in the profession, who immediately responded and said, “Oh really?” He started talking about the fact that he still does amalgams, and that made me feel pretty darn good knowing that there’s still literally world-class guys who still use the stuff. I love it. I love it.
Shaun: It’s a work there, and it helps people that … It works, and the cost effectiveness in this day and age, man. Hey, at the end of the day-
Dr. Test Dentistry is really, really tough. It’s a really, really tough venture, and I always wanna have as many tools in my toolbox as I can keep there. If I’ve got that 85-year-old patient with a crown that they’ve had since the ’50s, and there’s a little caries under the margin, and they don’t necessarily have great home care, and things are a mess, am I gonna take that 85, 90-year-old patient and cut a new crown prep on him? And deal with the hundred meds that they’re on and the bleeding and everything else? Or, am I just gonna go in there and put him on Peridex for two weeks and then go in and cut a little retention and patch that margin and give him another 10 years out of it? Heck yeah.
If I’m a no amalgam guy, how am I gonna manage that? How am I gonna provide the isolation and the clean operating field that I need to do a respective composite? The answer is simply, “I’m not.” I think that as more and more dentists get rid of this material, they limit their options, they limit the options to their patients to far more expensive, far more invasive, and far more risky procedures. I feel real strongly about that, and I hope there’s a lot of young folks out there that still keep it in their arsenals. I know there’s probably dental schools that don’t teach it anymore. That kinda breaks my heart a little bit because it’s still a valid thing.
Shaun: Well, you’re gonna go to heaven, Timmy. You really are doing a good service to the people, and I can see why you got so many great reviews on Health Grades and Vitals. You can’t teach that. A lot of almost 5-star almost on pretty much everything across the board from patients that are genuine reads. That stuff goes far. I think that makes you set apart in your area. That’s why people come to you.
Dr. Test It makes me feel real good. We’ve got a staff … Like I said, I have an assistant for 19 years, a hygienist for 17 years-
Shaun: Yeah, I got this one in Alexis: “I’ve been going to Dr. Test for years. He’s very passionate about his work. He loves what he’s doing. He can explain things very well to you. He’s gentle and considerate, and he’s reasonably priced.” People see that and they go, “Boom. I love that.”
Dr. Test I love it. She left out “devilishly handsome.” I’m a little disappointed.
Shaun: Timmay! That’s so cool, dude. So, what else can you tell me about your education and stuff? Was it a good deal with the dental school? Did you come out with a ton of debt?
Dr. Test Oh, God yeah. I went to Penn. I’ve been a Pennsylvania boy my whole life. College of Gettysburg, and then dental school at Penn, and actually we live in a house now that used to be owned by one of William Penn’s sons.
Shaun: You’re kidding.
Dr. Test I’m like Joe Pennsylvania, man. It’s pretty cool.
Shaun: It looks like it. It looks like back in the civil war area where you’re … You’ve got huge land.
Dr. Test It was built in the 1750s. It’s actually an old barn that we live in.
Shaun: You’re kidding.
Dr. Test But, yeah, I got out of Penn in ’93 with an absolute boatload of debt. Excuse me, ’93. Huge debt. We had about $3500 a month in student loan service at that time, the first 15 years. It was pretty horrific. But, I don’t have any regrets. Penn was an amazing institution. The people that I met there, the instructors, the everything, it doesn’t get any better than that place was and is.
Shaun: That’s awesome. A lot of guys don’t have such a great experience for dental schools, but that’s great that you had the love for it.
Dr. Test I did. I was a Delta Sigma Delta there for four years. I was the president of the place for three years. I had an amazing time socially. Being in a big city was great. I absolutely loved it. I certainly see the cost of dental education has gotten just obscene. I know that the level that I had 27 years ago, 24 years ago, is dwarfed by what young men and women are getting out with nowadays, and that’s a big hardship. That’s a huge hardship. How they’re doing it, I’m not sure.
Shaun: I don’t know, either. It’s just nuts to take it on, that kind of … It’s up to, like, 100 plus grand a year for some of these, and it’s just like how do you do that unless you got rich parents. To get that kind of debt, man, it’s just crazy.
Dr. Test It ain’t easy, but God knows it’s worth it. Looking back, I’m very glad that I did what I did. Looking where medicine is nowadays, looking at the future of medicine, looking at the difficulty to get into dental school now, my goodness gracious … There’s not a chance I could have gotten into dental school today with the numbers that I had back in the day.
Shaun: Back when it was D for diploma, man, you could get in.
Dr. Test Oh yeah. Absolutely.
