The Pathway to Peak Performance

Insurance companies don't necessarily have the patient's best interest at heart. They certainly don't have our best interests at heart. Our independence is being cut back. Not the king of the castle. What would you say to somebody who's considering a career in healthcare? Having started out when it was less technologically dependent and we had to kind of figure it out, but now being able to add the technology on top of that. I don't know if there's a lot of people that have had more experience with this than I have and uh that's a nice place to be. That's a unique scenario. A father who has tons of experience and a daughter who is really well-qualified. Having the same staff every day, the same partner every day who I trust implicitly, it's a nice way to spend these last few years of my career.

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Dr. Dalbert Fear, welcome to the Pathway to Peak Performance. So good to have you in, my friend. Well, thank you, Jock. Great to be here. Yeah. All the way from Ann Arbor, Michigan. Um, so your charity is the uh National Pancreatic Cancer Foundation. Yes. I've lost a a a couple of friends and and one 30-year employee to pancreatic cancer. And it's such a a terrible disease because it it strikes quietly and really fast and by the time you know you have it, it's often too late to do anything. So, it's a a charity kind of close to close to my heart because of personal experience with with folks I really care about that I've lost to it.

Yeah, that's a rough one. Uh it happens and it's like doesn't seem like there's a lot of a lot of options there. Most people don't survive it because you you f— it's in a terrible place. It's often inoperable. They don't have good chemotherapy for it. And uh cancer sucks, but pancreatic cancer really sucks. So yeah. Um that one is particularly nasty. Um, so what we'll do is we'll, you know, obviously the the proceeds from the views, you know, as time goes on and we send the the money to the foundation and then also we'll link uh the donation page in the show notes so that someone who's interested can go there and um and donate. Any little thing we can do in that direction is yeah is good for us. Absolutely.

So, um, you know, the format of the show, um, obviously is sort of about your pathway to peak performance and you are a peak performer and you've been in practice for quite some time. But before we get to the practice part, we need to kind of go back and talk about who you are and what were in the formative years and sort of what brought you to the place and point in time where you decided that you wanted to be a doctor and then all the things happened with with all that. So, let's take it all the way back.

Sure. I I grew up in southeastern Michigan, suburban Detroit. Um, three siblings. I'm I'm kind of in the middle of of of uh four kids. My dad was a commercial artist. My mom was a homemaker, which most women were back back then. I definitely admit to enjoying sports and things like that more than school as a as a kid, but I always always liked biology. I always liked the science part. Uh, and my brother, uh, was significantly older than me, was an orthodontist, so dental school seemed like a good good way to use the science component as a uh, as a path in the in the future. So, I went to undergrad at University of Michigan and went to dental school thinking I'd be an orthodontist. And with the time I spent there, I was fortunate to have some mentors that kind of broadened my horizons a little bit.

What you find is that some people are wired one way and some people are wired another way. I was attracted to surgery because it's a see a problem and fix a problem profession. It's not a see a problem and wait six months until the care shows what what's going to happen. Uh, and that's what I always explain to to students who ask me is if if you're in dentistry to establish long-term relationships and watch things develop over time, don't do surgery. But if you like to to fix things that are broken and and see the results quickly and and take care of that, then then surgery is a really good place for you. And you you need also to be able to take folks that really don't want to be and do what you do and and make them happy. Do something people aren't really looking forward to, but still make it a pleasant experience for them. But uh yeah, I I didn't as a little kid I wasn't going to be a dentist. Like everybody else I was going to be a football player or something. But you have to have to make adjustments to reality. And uh I I love what I do.

So growing up in in Detroit in those days was a different time. Detroit at one point in time I think was really was one of the most wealthy cities in the United States. And um and it's taken a big turn. Um probably starting what in the in the 70s '80s it's I got to watch that as a kid. My dad as a commercial artist worked a lot with the automotive industry and his business was in downtown Detroit about two blocks from the beginning of the Detroit riots in the 60s and stayed he stayed there through the whole upheaval and uh so we watched Detroit in its heyday as the automotive center of the world and then the automotive part stayed and his business stayed stayed busy but the rest of the city went downhill for quite a while for multiple reasons but the watching it come back has been great.

