Self-Awareness and the Importance of gaining Experience with Dr. Charles Brown, DDS

Announcer: Ladies and gentleman, 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 host, Shaun Keating.

Shaun Keating: Hey everyone, Shaun here. Welcome to another episode of the Dental Up podcast. Our guest this week is a graduate from the University of Detroit Dental School, and he completed the advanced comprehensive CEREC training course in cosmetic, implant, and restorative dentistry. Practicing from Irvine, California, please welcome Dr. Charles Brown, DDS. How’s it going, Dr. Brown?

Dr. Brown: It’s just fine.

Shaun Keating: Thank you so much, man. I thank you for all the work, dude. And you’re just around the corner in our neighborhood in Irvine. That’s the first dentist I’ve had in Irvine that came on to do a podcast, and I just can’t thank you enough, man. I know you just got out of work and came on over to the lab, so thank you, and good to see you, man.

Dr. Brown: Same here.

Shaun Keating: That’s so neat. Hey, I always start off talking a little bit about sports. I’m not sure if you’re into sports at all, but watching a little bit of football last night. Cleveland, heck, it was a five nothing game. That’s like a baseball or a hockey game. It was five nothing and they played- the Cleveland Browns played the Philadelphia Eagles, who was the world champions. They looked horrible. The eagles looked horrible, and they had Nick Foles, the starting quarterback from the Super Bowl, but you watch much football, or into football at all? A little?

Dr. Brown: I love the NFL, I love college, and I just read this morning where the Philadelphia head coach doesn’t think Nick Foles is gonna be around much.

Shaun Keating: I know. I couldn’t believe he said that. But I think they might’ve took it out of context in a way. And he was getting beat up a little bit, the fact that he said in the interview something like you see him in the first half, he had seen enough of him there, so he wanted to go to the other quarterback. But they put it, ugh, I’ve seen enough of him and he was done. You know, and hey he got them in the Super Bowl and he won that game. So you can’t throw him in the- under the bus too quick. But I think they came out of context on that. Yeah, but I read that and I’m thinking, what a knucklehead coach to say that to your star player, man.

Dr. Brown: I agree.

Shaun Keating: Especially Wentz, who knows if he can get back, you know, their number one pick. Yeah. It’s kind of mean. Then we got the Lakers. That’s kind of a little bit different. LeBron coming around town. What do you think about that?

Dr. Brown: Not a big basketball fan, but I would say that I’ve always watched the playoffs and it’s pretty exciting that he’s coming to LA. I don’t know that much about basketball. I kind of am a March Madness person for college.

Shaun Keating: There you go.

Dr. Brown: It’ll be interesting to see what the Lakers, what they do with this.

Shaun Keating: Yeah. Because they haven’t done anything for several years now. And I don’t think one guy can just do it. But at the end of the day, the dude has been to the finals the last eight years in a row with two, three different teams. I mean, it’s just kind of crazy. But he makes people better around him. But we’ll see, it’ll be something. I’m a big basketball guy, but lately with the Lakers, I kind of like just the playoffs too. I’m a big March Madness guy too. We do a pool that we- I just love to see the competition, who’s gonna win. I like the underdog and all that kind of stuff. It’ll be kind of interesting with the Lakers this year to see how they do and how they react with LeBron in the mix now. Yeah, that’s pretty cool there.

Well, hey, let’s dental up. Tell me a little bit about where you attended dental school, your undergraduate, stuff like that, if you could, Dr. Brown.

Dr. Brown: Well, went to Wayne State University, which is a city college in Detroit.

Shaun Keating: Okay.

Dr. Brown: I used to live in Michigan.

Shaun Keating: No kidding.

Dr. Brown: Then after that, went to University of Detroit, which at the time was in downtown Detroit. Has since then is actually now called the University of Detroit Mercy. They merged with Mercy College about 15 years ago.

Shaun Keating: Okay.

Dr. Brown: From there, went into practice in Warren, which is a suburb of Detroit.

Shaun Keating: Okay.

Dr. Brown: And practiced there for awhile. Went from being an associate then to having my own practice. And somewhere along the way decided I wanted to, no offense to those of you in Michigan, I decided I wanted to leave. Got the opportunity to go practice in Boston.

Shaun Keating: Okay.

Dr. Brown: And it turned out to be a good thing for me ’cause I got a position where, even though I was a general dentist, I was working with a group of three prosthodontist for about eight or nine years. That was great experience, even though I was low man on totem pole and constantly had to go for them for advice and stuff. You learn so much-

Shaun Keating: Oh, I bet.

Dr. Brown: In a situation like that. So it was great.

Shaun Keating: That’s really neat. Yeah, to be able to see what they’re doing, the big boys like that. I tell all these students starting off and especially get a mentor. Get some experience, even if it’s one of the mills, you’re gonna see a lot of patients, you’re gonna do a lot of different things. Get your chops sharpened, you gotta get in the trenches, so I think what would be better than having a few prosthodontists helping you out in the beginning there. So, Boston, man. I love Boston. My dad’s from Boston. Little place called Dorchester.

Dr. Brown: Oh. Know it well.

Shaun Keating: There’s a little Irish Catholic enclave of Irish people there back in the early 1900s where my dad came in. He wasn’t born, he was born in like 1930, gosh that’s a trip man. So then how’d you come on down all the way to the OC. How’d that happen?