Shaun: No one sees your grades, but a D is for diploma. I used to tell my boys that. “Boys”-
Dr. Test I think-
Shaun: Okay, go ahead.
Dr. Test One of the positive things about dentistry is that we’re still predominantly mom-and-pop shops. Certainly, the corporate dentistry and big group practices have their place, but even within those settings, it’s not a hospital. It’s not a place where we’re charging you $950 for an IRM restoration.
I had a friend on Facebook who’s uninsured just go through some minor surgery, and he posted his hospital bill online, and some of the numbers were staggering. $9,000 for a single lab test. $450 for a bag of saline. It’s pretty ridiculous. So, I’m kind of proud of how dentistry has … Yes, it’s not an inexpensive proposition, but we have fees that are at least justifiable and make sense, and I hope that continues. I’d love to see things happen with, heaven forbid the word but, socialized medicine. I’d love to see a single-payer type system happen, because we can’t sustain a world where we have 18% of our GDP as healthcare. That’s unsustainable. Something has to change with that, but I hope that dentistry can still maintain its some degree of independence from that, because I think we’ve kind of earned that and kind of deserve that. I’d love to see medicine follow that same blueprint a little bit.
How many people go to see their physician even once a year? But, yet there are tens of millions of people who see their dentist every six months, because dentistry has managed to explain to people that prevention’s where it’s at. You can pay me now or you can pay me later. It certainly makes more sense to pay me now. I think if medicine took that kind of approach, if we got more into prevention, if we got more into well visits, we could certainly save a lot of money in the long run. But, I digress.
Shaun: My doctor sees me, he goes, “No salty, no spicy, no snacks.” Anything that tastes good, don’t eat it. “Lay off the beer. Okay, get out of here.” It’s like, “Okay.”
Dr. Test People listen to them all the time.
Shaun: Yeah. It’s like, you know, you know what you shouldn’t be doing, and it’s just people don’t do it, but … Well, dude, that’s freakin’ awesome. So, what do you do for … I know you got great reviews and all that, but what do you do to drive patients to your practice? Do you do social media?
Dr. Test We’re predominantly word of mouth, for sure. We have a decrepit old website that I really don’t put much time into because I look at the numbers in terms of visits to the website and everything, and just really didn’t see much of a need for a big website. We’ve now for the last seven years had an office Facebook page. Again, not a real big endeavor, but we put ourselves out there in the community. Most of our referrals are simply word of mouth. We have a huge referral-based …
The pain management aspect of our practice is probably the number one driver of new patients. When you take a gal who’s had almost daily migraines for 20 years, and you get her to a point where she hasn’t had a migraine in the last three, she’s gonna tell her girlfriends. She’s gonna tell those moms at daycare, she’s gonna spread the word. We do a lot of kind of guerilla marketing, one of the smartest things I ever did.
We have a lot of universities in our town, and when we first opened up, I went to Lehigh University with a big stack full of cards, and I met with the director of the medical center there, and I said, “Who do you send your dental emergencies to?” “Well, we really don’t have one guy.” I said, “Well, now you do.” I said, you know, “I’m on call 24/7,” put my number, put my website and everything right on your contact info. Before you know it, we had a couple students come in who … They were studying late at night, and they tripped on the library steps and broke their front tooth.
Shaun: Uh huh. Sure, you did.
Dr. Test So, we fixed them up, and we did a nice job. They told people at the health center what a nice job we did for them, and before you know it, we got the director of the health center, then we got his nurse, and then we got the Dean of Student Affairs, and now we have probably nothing less than 350, 400 patients who work at Lehigh or are somehow affiliated with that place. That spreads, and that spreads.
Shaun: Absolutely, it does. Hey, I see that you just celebrated a birthday here. Big 5-0, huh? I’m looking at your Facebook page as I’m talking. You’re just a handsome-
Dr. Test 50 damn years old. I love it.
Shaun: Yeah, that’s when it all goes downhill, man. Once I turned 50, like everything started hurting. You gotta move, but you’re in good shape, dude.
Dr. Test I got the gray hairs to prove it, baby. It’s all good. I love it.
Shaun: You’re looking good. Shit, I remember when you had … Didn’t you have a back issue, and you used to have to hang on that thing, and it saved your ass, didn’t it?
Dr. Test I still do, yeah.
Shaun: What’s that called, the thing?
Dr. Test Inversion table. Yeah, I used to teach that. I lectured out at the Townie Meeting in Vegas, I lectured for Mikey Melker’s ten years ago down in Mexico. I still do it.
