Brews and Tiny Teeth, The Unfiltered Pediatric Dentistry Podcast

Dr. Gena Otto is an orthodontist and the owner of Otto Orthodontics in St. Louis, Missouri. Her office has grown tremendously to include three locations, 30+ staff, and a full time marketing specialist.  I wanted to have Dr. Otto on the podcast because we work closely together professionally, and I've always loved her hip and energetic enthusiasm for orthodontics. She has a fantastic social media presence, along with really nice clinical outcomes and a passion for what she does.  In this podcast, Dr. Otto and I discuss some of the following ortho-peds issues: - How has competition changed the marketplace for ortho work? Are orthodontists recommending comprehensive ortho earlier? - What kind of outside-the-box marketing works well for orthodontists? - When is the appropriate time to refer to an orthodontist? - What options do we have to treat skeletal class II issues? Is headgear still even a thing? - Congenitally missing laterals, do we canine sub or do we hold space and implant? - Second molar substitution, what kind of mess do we leave for the orthodontist to clean up? This was a great conversation and a nice refresher course on practical clinical applications for ortho issues in our pediatric patients. 

Dr. Peter Nguyen is a pediatric dentist who started First Bite Pediatric Dentistry in Henderson, Nevada. Dr. Nguyen grew up as the child of Vietnamese war refugees. He did his pediatric residency at UCLA, before moving to the Las Vegas area and associating for a number of practices prior to doing his start-up. Dr. Nguyen has a great sense of humor and as he puts it, "I'm not the smartest guy on iPedo so I have to make up for it with my sense of humor." I loved this podcast, I thought it was awesome to just laugh out loud and tell stories about ridiculous things that happen in our practice. We talk about Dr. Nguyen's start-up journey, then discuss crazy and ridiculous things parents and kids have done in our offices.  We also talk about "verbal judo" and the art of communicating with parents when it comes to tough treatment plans or difficult situations. 

Dr. Cyrus Safizadeh is a pediatric dentist who opened a practice with his wife, a general dentist, shortly before COVID. They grew this practice together throughout the pandemic challenges to come out thriving on the other side. Dr. Cyrus talks about the benefits of working closely with a general dentist and utilizing the skillsets and technology that his wife brings to the practice. He shares how they have balanced Medicaid patients to keep a healthy new patient flow on both the pediatric and adult side. He is kind of enough to open up and talk freely about his practice numbers and how he plans for growth.  We also discuss how they made a 150k investment in a CAD-CAM unit, and Dr. Cyrus has ended up using it extensively in pediatric dentistry. After being exposed to so much general dentistry, he also talks about why he no longer starts sweating at the site of extensive permanent tooth decay and treatment plans. 

Chip Fichtner is the founder of Large Practice Sales (LPS), a firm that specializes in partnering with large dental practices as they look to sell to DSOs. You may recognize him from the flyers and newsletters that his company mails out to private practices. Chip discusses how his company is able to achieve the highest EBITDA multiples by bidding practices to multiple DSOs to find the right fit. He also talks about "invisible" DSOs that allow the owner to retain full autonomy of the practice while still being able to cash out on a portion of practice equity. Chip likes packaging these deals as a "dental trifecta" to include pediatric dentists, orthodontists, and oral surgeons in the same geographic area to make for higher offers from DSOs. Some other questions I ask Chip: - How do pediatric dentists obtain the highest value for their practices? - Where is all this private equity money coming from? - As part of these buyouts, we often see DSOs offer shares of equity in the parent company. Is there ever a concern about the value and solvency of these shares? - How valuable are good pediatric offices, and what multiples are you typically seeing? - Are DSO buyouts here to stay? Or is this a short-term process that will likely end in the future? Chip can be contacted at https://largepracticesales.com/

Dr. Jason Bresler is a pediatric dentist practicing out of the Philadelphia, Pennsylvania area. His father originally started and grew the practice in 1982, and now Jason and his siblings and their spouses (5 Dr. Brasslers in total) own and operate this large practice.  They have grown the practice to include eight pediatric offices, four orthodontic offices, over 30 associate dentists, 250 staff members, and along the way built their own surgery center. This stand-alone surgery center operates five days a week, with a full time nursing staff, pediatric anesthesiologists, and CRNAs. This allows two dentists to see 15 or more GA cases every day.  We spent the majority of our conversation discussing how to set up a surgery center, regulatory differences, surgery center fees, and how a practice of this size is structured and operated. We also talk about what makes for a good associate pediatric dentist. 