Dr. Brown: Well, I was one day in the middle of winter and I made a remark while I was cross country skiing that when I retire, I wanted to go to a warm climate. And the person I was with looked at me and said, “Well, why are you waiting?” And then the little time bomb in my head started clicking and I thought, this makes sense. So after looking for I don’t know about six months, I went to Arizona. I had an opportunity here in California where one of my ex-classmates from school, who I stayed in touch with once or twice a year, actually had been in one of the mills you had previously described.

Shaun Keating: Mm-hmm (affirmative).

Dr. Brown: Decided he wanted to go out on his own and open his own practice and invited me to come out and be a partner. Which was, probably at that time a little daring, but I decided at that point, what the heck. So I did it, and I was very glad. We opened our practice in Irvine in 1990. And we were in a shopping center, so it was supposed to be for foot traffic. After 10 years of that, we decided that we wanted something, I hate to use the word more professional-

Shaun Keating: Mm-hmm (affirmative).

Dr. Brown: But we wanted to be in a medical building. So, I now obviously very close to your lab here. So we moved to a medical building right in Irvine, and it’s been 20 years there.

Shaun Keating: Nice.

Dr. Brown: Very good, yeah.

Shaun Keating: That’s so cool, dude. Nah, I love it man. You are real close. Tell me a little bit about the layout of your practice. How many ops you got? Tell me a little bit about your staff, if you could.

Dr. Brown: Well, when we originally built the office, in ’90 we were doing HMO dentistry.

Shaun Keating: Okay.

Dr. Brown: And if those of you out there know what that is, it’s a capitation system and we only did it because in 1990, as far as I recall here in California, the economy was a little slow and when you take on the financial responsibilities for all the money it takes to build out, get your place up and going and everything, we realized that that was the only way we were gonna make it. You need some guaranteed monthly income so you don’t have to worry about the nut. So at the same time, since there were two of us, we had the practice and each of us worked part time someplace where we could earn a living. So the practice, until it actually started turning cash profit, we took, I think, my partner left first his place, and it took me about two years until I was full time.

Shaun Keating: Okay.

Dr. Brown: At the practice. And that practice, we had nine ops, so when we came here, we just transferred the same number of chairs.

Shaun Keating: Okay.

Dr. Brown: And then after a couple years, we decided, you know what, we were tired of doing capitation. We knew that we had a good base of patients, and we decided, we’re gonna slowly cut back until we can be a little picky on which plans provided the best reimbursement and slowly, I think it took five years, we eventually eliminated all HMO, stuck with the PPO, and again, we’re a little choosy, picked the good PPOs that were providing a decent fee for your service. And even now, I’d say we probably have like 50% PPO and 50% quote indemnity insurance.

Shaun Keating: Okay.

Dr. Brown: Yeah.

Shaun Keating: Much fee for service?

Dr. Brown: Well that’s what I’m calling indemnity. Fee for service.

Shaun Keating: Okay. That’s awesome. Yeah. I don’t know how guys just have, I have a lot of guys in certain areas, it’s just fee for service. It’s just kind of, good for them, but it’s few and far between. Most areas that people can truly afford the full nut of what it costs to get a crown, or even extractions and stuff. It’s tough for some people, but I see how you can- you need to take insurance in certain areas. Even too, in this area in California, like Blue Cross just keeps cutting it and cutting it, and it’s like 40% of what you used to get 10 years or 5 years ago. It’s- I don’t know how they can do that as they get richer, but they just give less.

Dr. Brown: I also found from experience that in a city like Irvine there’s a lot of, I don’t want to use transient, but people who are not here for a long period of time. There’s a lot of businesses, they bring in their- the people from outside. They’re here for a couple years, and then they’re gone.

Shaun Keating: Exactly.

Dr. Brown: So the business provides them with a choice of a PPO or an HMO and usually quote indemnity isn’t even a choice. So, if you’re gonna try to be competitive here, you gotta participate in what’s realistic for you.

Shaun Keating: Exactly.

Dr. Brown: And I know there are the elite practices, for lack of a better word, that can command and get the fees, but we all know they use Keating Lab just like I do.

Shaun Keating: Exactly.

Dr. Brown: So even though they charge twice as much, they’re delivering the same crown.

Shaun Keating: Exactly. And it’s something that they’re so few and far between, those big ones.

I mean, I’ve said it before on different podcasts, here we are right here, we got Irvine here, you got a block over here is Tustin, a block over here is Santa Ana, and a block this way is Newport Beach, and they’re so skewed on the pricing. It’s area zip code, and it’s such a ridiculous thing, but in Irvine, it’s tough, it’s very expensive to live here. It’s darn, I feel for the young children and coming up, you need a really good education, you need a high salary to be able to afford an apartment here.

Dr. Brown: Right.

Shaun Keating: Apartments, one bedroom, two bedroom apartments are like over 2,000 dollars. How do you deal that? I mean, when you’re making- a lot of these people are you know- it’s tough. It’s a tough thing. I thank you for being- I’m blessed that I got through that, and my children, they’re in their 30s now. Knock on wood. It’s tough man.