Shaun: What’s that thing? What do you lay on? What’s that thing called? It’s a suspension …
Dr. Test Inversion table.
Shaun: Inversion table.
Dr. Test Inversion table. Yeah, yeah. I still do it routinely, not as much as I used to. Honestly, I’ve spent a lot of my life being really heavy, tried really hard to keep the weight off. That’s the number one thing for my back.
Shaun: I never knew that. You always looked slim and trim and in good shape.
Dr. Test Oh, no. My nickname in college was Chubby, and in dental school it was Norm.
Shaun: Really? What a trip.
Dr. Test I was 225 when I got out of dental school.
Shaun: How much? 225?
Dr. Test 225. 5’9″, 225. That’s one round mound right there.
Shaun: Hey, try being 5’8″, 250. I was like a fire hydrant, but I’m muscular.
Dr. Test You’re muscular, absolutely. I’m not. I’m a skinny, little, girly man. It was all gut, baby. Believe me.
Shaun: That’s freakin’ awesome, dude.
Dr. Test I try to take care of myself. I golf a lot, I try to stay active. One bit of advice for young dentists out there who are having back pain: pay attention to your posture. Get loupes, get a good stool. I’ve used an RGP stool, a real ergonomic stool, now for 17 years. It is a absolute Godsend. Wouldn’t practice with anything else. Loupes are so big. Any dentist not using good loupes and a good headlight these days just doesn’t know what they’re missing. Not just in terms of quality care, but in terms of posture and the ergonomics of doing that. It’s so big. When you get those loupes set up, you get that focal length set, and you can’t cheat. You can’t start leaning over at weird angles because you can’t see anything if you do, and you don’t need to because you’ve got the good vision. That’s such a big thing, I think. Paying attention to your posture, paying attention to how you’re working, because it’s a tough job, man.
I remember my first Dental Society meeting that I went to back in ’93, and sitting in that hotel ballroom, and looking at all these poor people just hunched over their notebooks and hunched over their dinners, and thinking, “Man, there’s gotta be a better way. Gotta be a better way.”
Shaun: Even when I was a ceramist, I got the best chair back in the day, it’s from Unitech and it was $600, but everyone just looked at me like, “What are you doing?” But, posture is so worth it.
Dr. Test Worth it. Worth every penny.
Shaun: Just like your bed at home. I got the Tempurpedic stuff I’ve been on for years, and now I’ve got the Grand. It’s called the Grand, and it’s Tempurpedic’s top-of-the-line, and I love my frickin’ bed, dude. Invest in your bed. I’m talkin’ about beds, you’re talkin’ about chairs.
Dr. Test Hey, it’s all important. I mean, exercise is great, and we all should do it, but we might not have enough time to get to the gym on any given day or to do this workout or Crossfit or whatever the hell we’re doing. But, every single day, you have the ability to control how you use your body in the things you about day to day. Those things, I think, are infinitely more important than what we might happen to do at the gym or in our workouts.
My big concern these days, I look at young people who have their phones grafted to their hands, and I see them sitting in my waiting room slouching with their head down on their neck, staring at that phone, and I just fear-
Shaun: You wanna go kick ’em in the nuts, don’t you? Or whatever, Jesus. “Get off the phone.”
Dr. Test I walk out to the waiting room, I will grab them by the shoulders, put them appropriately in the chair, and then I will raise the phone to their face. My mantra with my boys always has been phone to face, not face to phone. Lift that damn thing up. With your computer, you’re sitting in front of your computer on Facebook or Dentaltown all day, or whatever, adjust that thing so that you don’t have to be leaning over. Pay attention to how you’re using that body.
I think all the pain management work that we’ve done, too, because I always would kind of wonder what came first? Did the bad posture come first, and then came the pain, and then came the grinding and clenching, or did the grinding and clenching happen first and then … ? I think it’s kind of a big continuum that when we fix people’s pain issues, and they don’t have that constant pain, they have more range of motion, they have more mobility, and they can find themselves in better postures throughout the day. Making that all come together for folks, putting the whole big picture together, really, it can be life-changing. I get to hear that expression a lot with my pain management patients, that what we’ve done for them is life-changing.
Shaun: Well, that’s awesome. I just love hearing that.
Dr. Test That feels real damn good. Real good.
Shaun: When I hear “pain management,” I just think, hey, let’s give them Oxycontin, let’s give them these opioids, but that’s the … You’re not doing that. When I think of pain, everyone just eats the pill.