We we never lived in Detroit. I live in Ann Arbor, which is a suburb. I grew up in Oakland County, which has always been a a well-off suburb of Detroit, but Detroit always meant a lot. The the sports teams and the cultural stuff. And if anybody ask ever asked where where I'm from, it's Detroit. So, watching the comeback and and participating in the comeback has been great. Tigers, Lions, and Red Wings. Oh, yeah. And Pistons now. Oh, yeah. Yeah. Yeah. That's funny because you think about you forget about Isiah Thomas and and uh and just how big that that whole period of time was, right?

Yes. The uh the my dad was a primarily a hockey and and basketball fan. So my earliest memories are going to Red Wings games and Pistons games and and then um my older brother went to University of Michigan. So Michigan, you know, Michigan sports has always been a big part of our of our life. So yeah, it's a it's a good place to live. You can you can complain about the weather in the winter, but uh you can't beat southeastern Michigan in the summer. In the summer. Yeah. Pretty pretty nice place to be.

It's beautiful there. It has like a real a real kind of charm. Ann Arbor especially has a real charm as a college town or university town. It's just I was very fortunate to go there for undergrad and never leave. I just kept signing up for four more years and and finally had an opportunity to stay. I got offered a position in practice with a couple of my mentors from from residency and it's been been a great experience. It's been interesting 40-year ride. Yeah. So, you did University of Michigan all the way through. All the way through. Dental school, residency, everything. Yep. And pretty solid program.

Yeah. Uh obviously one of the best uh undergraduate programs in the country and the number one rated dental school in the country and one of the top oral surgery programs in the country and I and I always applied to other places but I was always very very happy to get an opportunity to stay at stay in Ann Arbor.

So, at what point in time in in your life? Um, so you you know, you're um in high school, do you have a sense of what you want to do? Although you say sports, but do you have a sense of kind of like where you like the biology, the sciences, you're leaning towards something in undergraduate, you're going, what are you thinking?

I in high school, I didn't have any idea. I I knew I wanted to go to Michigan. Um, and I knew I wanted to take science ba— a science-based curriculum because I figured I'd go in that direction in some way, but I didn't really commit to the idea of wanting to go to dental school till probably third year in in undergrad. But fortunately, I'd taken the appropriate prerequisite classes to make that a pretty straightforward move. I didn't have to do extra undergrad. I was able to get the the prerequisites in within the within the four years. Saved my parents some tuition.

What made you decide dentistry?

Well, part of it was my my brother. I kind of, oh, I got to hang around in his dental office when I was a little kid. It was fun to play with the with the tools and do the arts and crafts part of it. And then orthodontics seemed like reasonable, not just reasonable, but an an interesting thing to do. You're you're helping kids, you're you're dealing with with parents, you're all that all that interpersonal stuff is fun for me. Uh, and I actually was accepted into the orthodontic program at the University of Detroit coming out of dental school. And at the last minute, my mentor in orthodontics had a study club and he brought in a surgeon to do a lecture on orthognathic surgery, which is jaw repositioning surgery. And I went to the lecture because I was invited to go even as a student.

The surgeon named Bruce Epker, I'm going to say it because he's one of the famous pioneering oral surgeons in the orthognathic field in in the United States. Anyway, and I saw him saw this lecture and I thought I can go to dental school and do this basically repositioning people's jaws, fixing much more than just the teeth, but actually the the whole whole facial complex and and realizing that yep, I I didn't go to medical school. I'm not going to be a orthopedic surgeon or a plastic surgeon, but I can I can learn to do this and and this would be much much more fun than than for me orthodontics because I'm a I'm a see it and fix it person. And so I changed gears completely, taught oral surgery for a year in the undergraduate clinic and then applied to and and went to to Michigan's oral surgery program.

To be to get into accepted to orthod—, you know, to be an orthodontist or to be an oral surgeon, you got to be at the top of your class. So you got to be, you know, got to be pretty good uh because limited slots, right? There aren't that many available. So when you're going through the OMFS program, um those are not easy days. Um those are that's a kind of a tough it's a rigorous, you know, obviously I have a lot of experience with oral surgeons and know a lot of them um in in my my career. But um from your perspective as you went through that, were there times where you thought, "Oh man, I'm not sure I'm in the right place or doing the right thing or was it just happening for you?"