Especially dentistry. It’s a tough- we have so many dentists around in this area. There’s dentists on every corner, and it’s like, gosh competition. And it’s like, do you take my insurance, and do you- does that cover the whole thing, and it’s like, no, no, no. We can’t. That covers 200 dollars of this 1,000 dollar crown dude. And you get x-rays, man, for the year. But you got like 1,500 dollars total is what you have for the year. I feel for you guys. It’s a tough business, no matter where you’re at and what state.

You gotta have it together and have a good staff. You better treat people good and do good dentistry because those people are talking to other people and they can make or break your practice a lot of times. So, I just think do the good deed, treat the people good, and take the insurances that you can afford to do. Think it’s important for sure. So tell me Dr. Brown, what’s one of your favorite procedures in dentistry? What do you like doing? And maybe tell me a little bit about what you don’t like doing?

Dr. Brown: I pretty much like anything restorative like cosmetic, like removable. Maybe years ago, I would say that I found dentures difficult to do, but nowadays with implants especially on the lower arch, makes doing dentures more comfortable because the one thing I think even to this day, I won’t do. If a patient comes in and wants upper lower dentures and either they’ve never had them, I try to totally discourage the lowers. And if they come in with their bag of dentures.

Shaun Keating: Yeah.

Dr. Brown: I definitely won’t touch it because I know they can’t be pleased.

Shaun Keating: Yeah. It’s tough. It’s a tough thing man. It’s nice if we can sick a 22 and 27 at least, even if they can’t get full implants, minis or something just to lock and load it in because more so than not that ridge is gone and it’s so hard to grab on to. And dentures man, I’ve done quite a few for relatives and stuff and I cringe every time. It’s like, dude, ’cause I’m a fixed guy. Man, I love fixed prosthodontics, removable, man, it’s like-

So you’ve been working with Jim, and obviously [inaudible 00:14:05] and some of the other guys, I’m sure, but it’s a long start too man. There’s not many people who do it and the dental technology aspect of it. A lot of my dentists, man, probably 95% of our work is fixed here. 5% is the removable, but I did it because we do a lot of combo attachment cases that works with fixed, and I just hated working with other labs or whatever trying to coordinate where I’m set these PDs, or I’m set these ERAs. You’ve got to work in conjunction with removables, so that’s why we did it from pretty much first day. From the first of the year or so, I said we’ve got to do removable too, so we do full service, but it’s a fricking nightmare.

Dr. Brown: Oh yeah.

Shaun Keating: It’s a nightmare. We don’t make any money at it. It’s just a service that we have to do to complement our fixed work. It is very rewarding. Some people, that’s all they have. And you know, but when we can stick an implant here and there, stuff like that, or some locator, or something, just to hold them in. It’s really neat.

Poor people, I remember my mom when she was young, she had her lower teeth I think all extracted, you know. And I don’t know why they did it back then, and her upper teeth, I remember in the ’90s and stuff, or late ’80s, we did her upper, and I did a fixed ridge up there, couple segments. But she had a lot of upper teeth, but had lower dentures. How’d that happen, mom? Something, cavities, and this or that, and the doctor decided back in the ’40s or ’50s, they extracted them back then. It’s like, what the heck. Kind of tough.

Okay, so, what about, what do you outsource, do you like, I mean, do you do, are you doing your endo? Are you sinking implants? Do you use an oral surgeon? Tell me about what you do and what you don’t do.

Dr. Brown: I have a philosophy. If I can’t do something as well as a specialist, I don’t do it.

Because that’s what you’re going to be held up to when it comes to the standard of care. And I’m very fortunate, I have an incredible endodontist here in Orange County, and he’s one of the best I’ve ever worked with and I worked with some great ones in Boston, but this guy is great. He gets all my endo.

Shaun Keating: Beautiful.

Dr. Brown: I used to do surgery, but I stopped probably about 10 years ago. I just for those of you that don’t know, I’m 65, and I just don’t have the strength in my hand to do surgery the way I used to. So, I’m fortunate, I have a partner now who’s 15 years younger than me, and he does all the oral surgery. And I used to enjoy doing it, but like I said, I don’t want to wake up the next day with a sore elbow, or hand or whatever it is-

Shaun Keating: Yeah.

Dr. Brown: Because I had a difficult extraction. I don’t do implants, only probably because of my age. If I was getting out now, I definitely would do it because I find it fascinating. I’ve worked enough with surgeons that I’ve watched the procedure, I don’t feel it’s that difficult. If you’re doing extractions, you definitely can do implants. They’re made even more easy nowadays, with the guides and everything. Before you had to worry about your angulation and everything. I’m sure if you went to one of these couple day courses you could master it in a short period of time.

I think that’s one of the critical things when you’re deciding what you wanna do when you’re starting out. If you don’t really like doing something, just don’t do it. There are plenty of people that you can refer out to. And back to my original point, if you’re not comfortable doing something, don’t do it just because you think you have to because you got to make the monthly nut in your office because that’s the time when you’re gonna break a file and a molar, or break a root tip and not be able to go retrieve it, and it’s not worth the nightmare that can come from that.

Shaun Keating: No, that’s good advice. A lot of guys just try to push it. I can see you getting experience by pushing it, but yet I think for longevity, look you’ve been doing this thing for a long time, and you’re a happy guy. You’re kicking ass, and you’re enjoying life. I think that’s kind of a neat thing. You don’t want to do it, don’t do it. If you can’t do it as good as a specialist, why do it? Do what you like to do and what you’re comfortable with and what let’s you sleep at night.