Dr. Juan Yepes is a man who needs no introduction. He is a pediatric dentist, radiologist, physician, masters of public health... I'm sure I'm forgetting something. Let's just say he's smarter than I am. Dr. Yepes joins us on the podcast to talk about radiation safety in pediatric dentistry.  We had a great conversation highlighting the importance of being responsible with how much radiation we are prescribing in the office. Some topics we discuss: - Modern digital sensors vs traditional film x-rays, and why digital has its drawbacks - Rectangular beam collimation and why we need to consider it - Updates to wearing a lead apron, and how to change public perception - Background radiation doses and how we practically apply it This was a great conversation that made me stop and think about how many times my staff hits that x-ray button in the office on a daily basis, and it definitely stimulated some critical thinking. Dr. Yepes can be reached at jfyepes@iupui.edu.

Dr. Mitch Kramer is a pediatric dentist, partner, and soon to be 100% owner of a busy pediatric practice in central Minnesota. Dr. Kramer comes on the podcast to share his story about how he structured his initial buy-in in 2016. After helping grow the practice to four-locations, an associate, and 12,000 active patients, Dr. Kramer will be transitioning towards buying out the remaining practice equity from his partner Dr. Dennis Carreras this year.  It was great catching up with Dr. Kramer, as this was the office that I associated with between residency and the start of the COVID pandemic. We were able to reflect on our opportunity to work together, along with the challenges of finding and retaining both good staff members as well as associate pediatric dentists. We talk about the financial practice opportunities that can be found outside of the urban setting, how to keep team members motivated, when can you afford another dental assistant, and batting clean-up for restorative work from previous associates that doesn't go as planned. 

This episode is a boards-review style solo episode, where I take some time to review the AAPD guidelines, current literature, and throw in a little personal opinion on key topics in pediatric dentistry. In today's episode, I review: - Amides vs esthers, - Is septo really better? - When to give an IAN block and when to infiltrate - Buffering and computerized delivery - How to manage a local anesthetic overdose - Pharmacokinetics and contraindications to N20 - MTHFR, should we avoid N20 in these patients?

Dr. Tim Richardson is a pediatric dentist and the owner of Acorn Dentistry for Children in the greater Portland, Oregon area. After residency, Dr. Richardson bought and grew three offices in a five year period. After feeling the stresses of burnout coming on, he decided to sell these offices and start over with both a goal and team-oriented mindset. He has since started six pediatric offices in a five year period, and leads a team of nine pediatric dentists as partners and associates. In this episode, we discuss: - Where is the line drawn between "corporate" dentistry and large group practices - How to reinvest equity into growth to make other people's money work for you - Why Dr. Richardson went with a growth and volume model over being a sole practitioner - How to use real estate to minimize taxes - Why he doesn't put money into traditional investments like the stock market, and instead invests that money into his practice

Dr. Adam Priestwood is a pediatric dentist who practices in eastern Tennessee and treats a high-risk population. Dr. Priestwood comes on the podcast to talk about how he uses oral sedations to help manage shortages with his access to OR time. We talk about what the patient population is like in the Appalachia region of eastern Tennessee, oral conscious sedation strategies, Equia Forte for hypoplastic molars, when to graduated teenage medicaid patients, and personality styles of pediatric dentists. Dr. Priestwood is also a big deer and turkey hunter, so at the end we get a little off track talking about hunting. This was a great, very chill conversation for pediatric dentists in the eastern portion of the United States, or those that provide oral sedation.