Transcript
Speaker: ADEC's Smart Start program offers first-time practice owners their deepest discounts on equipment and furniture for two years, plus other savings and complimentary services. Ask your ADEC rep for details and start smart with ADEC.
Speaker: Join Drs. Savannah Craig and Renetta Sartor as we navigate life beyond graduation. Real conversations about forging our own paths in our early years in our careers.
Speaker: There's a reason it's called practicing dentistry. Welcome back, listeners, to another episode of Beyond Graduation. I'm Savannah Craig, and with me as always, I'm Renetta Sartor. So this week we have an exciting guest episode. We're really looking forward to seeing where this conversation goes. so Dr. Joe, thanks for hanging out with us today.
Speaker: ah if you want to tell the listeners a little bit about you, but I'm sure we'll get into more of the details as our morning progresses. Sure, Thank you for having me. well my My name is Dr. Joe Cicchetti. I practice in the Charlotte, North Carolina area. i'm also a I do a lot of teaching. I travel around the country and sometimes internationally teaching our cosmetic protocol. We also have a learning facility in Huntersville, North Carolina, where we host courses all the time. I'm in a little bit of a unique spot, and then I have a general practice, but I also have a specialty practice where I just do cosmetic dentistry. It's a lot of fun.
Speaker: I'm there three days a week. And then at the general practice, two days a week. And we sprinkle evening courses in between. And we have weekend courses. And but we we have a lot of fun. But I'm very blessed in that my spouse, Amy, she runs all the businesses. So that way, not a whole lot of mistakes happen on on that. day So yeah. So can you tell us a bit about, you know, your journey through dentistry? Sure, sure. So I'll be happy to, and I'll try to keep this as concise as possible. So I got i got out ah i got out of school before there were smartphones, and and I did ah an amazing residency at Wake Forest ah Baptist Hospital.
Speaker: And then right after that, I got asked to stay on as faculty teaching ah residents and med students. I really enjoyed it. And I was working as an associate, as a practice in the community, really kind of cruising along. Nothing too crazy. Very straight ahead dentistry. And this was in Winston-Salem, North Carolina.
Speaker: And then something big happened, like super big. I met a girl. Okay. and And, her name's Amy and she lived in Charlotte. I don't want to get, which is about 90 miles south of Winston. And I don't want to get into the weeds too much with the story, but I bet I basically figured out really quick. I need to get my rear end down to Charlotte and marry her as quickly as possible. So, so I did. And it was going to be a transition for me. I knew that without a doubt. And I'd always wanted to own a practice.
Speaker: So I found an amazing practice, brand new build, brand new technology. And back then it even had a digital Panorex. Oh my gosh, you know so amazing. Massive space. It was 4,000 square feet.
Speaker: It had everything I'd ever wanted in a practice except patients. So it made a lot of sense to go ahead and and buy that practice, which I did. And then this is a lesson on how not to transition a practice. OK, we met the seller on a Friday, closed that following Monday.
Speaker: He had a pizza, surprise pizza lunch for his staff. Texted me in the parking lot. You can't make this up. Texted me in the parking lot. I walked in. He walked out. We had the signs changed over in about 24 hours. And that's when things started to get pretty hard. Yeah.
Speaker: So it turned, it was a very, very, very difficult ah first 12 months to give you. i was I made the mistake of being in a hurry, thinking I was better than I was. I was only about three years out. didn't know I didn't know my own mistakes yet. And so I just figured, get the the shiniest, flashiest one out there, get the old guy out of there. And, you know, I'm a faculty at the hospital, right? I can do anything. So...
Speaker: Just to give you a ah little, and I love to talk about the business of dentistry as well. Okay. so I am going to sprinkle that in just to give you a little peek into our P&L at that time. My note on the practice loan was 10 grand a month.
Speaker: This is before smartphones. Uh-huh. ah My rent on the space was 10 grand a month. Okay. All right. a house to So that's 20 grand a month right out the door before we even start. Our collections the first year was 350,000. Yeah. How many employees? At the time I had four. So it was very, very difficult. So now we had to do, so I will never forget it. I had a month where I had 10 whole crowns and Amy and I were super excited because we thought I was going to be able to pay myself.
Speaker: Amy was an executive at Wells Fargo at the time, so she was keeping us afloat. And then the lab bill came in. So we had to do something. And I had been looking, i had been doing a lot of research. How can I differentiate? How can I differentiate? And and I came across CREC. And so I did an all-day course with them that was free, which was my first requirement. And basically, we milled and made crowns all Emax crowns. And I walked out of there knowing knowing that the technology works. And the only problem ah at the time, the entry point was about 140K of money we didn't have. So we'd have to take another note. So Amy and I doubled down, ah said a prayer in the truck, walked in signed the papers. And a week later, we had a C-Rac. But what happened is my practice went like this after that for for this for two main reasons.