The only thing I can see some patients, they like to go to the one stop shop, and just do it, and I can see doctors getting kind of enticed into, well, let me see if I can do this. I can probably do this and that, and I can see that, but again, like you said, you break a file, or you have something that just perfs, and oh man, it’s like dude you’re not going to lunch today. You’re gonna be working on this. Even too when some of my guys and some of the bigger bridges, I’ve got these guys that do some big roundies all the time with me but they’re horrible at endo, and they don’t want to do it, but yet they’re in certain areas it’s hard to get them to do endo right away when they’re knee deep into this fricking upper case and I got a canine that’s out in left field this way. A molar this way, and we can do stress breakers and telescopic copings to get the path of insertion right, but more so than not, out of these eight preps, we need endo on two of them for sure dude, because I got to bring it up about three millimeters and I know once we see red, we’re dead.

So that will hamper the case quite a bit when the doctor doesn’t have that dialed in. So maybe we can go to a temporary situation in those situations, but more so than not, we’ve got to get these final impressions, and on and on. But it’s neat how it does work when you do it right and you’re not pushed by the patient or the time constraints and let’s do it right, and then there’s some times when you’ve got to get this right, so I’ll do reduction copings and I’m letting them know dude, you’re gonna have 6 and 11, man, we’re bringing these in. So maybe get them out to the endodontist now because when this comes back, you’re gonna have to cut about half this rep. And they’re like, “Okay.” And then they gotta tell the patient, okay dude, and then well it’s like 1,300 bucks and the root canal each. So that’s 20- I’m not paying that. And then sometimes the doctor has to eat that if it’s not in the whole thing.

There’s a lot of ways to that, how to take care of that. I’m glad I work on just stone models and I’m not with those live patients all these years. ‘Cause I know with what you guys have to go through, I’ve seen it and it’s tough. It’s tough sometimes, especially when you’re doing bigger stuff and bigger more complicated cases. Get it done, get it done right. That’s the beginning. I find that best.

So tell me a little bit about your marketing strategy. What do you guys do? Do you guys do social media? Are you doing mailers? Working with the public sector? Tell me a little bit about that. How you drive patients to your practice.

Dr. Brown: Well, I can’t tell you specifically which groups we deal with, but we have two companies that at the beginning of each calendar year give us a schedule of all the businesses within say a 15 mile radius of our office. And we have a couple of girls that go out with our marketing stuff that they set up a booth and meet the employees during their lunch break or whatever and that works out pretty well.

Shaun Keating: That’s cool.

Dr. Brown: I’d say probably three to four times a year, depending on the zip code, we have mailers that go out to the resident areas surrounding our office.

Shaun Keating: Okay.

Dr. Brown: And it rotates in such a way that the mailers go out every month, but we might only touch a specific zip code four times a year. Then we also have a couple staff members that keep up to date with all the-

Shaun Keating: Facebook, social media.

Dr. Brown: Exactly. All that stuff. In my point in life, I’m not on Facebook.

Shaun Keating: Dude I’m kind of with you there.

Dr. Brown: I know what it is, but don’t care to get into it.

Shaun Keating: I know. I got stuff from friends I haven’t seen from high school in 40 years and elementary school. It’s like dude, you don’t look like-

Dr. Brown: Like your pictures.

Shaun Keating: Yeah. And then me too. They look at me and go, “What happened to you, Shaun?” Like my hair’s silver and I’m like the same height, but I’m 100 pounds heavier. It’s like life dude. That’s what happens. It’s kind of crazy how that works. I have a thing that I got on way back in the day, like 2002 when I started, it was Dental Town, and Dental Town’s kind of like our Facebook for us growing up back then in the dental field and I used to get so enamored in that where ’cause I’d be talking with dentists all the time and showing cases, and it was, I would be home at dinner and off in space and Sharon’s like, “What’s going on Shaun?” And I’m like, “Well I had this one crown that a doctor pulled up about us, and said he didn’t like the shading,” and then it just really gets to you, but then I was like a little girl in eighth grade, and I think people get that way when you start talking with peer to peer and it’s kind of a neat thing.

But I went through that four or five years, and then you gotta cut that off after awhile ’cause it’s 12 step program, people get into it. I can see the Facebook thing, so I’m not phased with the Facebook thing. I don’t do pictures. I do a little bit for the company, but on my personal page, they have that and I’ve never post a pic, my boys or someone will put something up there, but I just, I don’t know, it’s like, look at me, look at me, look at me. It’s kind of weird. It’s like, “Hey, look at me.” It’s like, “No.” If I did all the stuff that I ate, and all that, they would think look at this dude, what the heck is he all, two lobsters and a fricking eight pound T-bone. It’s just crazy.

I can see how people get into that, but and I don’t know how much it works really ’cause with us, my audience is dentists only. I mean, I can’t- I could try to go to the patients and hey tell your dentists, but that’s an uphill battle. That’s just hard, so we’re trying to find pigeonhole the dentist, and then the dentist doesn’t want to get bugged on Facebook by a lab, I would think. I don’t know. I don’t know when a lot of our stuff, we might, we have these little ads or these little pictures. I hope I’m not spamming there out there too much. I have too much of a conscience I think when you do that stuff, ’cause I don’t like to be- and it follows you around. Even me, my ads follow me and I think the guys that are doing our marketing for us do it on purpose.