Dr. Test I just read a really sobering statistic just the other day that in my state alone, in Pennsylvania, there are 13 opioid deaths a day. 13 a day. Nationwide, it’s staggering. It’s absolutely staggering. I, literally, in my practice, I write for an opiod maybe a couple times a month anymore. We use an ibuprofen and acetaminophen protocol. We’ll use low dose steroids for really hardcore pain. If I have someone who I know is really hurting, sure, we’ll give them a handful. But, I think the pendulum swung way too far in terms of the way we prescribe opioids.
Shaun: And the way they’re just so addictive. Even when I had bad … broke a leg, broke my arm recently. I’d eat some of those to try to deal with the pain, but it would mess with my stomach, so I’m so glad that I never liked pills. I don’t even take Aspirin or anything. I just don’t do it, but I’m thankful. So many other people, they just get addicted, then they start snortin’ the things.
You ever seen that movie? I seen it years ago, and it was the worst frickin’ movie. You feel so good about yourself afterwards. It’s called “The Wonderful World of the Whites.” You gotta watch that thing, man. It is a train wreck. It’s the White family, and they go back 100 years, like the old McCoy family with “The Wonderful World of Whites.” I think it’s in Virginia or West Virginia. These ladies are just crunching up pills and they snort them, and they’re like, “What the hell?” And the one lady just had a baby, and after she had the baby, she’s in the hospital room, and she’s snorting up pills. It’s like a train wreck, and it’s been years. I just-
Dr. Test I have a dear friend, he’s a young man, he’s 26, 27 years old, and he’s a singer/songwriter musician, just incredibly talented musician. He was a bartender at my golf club, and we became friendly and started playing together. We played out a little bit. One day, he missed a gig. I called him and said, “What’s going on?” He goes, “Yeah, I’m in rehab.” I said, “Oh, Jesus, I had no idea.” This young man, at 25 years old, was taking eight to ten 30-milligram Percocets a day.
Dr. Test Eight to ten 30-milligram Percocets.
Shaun: That’s crazy.
Dr. Test His whole life was revolved around how he could get his hands on those pills. He was stealing from his parents, he was working two jobs, doing everything he could. That’s unbelievable to me, and knowing that that’s becoming the average. At my kid’s high school in the last three years, there’s been three kids who’ve died of heroin overdose. Two from heroin and one from pills.
Shaun: Yeah, we got a ton out here with heroin, and it’s all being cut with that Fenotyl stuff.
Dr. Test Fentanyl.
Shaun: Fentanyl. That stuff is 100 times, just a tenth of it or whatever the … just a little bit, and it’s just killing people left. Man, it’s just too bad when you think about that.
Dr. Test Some of these people start from, you know, just the smallest of injuries, the smallest of doses, and realize that it’s the best high they’ve ever had in their whole life. Before you know it, their lives are over. Knowing that we have the capability to take people out of pain without any drugs at all, with no surgeries, minimally invasive, it’s a pretty powerful thing.
Shaun: This is a great podcast. I love [inaudible 00:49:30] a different aspect that I haven’t heard, really, and really looked into or thought about, because I’m a crown guy and stuff like that, but I think it’s a great service that you’re doing.
Now, let’s wrap this up with a little bit of advice for our guys out there, just for CE. I know you talked about Barry and Jim. Heck, I haven’t even seen Jim Boyd around a while. He’s just down the street, down San Diego, like Encinitas like a surfer dude. But, give us some things that you think are good for CE for some of the newer guys starting off.
Dr. Test Without a doubt, the most powerful CE that I ever took was with Barry Glassman and Jim Boyd. Completely changed my entire approach to dentistry. Not just in terms of the pain management but in terms of the prevention, in terms of “why are those patients in our chair?” At the end of the day everyday, I like to take a look at my schedule and say, “What brought this patient into my chair?”
Most days, I can literally say that 85 to 90 percent of the patients that I worked on were there because of para-function. Now, was there a periodontal component there? Well, yeah. Well, how much of that periodontal component came from the bruxing? Even in cases of caries … Okay, the patient, yes, had caries, and that’s why we’re working on them, but how did that caries occur? Was it because it was a lower second molar that they’ve been clenching into for 25 years and they shattered the enamel? Now, all of a sudden, someone who’s never had a cavity in their life has gross caries in a second molar.
Honestly, I would seek … Barry’s not lecturing as much as he used to, nor is Jim, but they’re still out there. There’s a gentlemen named Rich Hirschinger, from your area actually, who lectured. He’s strictly pain management and lectures on that. Absolutely, positively, I think every dentist should be doing sleep dentistry in terms of apnea. A simple TAP appliance, a Somnomed appliance, they’re the easiest thing in the world to deliver and figure out, and they can be as life-changing as anything that any dentist can do.