Speaker: One more important than the other one we had instant differentiation at that time no one had seen anything like that this was omnicam i don't know how familiar you are with the and so i may i scanned everyone who let me i was scanning people diagnostically before that was even a thing okay so that was one the differentiation but two and most important and i'm going to pause for effect okay i became inspired yeah Okay. And let me tell you something. When you're an inspired dentist, you're a better dentist. When you're an inspired dentist, you're inspiring your team. And if the team's inspired, this is the, this is, if the team's inspired, your patients are. I could not get enough of it. We started investing as much as we could in my, my CE. I bought a whole nother dental education in about three years. yeah Okay.
Speaker: I did everything. And then all of a sudden i started getting referrals from my colleagues in the community. Yep. Okay. What were some of those big CEs that you took? We're CE junkies ourselves. So I'm heavy, heavy, heavy, heavy into Spear.
Speaker: um it's And it made sense for me because Spear is so interrelated with C-Docs. Yeah. Which I just recorded several videos for that'll be out on their site soon. Nice. Very good. Anyway, but but point being, my dentistry got so much better. Our patients got so much happier and our growth just really took off.
Speaker: To give you some metrics on that, but we doubled our revenue within 12 months of that purchase. Wow. And then our our our growth metric has been double digits ever ever since in practice number one. But here's here's the kicker, and here's one that a lot of people don't look at. I love KPIs. You know, we all get into, you know, growth, collections. Of course, that's important. Patient volume. But Production per patient is something that gets really left out, and that's that's intimately related with sanity. Okay? All right? Because yeah if you're if you're if you're collecting, you know, a couple million a year as a single practitioner, that's great. But if your production per patient is $500 a patient, you're on roller skates all day, you know? Yes. So our production per patient is, is I think the 90th percentile is $800 a patient and ours is just under $2,000. So we're doing we're doing, you know, comprehensive care on these patients. Are you still heavily CERAC? Yes.
Speaker: Yes. If Densply Serona went out of business, I would probably have to so find another job. But, but, Well, we'll get to that in a moment. But yeah but anyway, hit a point where Amy left Wells Fargo to run the business, but helped me out and because of the growth. Then in 2020, I hit a point where I was getting underwater and we needed another dentist and I could be difficult sometimes. So I knew I needed someone who could put up with me. So I i called a friend of mine, Dr. Reena Fattel. We were in residency together and said, I need you to bail me out.
Speaker: And help help me out. and she came down. We talked about an associateship for about five minutes and just realized we needed to do a partner and get it over with. And we did. And it's been awesome. And our growth has been like this since.
Speaker: amazing Then around, and i don't want I want to keep this efficient. In 2019, we started noticing some real health issues with my daughter. And that revolved around her airway.
Speaker: And kids can get apnea. So we couldn't find anyone to help her. The suggestion was myofunctional therapy. So we went to a myofunctional therapist. I'm pulling out a charger for my computer. I just realized I'm... And we did some sessions and and the myofunctional therapist we had was a very nice lady. And I'm very grateful for her help.
Speaker: for those few sessions, but i was definite I'm definitely kind of of the mindset that i i I just felt like I could do it better. So Amy and I became my functional therapists and and we fixed Emily. okay She sleeps through the night, mouth closed, development caught up. Now she's in the top percentile in her class height wise and she's thriving and she's funny and we love basketball, driveway basketball and all the things. the Point being, I started seeing her mouth in my patients' mouths, yeah particularly my reconstructive patients. And I do a lot of big projects. That's the simplest way to put. You know, my two, I have Monday, I'm prepping 28 teeth on a patient. You know that's the type of stuff I i do. So...
Speaker: I decided i was going to treat everything around the airway in relation to all this wonderful technology I have that enables me to get objective measurables. What we found is the results were just out of control. i i do a lot of I've been doing a lot of cosmetic dentistry for a long time. And patient comes back in six months, are you happy? yes I'm happy. Everything looks great. And we move along. But after we started designing things around the airway itself,
Speaker: and rendering either orthodontic, myofunctional or prosthetic treatment to expand that airway or all three, the six month check in was more like this.
Speaker: Doc, I am doing unbelievable. Guess what? I finally had the courage to open up that business. Doc, guess what? I'm losing weight for the first time in my life. God, ah Doc, guess what? I've i ah met the man of my dreams. I got myself out. I mean, it's just the stories were just crazy. So Amy and I decided we needed really to systematize this. So we hopped in the truck with a blank legal pad and drove around in circles. This is how we figure stuff out and came up and came up with the Harmony Protocol, which is my cosmetic protocol, which is a very predictable way. It's a nine point checklist. It's a treatment planning modality for doctors, but it's also an amazing patient presentation modality because it's easy for them to digest. We have the nine points in doctor language, but also nine points in patient language.
Speaker: And this started to really get gain traction within the community. Then, Dent Supply Serona just started started noticing I was doing more aligners than anyone else and asked me to start speaking for them.