I don’t want to go and say, “Quit sending this,” ’cause that’ll probably make it bad. I don’t know how that stuff works. I go yeah, dentures, and partials, and your digital dental lens. What the heck. I’m reading something about John Travolta and all of a sudden, Keating Dental Lab in the middle of nowhere, it kind of makes you feel good a little bit, then I bet after awhile ’cause I see them over and over, it’s like dude, okay, enough already. I don’t know. I think it’s how they do that with that marketing stuff, it wears you down. Let’s order something, or Amazon does the same kind of stuff. Follows you, hey Shaun, you bought this, what about this, this, this. One click, get it. And it’s like, no.

Today, just before you came in, I got a motor or a battery for my little Honda Grom, I can’t charge it and I let it die too many times. One click there and [inaudible 00:25:35] said I don’t have this little bolt I got to get off and I got pliers and crescent wrench and I only have sockets. I’m not a real mechanical type guy. So gave me a little 20 dollar socket set and a battery with one click, it’ll be there tomorrow. It’s like, dude, that is so fricking amazing how that works.

I was just reading the paper at lunch here and Wall Street Journal had it to where Toys R Us, man, like 33,000 people losing their jobs and they’re gonna do a bankruptcy, but then the venture capitalists that own whatever they own, they’re saying no, we’re liquidating ’cause it’s cheaper to get rid of the whole thing, and we’ll make more money off it then restructuring it. ‘Cause it’s like five billion dollars in debt. It’s so sad. So 33,000 people are out of jobs from all over the US, like 900 stores. And it’s just because the bean counters want their money and they’re gonna get more by just dissolving it all. They’re just saying Amazon killed it ’cause they’ve got all these toys at half or a quarter of the price and they can deliver them to you. It’s kind of sad, man, how it changes, the brick and mortar things and all that stuff out there.

Yeah. Got a little sidetracked there. But okay, so what’s the latest piece of equipment that you’ve got in your office? Purchase anything lately?

Dr. Brown: Upgraded to the latest generation of x-ray sensors because our originals were 10 years old.

Shaun Keating: Okay.

Dr. Brown: We have a couple of hygienists in the office and I was at a course last year, and I saw, I think they call it a linear piezo scaler, and we’ve got three of them now.

Shaun Keating: Okay.

Dr. Brown: And I, one of our hygienists was sick this week, so I got to do some [profies 00:27:26]. And I found it’s quite amazing. It’s very kind to the patient. Very quiet compared to a Titan, and is so adjustable that you don’t have to worry if you have it on the lower settings that you’re gonna be removing cementum or dentin when you’re done on the root.

Shaun Keating: Okay.

Dr. Brown: So I think it’s really good.

Shaun Keating: Is that like a cavitron?

Dr. Brown: It’s like cavitron, but I felt cavitrons are way too powerful-

Shaun Keating: Yeah.

Dr. Brown: Compared to what you- the hygienists especially, they both came from using cavitrons, and then one of them migrated over to the Titan and they both use the linear piezo almost exclusively now. We have a Titan still, but I don’t think it’s ever used.

Shaun Keating: You know what? I just went to across the street, I couldn’t get my teeth cleaned by my regular dentist, so I went across the street ’cause they’re just getting a little- I can feel it on my lingual, on my tongue there, and my regular hygienist, she just scales it and I love the way it goes into the gums and the scraping, but I think they had this over here, this cavitron type thing and it was the neatest thing. And it came in and did my teeth. Really amazing. Really clean feeling. And it just really got them really clean. It was a neat thing. I bet you it was that, ’cause I didn’t even ask them about it. But I bet you it was the same, similar thing.

Dr. Brown: I think the benefit for the hygienist than even the dentist that use an item like that, it’s much less stressful on your hand.

Shaun Keating: Okay.

Dr. Brown: And your wrist. So you’re less likely to develop complication or overuse of your hand.

Shaun Keating: Yeah.

Dr. Brown: I just think you have to think about those things if you want a long career. Try to purchase or get using those things that make your life easier.

Shaun Keating: We have a big thing that’s prevalent in the dental lab industry is carpal tunnel syndrome and it’s just from grinding with those hand pieces all day. You just got to have certain exercises and it’s so important that you really take care of it. ‘Cause you work with your hands all day and you’re just grinding and grinding and it’s too bad ’cause the surgeries are pretty invasive when they do go in there and yeah. Tough. So we definitely do that and make sure we have our eyes covered, ’cause they’re the only two eyes you’re gonna get. A lot of things come flying out. Those disks and stuff break. So tell me about do you attend dental conventions or gatherings? Tell me a little bit about that.

Dr. Brown: I would say for a good part of my career I used to go see Gordon Christensen annually.

Shaun Keating: Okay.

Dr. Brown: I liked his update. The last couple years, he actually shuns California now.

Shaun Keating: Why, he doesn’t like us?

Dr. Brown: I don’t know. I used to see him in Anaheim. I noticed now, he’s pretty much Las Vegas.

Shaun Keating: Okay.

Dr. Brown: You know he’s getting at a point in his life where he doesn’t do a lot of traveling, but he’s still- I think he’s near 80.

Shaun Keating: Yeah. I think.

Dr. Brown: So he’s a pretty amazing guy. And he still practices a couple days a week.
Shaun Keating: And his wife Rella, she’s a spit fire.