Shaun: What about your implants? You do a lot of implants. How’d you learn-
Dr. Test I don’t place them. I restore them. I have a number of local surgeons who I just love and who do a fantastic job. It’s something I’ve considered doing, but at 50, I’m not necessarily looking to get into anything new. I think that for the general dentist doing basic implant placement, I certainly think it’s a great idea. But, in terms of CE for that, my number one referral for implant placement is a group practice here, and they run a fantastic local CE program for implant education. I think everybody should kind of look into that as much as they can. But, honestly, if I were to tell the guy starting out the two areas to focus on, figure out a good way to provide parafunctional protection to help patients with headaches, TMD, et cetera, and absolutely get into apnea, get into sleep dentistry. It’s huge.
Shaun: I bet it draws a lot of patients to you just for that aspect, and then you can come in with your hygienist and stuff like that to check out their other needs, for sure. What about endo? Do you do your own endo?
Dr. Test I do anterior, I do premolars, a rare molar here and there. I’ve used, from EDS, I’ve used the SafeSider system now for almost 15 years. A reciprocating file system, I love it. I absolutely love it. I think well-done endo should be a part of every general practice. No doubt about it. I’ve always shied away from molar endos simply because I don’t enjoy it, and I don’t think that I can produce the level of quality that my local specialist can. But, certainly, for premolars and anteriors, if you take your time and do everything right …
The other reason I think every general dentist should do at least some degree of endo is that the best endo restoration is one that’s placed right then and there when the endo is done. The biggest heartbreaks that I’ve seen with endo are the person who got the endo done, and then they didn’t get back to their general dentist in time and walked around with a crappy temporary for how long. Temporaries leak, man. If you can, every single time you can, get that permanent, definitive restoration in at the time of the endo.
If you’re referring them out, my favorite local endodontist, most endos that he finishes, he puts amalgam right in there at the time of the visit. John Khademi, who I think is probably the best endodontist out there … I’ll be right there, ladies … has done pours at the time of placement or time of finishing his endo, every time for years. That’s the way to go. Seal that sucker.
Shaun: That’s awesome. What about cements? You use Kanca’s stuff or Apex?
Dr. Test I use Johnny Kanca’s bonding agent. I use [crosstalk 00:54:24]
Shaun: Kanca Bond. Love Kanca. He’s the shit.
Dr. Test Every bond and restoration we do is well isolated. It gets Clean and Boost, which is surface pre-cleaner. It’s got a mild etching in it and a disinfectant, surpassed for every bonded restoration now for, gosh, probably 12 years, at least. For cements, I’ve used RelyX, which, believe it or not, even though John produces and sells a crown-luting cement, still recommends at his lectures RelyX. [crosstalk 00:54:59]
Shaun: It’s reliable, he says.
Dr. Test Absolutely. It’s a great product. But, Powder and Liquid, for sure. I actually just talked to him just two days ago. He actually switched, after using RelyX, he’s now using Unicem from Ultradent, a fantastic company. I use a lot of Ultradent’s endo products and bleach products. I think Dan Fischer is the greatest figure in modern dentistry.
Shaun: Dan Fischer’s the man. I think we know him. Man, we hang out and have cocktails with the dude.
Dr. Test I love that man. I absolutely love that man. I think he is just head and shoulders above everyone in dentistry, and there’s nobody like that man.
Shaun: We gotta get Kanca out to your little Kancapalooza out there to your little annual thing, because he shreds on the guitar, too. He’s got a Les Paul.
Dr. Test Yeah, he’s a guitarist, he’s a singer, he’s a pianist. He’s quite a talented guy.
Shaun: Yeah, he is. He likes his cigars and his champagne, that’s for damn sure.
Dr. Test Oh, yeah. No doubt about it.
Shaun: Well, dude-
Dr. Test Hey, I got a dental hygienist standing outside my office door with angry looks on her face.
Shaun: I know you do. Go cut me some more crowns, dude. I thank you for everything, Dr. Test, man. Great podcast, and I can’t thank you enough for taking your time out of your busy practice today, and God bless you, your family …
Dr. Test You put me in front of microphone, bad things always happen.
Shaun: Timmay! Love you, man. Talk to you real soon.
Dr. Test Thanks so much, brother.
Shaun: Alright, dude.
Dr. Test Peace, man. Look forward to seeing you some time.
Shaun: Later, man.
Dr. Test Thanks again, bro.
Shaun: Bye bye.