Speaker: So I started doing that, and that really started to blossom. That started 21 or 22, think. thank So all that's going on. Harmony Protocol is going on. And then HKB plastic, HKB cosmetic surgery, excuse me, contacted me. They're the largest cosmetic surgery group in Charlotte. They have nine, 10 locations nationally. They asked me to open a cosmetic only practice in their mothership in Huntersville. Oh, wow. So we took advantage of that to, because it's a big, you know me, if I'm going to do it, I'm going to do it It was a 6,000 square foot space. So we divided it into two spaces. Obviously the clinic, which is completely connected technology driven, not digital. And I can talk about the demarcation. Yeah.
Speaker: And then for our cosmetic procedures, and then a there's classrooms to start teaching this and hosting the other things I teach on. Amazing. One of the partners in the cosmetic surgery group, him and his wife, went through my protocol. That's what perpetuated that. So now that's where I am three days a week. I'm at our Chiquetti and Patel Wellness, our general practice, where I do a lot of big cases as well, as does Dr. Patel now. And she's a speaker now. She's a rock star. If you get a chance to see her speak, do it.
Speaker: I mean, she's fantastic. But anyway, so we have, we built a state-of-the-art facility. I'd already been a beta tester for ds hardware and software. And I i met with their their big guys to say, how do I build the infrastructure to be this and entirely around connected technology? Meaning every film we take, every scan we take, and every photo we take automatically drops into DS core.
Speaker: And I know a lot of people aren't crazy about DS Core and that there's reasons for that. And I'll explain. i can probably change your mind in about five seconds. But the reason for that is there's a piece of DS Core called the Canvas that is a mint as far as patient presentation. And I teach docs how to use this. And to give you you, know, one of the barriers I see sometimes with patients are financial. Our acceptance rate is well above 90% at Harmony.
Speaker: And our average plan is probably between $35,000 and $40,000. And these are all-at-one procedures. Yeah, right. It's everything. Yeah. And I firmly believe it has to do with how we're able to present our new patient process. And those are the videos that'll be on C-Docs where we teach docs how to do this. But basically, in a nutshell, when everything goes to core quickly, so for example, our new patient coordinator, Greta, she's able to get my 15 photos, our CBCT, our bitewings, and take a digital scan with the PrimeScan2 in about 15 minutes. It all goes to core. Mm-hmm. And then it's on 75-inch TV in our new patient operatory. We have an operatory just for new patients. Just patients. Okay. Everything's uncluttered up there. I'm not wheeling in a computer on wheels. not clicking through all this stuff. It's very powerful for patients. So anyway.
Speaker: at That perpetuated a lot of our our recent success. and And now our courses are real taking off. a Harmony Protocol, that's my aesthetic protocol I told you about.
Speaker: yeah um Those courses start in January. okay We're doing a lot of smaller courses, a couple half-day courses and some evening stuff right now. And then and that that's and now we're here on the
Speaker: that's That's about where we're at at this point. so That has been quite the journey. Yes, yes. how How would you say, I mean, i have i have tons of questions, but the yes the thing that sticks out to me and Renetta and I talk about this all the time is like how important your life partner is. How has working with your spouse been having her in your business? Did she know dentistry at all or did you guys grow into that together? What was that like? So Amy's the love of my life. i mean, dental, um' ah I'm going to, I could talk about her forever. I'm very biased. I think she's best ever. yet No, you should because she's, she's actually, now she's speaking for DS on the business side. That's amazing. in relation to maximizing big technology investments because she's lived it. So actually earmark that. Yes, absolutely. oh so So anyway, but it's critical, particularly if you're a dental business owner, because being a great dentist is hard, but being a dental business owner is quite a bit harder. And if you don't have the support, one, it'll eat you alive. And if you don't have someone in in your corner who takes a vested interest in that, you could get in a lot of trouble. And and where I was truly blessed,
Speaker: Amy was a senior vice president at Wells Fargo in treasury management. She has a business background. So yeah when i when I just couldn't handle it anymore, she came in on day one and found 5%. I mean, so you can you either need to pursue business education with all that extra time you have, yeah or if it's right there, partnering with your spouse is is is, I love it. I mean, we work together every day.
Speaker: that's And then we come home and, you know, are' working with our our our our kids and and that sort of thing. I can't imagine not working with her with her every day. Are there times it's hard? Yes. Are there times I drive her crazy? Probably daily.
Speaker: yeah But it's been, this has been so, it's been amazing. And then opening the new business, Harmony and the Learning Center has been, um may it's been a lot of fun. And you know what? Kudos to Amy because she had no dental background, but she leaned into it.
Speaker: And now she's in dentistry and enjoys it. And she she enjoys meeting the the patients because, ah and you know, our our big projects, these these are these are before and after moments for our patients. these are This is that line in the sand, that rite of passage. So her and our our teams get really involved involved with that. So to answer your question succinctly, I would argue it's everything.
Speaker: Yeah. I mean, it's very, um it's very important. Do you guys have boundaries or rules about talking about work versus home or, you know, some some my husband's not in dentistry. And there are days where we have to be like, we're going to shut off the dental talk and be the two of us. What does that will look like with you guys working so closely together? So great question, by the way. So for us, because the two because essentially we have three simultaneous businesses, you could argue four because of the real estate component. Yeah. The day-to-day is very fluid with family time. It's more a lot like handoffs, so the kids are having fun and that sort of thing.