Dr. Brown: Yeah.

Shaun Keating: She’s rolling along.

Dr. Brown: But I enjoyed him because he’s a nuts and bolts type of guy. Tells you what products work in his experience, which ones don’t. Even when it came to procedures, he was always out there trying everything and if it didn’t work, or he didn’t feel it was worth the effort, then he kind of let us know. And I occasionally would go to a convention, but at this point, I don’t see that much new that comes out when you go to conventions. And I don’t take my continued education at conventions only because I don’t feel- at this point, I don’t want to go over things that I’ve known about for a long time.

Shaun Keating: Mm-hmm (affirmative).

Dr. Brown: I try to seek out continued education courses that I have an interest in. And that’s pretty much the way I’ve been going probably for the last seven, eight years or so.

Shaun Keating: Cool, cool. That sounds good. Tell me a little bit about your thoughts on new technology and dentistry like compression scanners, CAD, CAM, et cetera. I know that you’re a bit CEREC guy, aren’t you?

Dr. Brown: No. Sorry. I was.

Shaun Keating: Okay. You were.

Dr. Brown: No.

Shaun Keating: That’s what I meant.

Dr. Brown: That’s why you’re doing my crowns now.

Shaun Keating: Yes. Drop the mic. Little plug. Nah. That’s so cool dude. Tell me about-

Dr. Brown: I used CEREC from 2007 probably through 2011 or maybe it was ’10, but once I saw your zirconia crowns and I went into it slowly because I’ve been burned in the past, not by your lab, but just materials that I would try. The manufacturers tell you how great they are, and the labs really aren’t to blame because they’re listening to the manufacturer. So you know, you’d go and you’d use it and then a couple years later you’d evaluate what they look like based on wear and tear compared to other materials. And then you’d say, “I’m not happy with this.”

Shaun Keating: Yeah.

Dr. Brown: And my problem with CEREC, and not only my own, but I see a lot of other CERECs coming in, is they’re probably great for super gingival restorations, but crowns, and I haven’t used it for a number of years, so those of you CEREC users don’t come down on me for this, but I just think that zirconia is a great material. Your new translucent zirconia is fantastic. I have for probably the last year and a half, I’ve only used anterior zirconia crowns.

Shaun Keating: That’s awesome.

Dr. Brown: The translucency is great. And I’ve ever gone against the advice of your lab a couple times because I find that if I can take a tooth that maybe was dark, I can put a composite basically build up even on whatever remaining tooth structure or if some cases I noticed my endodontist will send me back a core build up that uses that bright white opaque composite. And even though I know it’s strong, I’ll go in there, reduce the core about a millimeter, build it up with a A2 regular composite material and I find you can use your translucent zirconia and you can get a beautiful result from it.

Shaun Keating: Absolutely.

Dr. Brown: So I’m kind of, when I treatment plan, that’s what I’m counting on. In fact, Monday back in the office, I have a crown that I know I’m gonna have to do that for. Number nine. And I just find that trying to do a porcelain covered zirconia for some reason just doesn’t have the quality that your translucent zirconia does. It’s just a great material.

Shaun Keating: Yeah it is. We really love it. Our doctors are loving it. It mimics, if not even surpasses, emax in the interior segment.

Dr. Brown: I agree.

Shaun Keating: I think it just blends in the old environment so nicely. You know, I used it in a poster your bridge on myself. I just love the aesthetics and the strength is there. If I can get three by three connectors, this stuff is not breaking. It’s strong as heck. I’m at 18, 19 pontic and 20 abutment and it’s been in there six months now and I grind the heck out of it, and it looks good. It can be anteriorly, posterially, just long as you’ve got enough support and everything else on your connectors and your thickness of the restorations themselves, man. This stuff is the real deal and heck the pricing’s almost like back in the ’90s. Keeping it around 100 dollars is pretty amazing.

It’s just crazy. Where PFMs, we do PFMs and then we have to charge an alloy, unless it’s a base alloy it’s just one flat rate price, but our PFMs can get up there at a buck 50, buck 75, 200 bucks if it’s a high noble. It weighs two or three pennyweights just depending. Gold’s still up there, 13 1400 dollars an ounce, kind of crazy. We still do a lot of PFMs, but this zirconia, my sanity with the breakage for all 33 years of making teeth, I just love it now where we take that
variable out pretty much. There’s no breakage. And now, like you said, even back with the emax, before emax we had [Heiress 00:35:35] but that stuff all broke and Empress too, that stuff kind of broke. We got burned. Art glass back in the day, that used to peel off like a hard boiled egg. It’s like what the heck.

Then we got these composite hybrids, it was supposed to be the best next thing, and I forgot the name of that one, but that kind of was leaking in the mouth. It was fricking absorbing all the bonding mediums into it. But this stuff’s the real deal. Especially with the aesthetics now. Because before just like you were saying with the CEREC, behind the lips it fits, back in that day, and it looked like a popcorn kernel and it was white, and it just fit and got it, and he did it in the office, and it was a great thing. And it’s evolved with [inaudible 00:36:15] with their ingots and stuff. Got some nicer ingots, but yet, at the end of the day, it’s for certain practices. You can see a couple patients a day, or you want to do a couple onesies, twosies here and there. I can see it working and it’s looking better. But nothing like a lab process indirect restoration.