My third month of general surgery, which you don't really think about this as something that a dentist would do, but part of an oral surgery residency is doing the same rotations that physicians do if they're going to go on and be whether they're going to be orthopedic surgeons or ENT surgeons or whatever. So, you spend several months being kind of low on the totem pole in a in a surgery service. I did three months of general surgery and the last week of my third month, I don't think I got any sleep at all. And I remember walking down the hall in the old University of Michigan hospital thinking there's got to be something better to life than being up at 4:00 in the morning trying to go take care of somebody that I may I don't know yet and I'm going to try to figure out how to help them. But it it it teaches you to persevere even when when things are hard. Um, mostly it's fun. Uh, you don't don't ever do something just to do it. Do it because you enjoy it and do it because you know you you see what the the end goal is and and keep your eye on the end goal. Don't don't worry too much about the process. But no, you could have you can have general surgery. I don't need to do that anymore.

And you're doing like appendectomies and all sorts of stuff, right?

The last service I was on was transplant surgery. So we were transplanting kidneys and livers and hearts and things like that. And that that was that was a tough service because these are these are very sick people. Yeah. But but rewarding too. It was it was fun to see the see the end result. This was a long time ago and a lot of this transplant surgery that's become very uh commonplace now was was pretty experimental.

Yeah. So you get to that spot where you think to yourself, okay, maybe I'm not not wanting to do this. And did you consider something else at that point in time? Did you think, "Oh, I'm I'm going to go someplace else and do something else."

Actually, no. Um, at that time, oral surgery training has has evolved and and gotten longer. When I was a in my residency, it was a three-year residency program. So, more the higher percentage of it was doing oral surgery and a smaller percentage was the the things that were not quite as as focused on what we do. And I I I never really questioned whether I was in in the right place. I just what we had to do to get there seemed a little difficult sometimes.

Yeah. Tough path for sure. Not not easy to not easy to do. Um so going back to like at this stage of the game, you're at University of Michigan, you're in a residency program. That's that's a tough program. Um it's not like they're uh just letting anybody in there. So, um, you got to you got to make sure that you're doing well. What's going on in in around Ann Arbor and Detroit at that point in time? What's like the climate of the of the area? Like things are changing, right?

When I was in undergrad, it was the era of bomb threats and protests and Ann Arbor was kind of the center of the hippie culture at at the beginning and by the end it it it became more of a let's go blue kind of sports sports town. Um Ann Arbor's 40 miles from downtown Detroit, but it's a whole it's a town unto itself and it centers itself around the university. So whatever kind of political mood the students are in that that kind of permeates the the culture in the town. But it's a great great town to be in. Great community to have my kids grow up in. Fortunate to be able to stay there.

Yeah. I remember being there I guess it would have been 11 years ago and having dinner with you there. Um and that was it was really it was really fun. It was really it's just a cool place. I mean like um I I really I really liked it there.

We're having the same same issues that that other communities are. We have the affordability problem where the people that work there sometimes can't afford to actually live there. The town's changed from a community that had height restrictions of three stories for any building to the land of 18-story apartment buildings. They just it's growing and growing and growing. It's a it's a very popular place to live. You you read, you know, best places to live in the country and Ann Arbor is always up toward the top and that's that's saying something for a town that's weather sucks a lot of the time.

Yeah. And great place to be unless you're an Ohio State fan, right?

I don't even talk to Ohio State. Sorry. I don't even know how you can be an— yeah. Yeah. I mean, like you step on Buckeyes, you don't um— yeah. Unless they step on us. I'm also a realist. They're going to beat us about half the time, too. So, I think that's what happened last just recently, right? Yeah. Sorry to rub that one. Uh s— how it— yeah, it is what it is. Um Wolverines, uh had a pretty good run there.

Um and there's always something there's always something we're good at and and we go to a lot of sporting events. My my kids grew up there. They they're sports fans. And uh I I hate to admit it, but I think we have basketball season tickets, hockey season tickets, gymnastics season tickets, football season tickets. That's about it. But that's enough.

And also, you think about the hockey team there is pretty amazing, right? Isn't the number one hockey program in the country right now?

It's the number one in the country. And they're they're really good and they're they're good kids. We I grew up liking hockey and then when when my my children were in high school, my kids— the United States the Olympic development team was headquartered in Ann Arbor and they needed places for their players to live. So, we had a series of 15 to 17 year old hockey players living with us. And uh so I I think it helped my kids to see how hard you have to work to get something that you really want. Um and I I think it it it helped them to to learn that you got you got to you got to keep trying hard to get where you want to go. You've got to want to get there.