Speaker: Yeah. the What really sets us up for success are Sunday planning sessions. okay We get up, we get up, and we go through the week in relation to business A, business B, family. And it's very intentional to where how we don't impact our kids negatively, who's picking up who, that sort of thing. And then we really try to protect certain times during the week. for for family time. And and that that's that's been really, really important.
Speaker: This gets into something that I think has been really helpful for me. I'm just going to touch on it really quick. Discipline is very important in relation to your family time, in relation to your physical health, in relation to your businesses and dentistry, but consistency is more important. Speak a little bit more about that. What's the difference? So if you're not consistent on how you handle things on a weekly basis, that's when things can get get out of control. That's when things can get in a lot of trouble. So going to bed at the same time and waking up at the same time every day.
Speaker: Maybe waking up 15 minutes early. Here's a little power tip. Yeah. Whatever time you wake up, wake up 15 minutes earlier and have two things on your business checklist.
Speaker: Do you like candlelit dinners? Do you like late night walks on the beach? Do you want to watch the sunrise over your own lakefront property? Do you want slow mornings?
Speaker: Do you want afternoon yoga classes whenever you want? Do you want peace of mind? If you answered yes to any of these questions, help us build the self-determined future you're looking for.
Speaker: Check out Ignite DDS Coaching. Mention the On Graduation Podcast for a free consultation with Ignite DDS Coaching. Seven, you just bought yourself two more hours working on your business. Do it in the morning before anyone else is up, before that assistance is coming in. You know, Mrs. Jones is class four, number eight chip for the third time because she, you know, talked you into doing a composite instead of a crown to save her $200 and you own it, you know.
Speaker: you know Get that done. So so consistency. and And then that's important for taking care of your body as well, which really gets left out a lot. One of the things, we have great equipment at Chiquetti Patel, but we we we really invested in a little bit higher of higher test equipment, quite frankly, the 8x top of the line of the new practice.
Speaker: Yeah. And that's been really important for me because, you know, I got an all day prep on Monday. i got I'm going to be sitting down five, six hours and and that patient's going be laying down. Everyone's going to be comfortable. So point being is consistency will help you. So back to that Sunday meeting that happens every week.
Speaker: There are weeks sometimes we miss it. Man, those weeks are tough. Yeah. Because we don't know where everyone's at. Yeah. with the With that consistency and and discipline piece, when do you feel like you were you always this way in residency when you came out? Did it take you time to find that? And and how have you and Amy I'm sure that routine has changed as you've had kids and new practices and, you know, those are all babies in their own way kids and practices.
Speaker: How has that process of fine tuning that consistency and what's that looked like over your career? um it Fine tuning it was a result of of not doing it initially and and realizing the mistakes along the way. Sure. You know, I mean, it's as simple as that.
Speaker: And then just trying to hone in as you progress in your career, as you progress with your family, as you progress with your spouse, your time is going to become more and more valuable. All right. It's already more valuable than any currency you have in your pocket.
Speaker: yeah Okay. But as you get older, it's just going to increase in valuable. So if you're able to protect that time in any way, it makes a big difference. And you can get overwhelmed so quickly in this job because if you care even a speck about your patients, if you're like me, you know, youre're you're going to go to bed thinking about, man, I hope Mrs. Jones is not upset because that composite I mean, we all kind of halfway smiled in the op, but, you know, I might be visiting that again, you know, stuff like that. So so if you if you protect your time, everyone in your family is going to sleep better. Your team's going to do better and things can get less chaotic. And and and I'm not perfect at this. I want to be clear about that.
Speaker: All right. I'm not. and But I've found anytime I miss weekly scheduled meetings with my team, anytime we miss our planning session, things things snowball.
Speaker: So there there's got to be consistency and structure. And the the more consistent you are at that, you'll get more return on your time. You'll be, you know, like that 15-minute trick. You just got two more hours that.
Speaker: of of admin done. If you're doing your own payroll, that took care of payroll that week. You know, you're not trying to mix that in. You're not mixing that in at lunch and that sort of thing. So that's where it's important. Yeah, it makes a huge difference. One of the things that we hear you say consistently is having systems and processes.
Speaker: um One of the things that I really, really loved is when you were talking about the protocol that you guys came up with that, you know, part of the protocol is how the dentist communicates with the patient and other one just more... So patient specific, can you speak more to that? Because I think, you know, dentistry teaches us the clinical part, but case presentation, even if, you know, a lot of times we go to a lot continual education stuff, the implementation.
Speaker: And correlating that to how you said, you know, from a business perspective, seeing your practice sore, that can be something that's truly missed. Sure. So the first thing ah with that in relation to case presentation, I'm going to put it in a new patient arena.
Speaker: OK, I don't want you to think about it as as a presentation. I want you to think about it as an experience. You want to create the most amazing patient experience you can for that new patient.