Dr. Brown: Plus I think your lab’s probably moving in that direction. That impressions with scanners are the way of the future.

Shaun Keating: They really are.

Dr. Brown: We’ll just have a little drone from your lab come over to my place and drop it off two hours later and I’ll just cement it in.

Shaun Keating: I’m telling you, if we can do that, I’ll do it. Amazon probably, that Bezos dude, Shaun I could send it to all 50 states with these drones. I’m like, “Yes sir.” But I almost want to get it because we’ve got these carbon printers, man. They’re just so on top of it. The service. So we’re doing all our models and everything for all our implant cases where that’s the only thing we have to outsource back through the last few years. So we’re doing them in house. But I almost, just for the accuracy, I want to just start scanning every impression from the dudes that aren’t doing them. They’re doing conventional impressions, that’s fine.

We’re almost up to 25% of us being scanned coming in to us on our monolithics, and where it used to be 2, 3%, now up to 25% of our work in the monolithic areas are all digital coming in to us that way. But I want to get it to where every impression I get in for all of my regular work and everything, I want to scan those myself and just do my own printed models instead of me pouring them, letting them dry, pinning them, cutting them, pinning them, indexing, all that.
It’s quite a bit of- it’s a lot of moving parts in the plaster department to pour a case up. There’s several steps to it.

And you got impression material likes to do their things, but then you have stone that’s expanding and then contracting and coming back and it’s all liquid powder ratio’s gotta be on the money, and they gotta be a really good company that’s making your stone because you can just have the most nightmares in the world by well it fits the model, it should fit the mouth. well my model was expanded by 3% more than it should’ve because the science behind the liquid powder ratio in the R&D of that company wasn’t proper, so we have to do our own test on our own steel dyes. We do inlay tests and onlays on expansions and we do that with our investment for casting. And then we also do it with our stone and liquid and gypsum powders in our plaster department.

But if I can go and scan it, the computer’s not gonna lie to me. They’re gonna give me exactly what that impression says without us trying to distort it by this hot material and stone going in it and doing all its stuff. It’s gonna be a little bit more on my end, but it’s a little bit more labor intensive, just to be able to go in and have these machines, it’s quite expensive. But at the end of the day, for me, it’s the consistency and accuracy is what I’m all about. If I’m gonna lose a little bit on it, let that be because I can take that other variable out that is another little variable to have with expansions of impression material and pouring of models.

We can do it digitally with our printers man, and so we’re looking at that, but then I gotta get a bunch of these printers because we’ve got a few hundred cases a day to do that way, and that’s gonna be a little learning curve, just not learning curve, but man power. A different, almost like IT guys coming in to be able to make sure we’ve got everything dialed in, but then the technician’s having to know exactly in certain areas that we have to pour this one with stone, this has implants here and there and so all these doing, pouring models in certain situations, but if I can scan these things and do them through the machine, then I can get these accurate models, so accurate, and it’s do them through the day and night. ‘Cause we have a night crew and it does the machines work.

So it’s exciting for me to think about our model work being all digital going in the future, but yeah. Pretty cool. Kind of probably boring for some people to hear that little rant, but I get excited. Thank you lord, let’s get this in here.

Money. Couple hundred grand more and more machines, right? And you need more people to run them. No, no it’s all good. So tell me what do you like to do when you’re not working? What do you do to keep yourself in sanity? Keep your sanity.

Dr. Brown: Well I recently moved to an area where there’s a bunch of hiking trails because I used to live in Irvine but it was a little restricted to where I could go, ’cause almost always had to jump into a car to drive three miles to get to a hiking trail.

Shaun Keating: Yeah.

Dr. Brown: So, I moved to a place now where I’m just south of Mission Viejo and I’ve got trails everywhere and I just like to get lost for a couple hours.
Shaun Keating: That’s good. I need to walk my big fat butt a little bit more. I do. My wife does. She walks everyday. She’s so good. I just come into work and sit on my chair and I go home and sit on the drum set then I sit in front of the TV and I got to quit sitting, get my butt out there. Okay. You may want to cut that, David. We don’t want to give TMI, a little too much information there. So what concerns do you have about the future of dentistry?

Dr. Brown: I think that most dentists have to be concerned about what dental insurance companies are doing to the dental profession. Most people when they get a job, they get dental insurance with that job. And because of that, the employers who pay for the insurance premiums are trying to limit their dollars in what they spend in both medical and dental and the way I see it, this might be wrong, because their medical costs have gone up in recent years, they’re trying to decrease their overall medical costs and where do they cut? They cut in dental. So where in the past they might’ve offered a choice of an HMO and a PPO, and maybe the person who is making the choice had a little more removed from their paycheck to pay for the PPO. A lot of them now are only getting a PPO as the only option, I’m sorry an HMO as the only option.

And I think that hurts dentistry a lot because most people, and you can’t blame them, don’t know the difference. To them, it’s three different letters, and they have no idea. And they expect all dental offices are the same, and if you’re in the profession of dentistry, I just don’t see how an HMO office can deliver you the same care as any type of office that’s able to give you the options and, as you know from earlier in our conversation, I did HMO dentistry and while I did it, I followed all the rules, and I gave every patient the same quality crown or filling that I did my regular patients. But after awhile, you just, you realize it’s tough to deal in only that type of situation.