Speaker: All right. And the best way to do that is working with your team and creating that experience to start right from the phone call. We have little red flags at our front desk. If someone's on the phone with a new patient, that flag goes up and no one's allowed to talk to her him or her while they're talking to that new patient.
Speaker: That's an example. We rehearse walking the patient back. We rehearse finding that patient's why and getting that to the doctor so we can link their or why to every recommendation we make. I just increase your production by about 20% with that little trick right there. Yeah.
Speaker: um So to as far as acceptance and presentation, it starts with the experience. If you're cluttered, if you're running around, if you have five minutes to examine, diagnose, and present, I mean, you're going to be chasing cavities.
Speaker: You're going to be chasing, you know, cracked teeth. You're not going to have the time to treatment plan, you know, comprehensively. And now with that being said, one thing I did ah that really made this a lot more achievable, and I recommend you all do this or at least consider it. None of my new patients go through hygiene.
Speaker: They have an hour with the doctor. And I started that a long time ago before I got into all this other stuff. And then we were rehearsing our experience, you know, how we're going to bring the patient back. I mean, down to this is how you adjust the headrest. This is how I would like you to make sure they're comfortable in the chair.
Speaker: This is the comfort menu. Dr. Patel came up with that. Ask them what they would like for that. I want to know why they're here. I want to know why now. Yeah. So you're not going down a rabbit hole.
Speaker: You know, I missed a lot of larger cases when I was younger because I'd start talking about stuff that I saw, but I didn't understand why the patient was there. That patient was there for veneers, you know, so that that's so it starts with that with the presentation. So the experience, the experience has got to be better than anything they've ever had.
Speaker: OK, I mean, this is we teach on this at at Harmony. Now, as far as the direct presentation with to patients about comprehensive care, this is where it's a little bit counterintuitive. The more complex the situation, the simpler analogies you need to use. Fascinating. So, for example, I tend to get a lot of wear cases where the vertical dimension is gone and we got to increase vertical dimension, put them in centric relation, and then we're to build them back. That's, I mean, that's heavy stuff, right? That's heavy stuff for dentists. Yeah. Mrs. Jones, there's not enough tread left on these tires. It's time to get this going.
Speaker: I get it, doc. Fair. Yeah. And that that analogy combined with an uncluttered... I'm pointing at the screen in my operatory right now, by the way. Right. Combined with an uncluttered presentation modality, meaning you have what's important to this patient on that screen, not wheeling in a computer with wheels, not flipping through all this out that is really concise.
Speaker: That's where you get acceptance. Making the complex simple and making the presentation clean That's where it goes. So back to Core, we leveraged that canvas very heavily.
Speaker: And what's nice is i have um I have the big crazy camera for all my cases. you i'm I'm sure you know what i talk about. But we found using a phone, an iPhone, because that will automate, because Core's online, you open up the patient Core card in the phone, you take pictures, it uploads it to an instantly. The patient can even see if it pop up on the screen. oh Wow. All our scans automatically go, our prime scans, prime scan two scans rather now, ah they go directly to core. So does prime scan one. You don't have to press a button or anything. yeah
Speaker: All our x-rays go directly to the core. you don't have to press a button. So my staff gets all that. And then we have a, I call it a template we make that starts the conversation, which is usually three pictures and the prime scan image all right there with a nice dark background. And then they'll drop things in as I talk about it.
Speaker: Here's your airway map from the CBCT. Boom, drop in. Here's another picture showing this. Boom, drop in. And my assistant's driving that as we're talking. And then that gets emailed to the patient like a shared document. Wow. And they hear it ding on their phone while they're sitting there.
Speaker: Nice. While all this is going on, my treatment plan is already made out. They understand me now. They know where I'm going. And that is relayed to the front desk while I'm talking to the patient.
Speaker: So when the patient walks up there, they're not scrambling, trying to figure out what it costs or anything. They're ready to go, looking good. And then here's the critical part. When that team member walks that patient up, we call this the baton pass. If you watch a relay, how even though they're going 1,000 miles an hour, how careful they're that baton.
Speaker: They hand that patient off and they comment positively about the team member of the front desk. Hey, Mrs. Jones, here's Andrea. She's going to go over Dr. Cicchetti's recommendations with you. She is a rock star. She's going to take such good care of you.
Speaker: And then Andrea's prepared. Hey, Mrs. Jones, I'm so glad you're here today. I know Dr. Cicchetti talked to you about how we're going to do six months of ortho and 10 veneers up top and 10 veneers on bottom.
Speaker: So you're ready for that wedding next year. That's the why. You always like the treatment back to that. Yeah, that's one okay incredible. Yeah, it is. One of the things that we heard you say a whole lot as you were telling us about this is team. What was it like getting your team on board, you know, as you created more to help with the patient education and communication? So we spent a lot of time leveraging ah resources through Spear. They have a lot of frameworks very close to this. And then we shaped it through there. So what we it's all about time. Remember how valuable that is? So we schedule a three-hour block for a team meeting every month for training, not during lunch.
Speaker: Lunch is for eating. So we we we cut out production time for it to get it done. But everyone takes it seriously. We're paying them for it. And that's where we develop those systems and we work together with them.
Speaker: So that's number that's number one. i think, and I used to do it all too. let's have We're going to have ah an amazing team meeting where we're going to learn about how to raise our aligner acceptance during lunch.
Speaker: And then Dr. Cicchetti is 10 minutes over. Then the assistants are still cleaning up rooms. And Mrs. Jones showed up 30 minutes early. Yeah, we've all been there. We've all been there. How much of your team is still that original team from the office you bought? fine okay Remember I said a lot of mistakes along the way? Uh-huh. It happens. Yeah.
Speaker: Yeah. and I mean, and truth be told, I had the majority of the original team. There was only, there was only, there were four, one left within a week. So there are really only three. The one, she decided to go back to school.
Speaker: She's still a patient. And then the the other, we picked up some more along the way, but a lot of people retired during COVID. Okay. So we had to, we rebuilt a team. But we've worked hard to to get a a very stable team now. We have ah we have a great group.
Speaker: That's amazing. so One thing i would love for you to touch on, and this might be I don't know, controversial, but I feel like there has been a lot of talk about airway dentistry and and there was a white paper that came out from orthodontics about maybe this isn't the realm for dentistry. And you've built a whole protocol and have seen lives change related to this airway dentistry.
Speaker: what What is your take? Dispel the myths or or let us know what your experience has been. Sure. so Upper airway resistance, meaning teeth, gums, all that stuff getting in the way the air is is legit. ah The ADA released a statement in 2017 that the recommendation is for all dentists to screen. And in relation to that, ah to that you know i I work with sleep physicians as much as possible. I get a lot of referrals from sleep physicians. So so the key to that is objective measurables. yeah So where dentists get in trouble is if they're looking in a mouth and they're just saying this is an airway thing and then we're treating it.
Speaker: one of the One of the things I agree with the North Carolina State Board is if you're doing any airway treatment, you have to go through a sleep physician first, you know. Makes sense. So that's where we'll work with them. We can titrate them. So I'll send them home with a take-home sleep test. And then once I have them in the green on my reports, then I send them to the sleep physician for verification. So i i it's there's really not a whole lot of talk about if I have objective measurables. yeah that's And and way the way we treat patients with this is either with appliance therapy, your standard mandibular advancement devices, or
Speaker: Maya functional therapy, which can lower an ai of up to 50% in adults or 65% to 75% in children. You can also lower upper area resistance with increasing a vertical dimension. And you can measure that by doing an airway map on a CBCT.
Speaker: And then you have them take home the test. and you can you With objective measurables, there's there's no argument. So I'm not trying to circle the airport, but it's just... and I mean, that's that's the reality of it. and and and the the problem is orthodontists have gotten a bad rap on this deal. You know, I feel bad for them. And I work with orthodontists all the time and I have amazing colleagues. But, you know, years ago, we thought it was a good idea to take out teeth.
Speaker: I mean, that's all there is to it. You know, we weren't trying to hurt people. We didn't know we didn't know. So, I mean, it's as simple as that. You know, it's not worth pointing fingers and getting to this, that and the other. They were doing what was what was standard of care back then.
Speaker: You know, there's stuff I did a long time ago that I would never do now. You know, we do the best with what we know. at that time Yeah. so So as far as airway in relation to dentist dentistry, get trained.
Speaker: Yeah. American Academy of Dental Sleep Medicine, which is a sister association to the American Academy of Sleep Medicine. That's how you get trained. yeah So you work handin hand in hand with a sleep physician.
Speaker: That's what I did. yeah That starts there. You got to get trained. yes And then follow the proper protocols as to when to get a sleep physician involved. And then, you know, everyone's on the same same team. it's it's It's literally that simple. It's like you get a med consult for, you know, before you, you you know, same deal.
Speaker: Absolutely. When you're talking about the myofunctional therapy component, is this still something that you are providing in your office or do you have auxiliaries that are trained to do that? what does Walk me through what that myofunctional therapy process looks like, but also where is that in, let's go with the where patient who you're doing that full mouth rehab. Obviously, every case is different, but somebody who would benefit from myofunctional therapy as well and when that would be in the treatment modalities and how often they're coming to see you. Sure. So,
Speaker: We have multiple myofunctional therapists in the office right now, ah just because we had one make a switch or leave our practice. Myself and my wife are the only ones. Okay. But ah where where to answer your question, how that fits, I typically do myofunctional therapy in combination with aligners. Interesting. That works the best. Yeah. Okay. Yeah. so So a little bit of dental expansion, torquing those posterior teeth, not tipping before everyone freaks out, in combination with teaching the patient how to sleep with their mouth closed and position their tongue forward and and strengthening those pharyngeal muscles is very, very effective. That's where I love to do it. That works better than anything. And then when we get to the restorative component afterwards, the aligners, the the good habits are already in place. So that's that's where 90% of our myofunctional therapy is. It's in conjunction with with aligners. That makes a ton of sense because you are changing the position where the tongue can be at the same time you're retraining it so that
Speaker: makes a ton of logical sense to me. What do you find? i don't know that this is also maybe a a social media rabbit hole. Do you find that patients need retention as much when you've taught them where to keep their tongue? So it depends on the patient. If we're correcting a swallow, if if we're correcting a swallow, the answer is no, if the swallow is corrected.