My other concern is when you’re getting out of dental school, or you’re just starting, that you almost have to go into a large group practice, and here in California, we might be ahead of the what’s considered the norm in the rest of the country, but we have a lot of huge 30, 40 chair practices.

Shaun Keating: Oh no.

Dr. Brown: Where it’s the only place you can get a job. And they’re dealing in HMO dentistry and I know from personal stories, and I won’t tell them, but I’ve worked with other dentists who’ve told me that they just do things that are unethical because they’re maxing out whatever they can to create the dollars that are needed to run that type of a practice. And my concern is that train of thought that if you’re a young dentist, you just went to dental school, you learned what considered ideal dentistry is, but you haven’t yet learned what practical dentistry is. And you’re gonna get some bad examples set in front of you in that type of an environment. So if you can learn what you can, as Shaun mentioned earlier, take what you can out of that type of a situation, I think that’s great, but for a career, I just don’t see anybody lasting that long. It’ll mentally drain you, or you’ll just become basically a bad dentist. If you’re out there and you’ve been doing that for 10 years, God bless you, but I just don’t see how you can do that.

Shaun Keating: So what about on some of that other advice you can give some of the newer dentists starting off. What do you think, some of the dos and don’ts, maybe try to get into a, not a mill type situation, but try to find an associateship or start your own practice. What’s some advice you can give some of the newer guys just starting off?

Dr. Brown: Well I can only speak from what I’ve seen. Personally, as soon as I left dental school, I went to practice in, back then was a large group practice, there were four other dentists. It was a great experience. Unfortunately I did children’s dentistry for three years straight. And learned how to do everything really fast, very efficient. But it came to the point where I decided I wanted my own practice. I kind of think that’s where most graduates, I’m sure there’s some that are just go ahead and kick butt and get out there and start their own practice, but for most, from what I’ve seen in my years, you don’t really … I feel you don’t know what you’re really doing in anything unless you’ve been out at least 10 years.

Maybe some people can disagree, but when you have seen over and over again situations where the outcomes could be different, you already know when you see the broken tooth on the x-ray whether it’s salvageable or not. I don’t even have to go and look in the mouth. You just know, crown to root ratio, and where someone might try and do heroics, yeah you can put that post in, but you’re not gonna get Ferrule’s rule and get that two millimeters of tooth structure on the root to make sure it’s gonna be a long lasting crown. I just think that that little bit of information you gather from older dentists in a group practice is invaluable.

Shaun Keating: That’s beautiful Dr. Brown. Well said, man, well said. I just think you got a good head on your shoulders man. That’s why you’re so successful at your practice. Why you’re kicking butt. How we doing as a lab? We doing okay?

Dr. Brown: You guys are doing great. I’ve got no problems. Unfortunately I’m not one of your people who’s using a scanner yet, ’cause I’m still having a lot of old CEREC crowns that I’m having to remove. I find out it goes so subgingival, I just don’t see a scanner being able to quite capture that deep margin. We use lasers to open up the sulcus and everything, but I’ll be sold one day they’ll come along with a nice small version.

Shaun Keating: I think we can scan those subgingival margins quite easily. I might have to get my three shape guy over there with a little loaner at your office, show you what it’s about. Get you excited about that. I got one of my doctors out of Florida, he’s getting one right now too and he thought the same thing, ’cause he’s a double cord guy, but he likes to go sub. I think they got that thing licked. We’ll see. We’ll see what we can come up with.

Dr. Brown: Okay.

Shaun Keating: But if it can make your job easier and we can do it to where we can really crunch numbers to show you that it will pay for itself in a little bit of time, six months to a year. I think it’s a neat thing and I think it’ll- I think it’s the future for sure. I think we can wait another couple years still and it still might even improve quite a bit and costs I think are gonna go down. They’ve got to go down. They’re in the 30s and 40s and I think they’re gonna get down to the 10 to 20s, once some of the other guys really start getting into it. The technology’s there. I think it’s like back with the VCR with the beta and all that stuff, the got cheaper and cheaper for the units in time. It’s best not to jump on it so quick, and I think we’ve gone through the quick part. I think now it’s coming to a really neat thing, where if we can get pricing it’ll make sense for a lot more dentists.

Dr. Brown: I agree.

Shaun Keating: But I think it’ll be cool. Well, hey, Dr. Brown man, I can’t thank you enough.

Charlie Brown. Charles Brown. You ever get anything on that at all?

Dr. Brown: All the time. As I told you, even today.

Shaun Keating: What happened today?

Dr. Brown: I had a patient come in and his name, his first name wasn’t Charles, but his middle name was Charles and his last name was Brown.

Shaun Keating: No kidding.

Dr. Brown: That’s why he chose my office.

Shaun Keating: Hey man, that’s perfect. Hey, Dr. Brown, Charles Brown. I’m going there. That’s so cool dude. Well, hey man, thank you so much. Thank you for all the work. If there’s anything you need at all, I’m here everyday, you know it. Say, “Hey, Shaun said this round house needs to be done in three days and he said 50% off because I’m his best buddy.” They’ll go, “Shaun says that to everyone.” No, just kidding. But hey, Dr. Brown, thank you so much dude. I can’t thank you enough for all the work. I appreciate it man. God bless you and your family and we’ll talk real soon.

Dr. Brown: Okay. Thank you very much.

Shaun Keating: All right buddy, thank you.

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 national wide. 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.