Speaker: Okay. Yeah. The other thing that I teach a lot of on aligners, so it's going to be hard for me not to just throw in little pearls here or there. yeah So expansion directly offsets IPR, ah but IPR actually helps with retention because you can get those roots parallel. Okay. Because you lower the height of contour.
Speaker: All right. got it So I mentioned that in relation to the to the retention, even though I'm expanding, I might do 0.2 of IPR in those lower anterior teeth because if those roots are splayed if they have a high contact, you're going to battle retention. Where if you do some ah IPR to get them more parallel, that in combination with proper oral habits because teeth tongue excuse me cause cheeks, lips, and tongues move teeth better than anything, you have a better chance chance of retention. So So to answer your question, it's not as simple as, in my experience, it's not as simple as if they do the myofunctional therapy, they'll have retention, better retention. I think that in combination with some other more traditional modalities work best.
Speaker: And the the swallow process. is definitely the biggest one where you'll see that become a lot easier for you. Because if you get the teeth in the right place and the swallow is not corrected, you'll have the open bite back in a year.
Speaker: you know so Interesting. Yeah. so So I hope that wasn't too confusing. no that makes a ton of sense. Yeah. So... um with With your two offices, what made you decide to open the two offices and and how, I'm assuming you're using the same protocol in your patients in both practices, but how did you decide to make that distinction? So we did it by making them separate businesses. We did it by making clear boundaries with marketing. So for example, we don't do any marketing across county lines. I can't, and this has been challenging, Okay. Also, at the new office, we do not accept insurance, nor do we file. Okay. where truly fee-for-service. Yes. Yes. Nice. But we do file insurance for patients at the other practice. So there's there's been there's been some things there that are more challenging administratively. The other thing is sometimes my schedule is booked out very far at practice number one now. Yeah. Okay.
Speaker: And sometimes there'll be someone who we just need to get in and I'll swing them over to the other practice. Fair. So a lot of that's been in and messaging as well. We're not keeping secrets. They know I have another practice and they know but they, but we, we just revolve it around the teaching component, which is the the truth. Our ops at the new practice, I hope y'all come to see it.
Speaker: We would love Our massive. would love to. So people can get around me and see everything while we're doing it. So that's that's how we we kept that demarcation. They're two separate business entities. We do our best not to compete at all, which has not been a problem.
Speaker: There have been a couple situations where, you know, we I treated ah a CP patient at Harmony and CP collected it and, you know, whatever. yeah mean i mean, stuff like that happens.
Speaker: But that that's generally how we had to do that. Now, with that being said, if it wasn't a specialty practice versus a ah more general expanded scope practice, I would keep them the same business. Sure. I would keep them the same business. There is a clear… Yeah, yeah. This is an extremely unique situation. And that has to do with our partnership with the ah the cosmetic surgery office. We have a very captive audience right there in the that building. Yeah.
Speaker: So and their philosophy business wise, and they have different surgeons who specialize in different things. If someone's giving a consult with someone ah talking about body and they're interested in face, they ping the face surgeon and the expectations they see the face surgeon that day.
Speaker: yeah So now with us, if they start talking about teeth, we got to be ready to rock and roll when they come upstairs. So we have multiple scanners to handle that. really cool. I just want to highlight, I think there's this movement in dentistry right now.
Speaker: and maybe it's been this way, but people are are very competitive and very scarcity mindset. And I want to highlight that you were able to have two successful practices, not very far from each other doing similar things. and And it sounds like you believe a lot in abundance in what you've created for patients. So i want to i want to highlight that. And have you always had that abundance sort of mindset?
Speaker: around ah yeah your offense? Yes, yes, yes you got you got to be the You got to be the light in your practice. you got You got to be the de-stressor for your team, even if it's, you know everyone's freaking out. And I have my moments. Totally. i mean You're a human. yeahs but But yeah, it's an abundance mindset and faith is very important. You know, we're very, very, Amy and are very mission-driven.
Speaker: our Our mission is kingdom impact more than anything. We feel like we can help more people um and impact their lives positively. That's that's that's where it all starts. And, you know, attitude is everything. So if you have a an abundance mindset, there's plenty for for everybody, more than enough for everybody. and And I mean, statistically, we're not doing as well as dentists.
Speaker: Clinically than we were 10 years ago. So we're going to have to help each other out, too. You know, there's plenty of plenty of needs. So along that along that line, the competitiveness and that sort of thing, do everything you can within your local community to dental community to try to get around that work with people to, hey, hey, everybody in this neighborhood who is dentists. Why don't we get together for lunch on Wednesdays?
Speaker: ah this podcast you're doing. I mean, stuff like that. It's really important. We're all in this together, you know, and and and I realize particularly with social media marketing and I'm doing it now too, it can get very competitive, but but we have to do it nowadays. But you know, the patient needs help. Whoever they go to, that's all that matters. And helping each other out sometimes is is is really important too. I tell this story all the time in my courses. I do aligners all the time. I do a lot of aligners, but I i work with orthodontists too. And i I've had conferences with them about how to not get out of my wheelhouse and You know, not too long ago, i i took on a case I shouldn't have. The teeth weren't moving. The patient was mad, you know, as she should have been.
Speaker: And I had to refer to an orthodontist and I called him up. His name's Chris. I'm like, hey, Chris, i I didn't follow your rules. Patient's upset, you know. I need you to finish this case, charge my office, not her, yada, yada, all that. And, you know, you know we've we've been working together for 10 years, sending each other patients like I got, don't worry about it.
Speaker: You know, stuff like that. You know, and I didn't. And now I'm not saying you'll get bailed out like I did. but But the point being, we have we he knows I do aligners. I didn't hire. I went to him when I started doing aligners saying I'm go to start doing this. I don't want to get in trouble. When when do I need to refer to you?
Speaker: Because I'm going to talk to every patient who needs ortho about ortho. Right. And whether it's me or you doing it. And so he ended up getting more referrals. So yeah stuff like that. Yeah. That's such a good example. Yeah.
Speaker: It's all from mistakes. It's all from mistakes. Let's be clear. You know, this is object lessons. I don't want anyone to make all the mistakes I did. OK, I really don't. So, yeah.
Speaker: So that was leading me to our next question. You've dropped so many gems today and, you know, we're looking forward to coming to visit and. here in a bit we'll have you kind of leave information for our listeners to know where they can come and visit and learn more what you know last pieces of advice would you have for young dentists that's just trying to figure it out you know dentistry like you said if you don't have a lot of people around you to kind of help inspire you and motivate you you know if you think back to the you know, the beginning years of when you first took over your practice, what advice would you give young dentists to help them through?
Speaker: um From a clinical standpoint, after about year four or five, when you've started to have some real failures, I'm serious, don't do this early. Wait till about year four or five. And after you've seen a lot of your own failures, invest in a comprehensive treatment planning course. Spear, Kois, Panky, but they're all great.
Speaker: Dawson, whatever is closest to your philosophy or whichever is closest actually to your current workflow, that'll make it easier for you. That's one from a clinical standpoint.
Speaker: Number two, be very intentional about your time on your schedule. OK, if so, and this is going to be counterintuitive, but just stay with me. If you're not meeting production goals, lower your production goal by 25 percent. Once a day is at that goal, do not book anything else on that day except for day of emergencies and new patients. What that will do is you won't be running around like a crazy person and you'll have more time for quality exams and hygiene. OK, so whenever we were getting in trouble with why are we not meeting numbers? Excuse me. We we lower the goal.
Speaker: And then once a day's at goal, no more treatments booked that day. We close that day. That's a good rule just in general. And then more quality new patient exams, more quality hygiene exams than your average treatment plan's going up.
Speaker: If you're running around like a crazy person and you're not taking the proper time to look at each tooth, you know you're you're in trouble and all of a sudden you need the production more than the patient and that one everything that's when everything goes south.
Speaker: Yeah. Time. And find it find a good life partner, right? Yes. Yeah. Yeah. Yeah. I'm really good at not finding the right life partner actually or was once upon a time. Other mistakes. That's a different podcast. Yeah, yeah, yeah, yeah. Yeah, exactly. That might not be a dental podcast. Dr. Joe, we have had just an absolute blast with you. And like Renetta said, we would love to come learn from you. But I would like for you to take a couple minutes and let people, our listeners know where to find you about your upcoming courses. Obviously, check you out on Cdocs, but there's a lot going on. So we would love for you to drop all of that.
Speaker: So at Dr. Joe Cicchetti, and it's spelled ridiculous, C-H-I-C-H-E-T-T-I. Well, you can see my my spelling right there. So at Dr. Joe Cicchetti, you'll see everything on Instagram. that That'll help you help you quite a bit. And I do weekly clinical pearls on that as well. So you can hopefully learn a little little something. but You can go to the highlights and see the past ones. Some of those are really, really popular. So, yeah.
Speaker: Awesome. Well, thank you so much for for meeting with us. And we will be sure to get in contact with Amy and she can tell us her side of the story next. i she she's She's ready to do it. And she's a lot smarter than me. So you'll probably learn a lot more. for joining us for this episode of Beyond Graduation. If you enjoyed this week's episode, be sure to share it with a friend.
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Speaker: and remember, you are not alone on this journey. ADEC certified pre-owned equipment is a sustainable, affordable choice that makes genuine ADEC equipment available to every doctor. Each package is sold on a first-come, first-served basis. So if you see one you like, contact your dealer. For more information, go to www.adec.com backslash findadealer. Thank you for listening to Beyond Graduation, brought to you by Ignite DDS and Future Dentists. This episode was sponsored by Ignite DDS Coaching.
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