Yeah. Be willing to work for it. I think that's the interesting tie-in here on the pathway to peak performance and being in in around that like a center of excellence. It's sort almost everywhere you go. Um well, you know, there it is really truly a sports-oriented uh town and there's such a performance-based culture there. Um, it must be interesting to be around that consistently. And do you feel like that had had an had an impact on you professionally after your residency was over and you went into private practice?

Yeah, my um when I was a resident, we used to take care of a lot of the the U of M athletes being the you know the the University of Michigan hospital. So, um, a lot of interaction with the trainers and the coaches and the the administrators, and I've continued to see a lot of University of Michigan athletes as patients in our practice, and you just realize how hard they work. This that isn't easy. Uh, combining trying to go to school and and being an athlete, everybody thinks their their life is is easy, but they're pulled in a lot of different directions. Right. The new way of compensating the kids is is certainly going to change things, but that's so new it's hard for me to tell how that's going to affect things. Now, you can be a college athlete and make more money than you can as a professional athlete, and that's a whole different whole different thing. But the the effort is no less. You still have to still have to put the work in.

Yeah. I remember when my summers at Ole Miss and um the NIL stuff started happening and I was I was like, "Wow, Jaxson Dart's like making 900 grand, you know? It's like um it's pretty amazing to think."

Yeah. I don't know what we're paying the quarterback for Michigan now, but it's a lot more than he would make as a a rookie quarterback in the in the NFL.

Well, when you've got a team that's like, you know, you guys are always u— always up there, it's always Ohio State, Michigan. Um I think it's like the first time that um in the playoffs happening recently, like Clemson wasn't involved. One of the four, you know, uh bigs, you know, teams that you always see weren't in the um in the playoffs. But it's it's a really it's a it's an interesting uh kind of place to be from. And high energy. It's interesting. I didn't really think about it that much, you know, but when I went there, I was like, "Wow, this is like there's a real energy here. It's a really uh interesting place to be."

And um in your in your practice, you know, at some point in time, you you know, this whole notion of orthognathic surgery and that's such a profound procedure. People most people don't know that. We've talked about it on the show. Had a couple of ulcers and one guy from UCSF um Nester Karas, Dr. Karas, uh we had another guy from Tufts. We talked a little bit about orthognathic surgery with Dr. Karas um a little bit more and you know the the reality is that's such a profound procedure to see the end result on that is just amazing. Um, and you know, people who have those, I guess, recessed uh, mandibles and or protruding maxilla or whatever whatever the combination is. That seems to be like when I first heard about that, I was like, I can't even believe that you guys actually do that procedure.

Well, as I said, that was that was what kind of set the light bulb off for me that I I could bind that the dental degree I was getting with the the anatomy and the and the problem fixing that I keep coming back to because it when I try to think about what led me to enjoy what I do, it's it's the the I guess I'd call it immediate gratification of of establishing the result quickly. You know, you just fix it.

And I mostly as a as a resident start out treating trauma because those are patients that come in in odd hours of the night. And trauma surgery really is what generated the ability to do the orthognathic surgery because understanding how you could have things break into little pieces and put them back together again is is kind of how they— well, jeez, if if this breaks and you can put back, what if we break it intentionally and put it somewhere else? And that's really what orthognathic surgery is, is moving parts and pieces to the place they belong even though they didn't start out there. So, it's a big part of it's a big part of what we do.

They're also the the happiest patients because, you know, if you take somebody's wisdom teeth out, they didn't care. They just had it done and now they feel a little better. But when you really change somebody's life by by allowing them to chew better or or or look better or or and everything function better is is is is a big reward. My staff loves it. The the assistants love going to the OR and participating in those surgeries. My daughter who I practice with is a big part of her training. So, we uh we do those cases together which is fun. Mostly what we do we do separately even if we're in the office together. But the the orthognathic procedures often go better when you have a surgeon on each side. So, we that's the one time that we actually just we're sitting like this and doing the work together.

That's pretty wild to think, father and daughter in an OR.

I'm sure there are others, but it is it is really fun. The uh the operating room— I mean, everybody watches these TV shows. Nobody watches a TV show about the office oral surgeon, but you see the TV shows of stuff in the operating room, and it is a lot like that. It's a lot of bantering back and forth and a lot of a lot of stress sometimes, mostly just calm, technically competent people doing their job. And being able to do it with my daughter is a kick for sure.

Yeah, that is pretty wild. Um what do you think— somebody says Dr. Fear and we both say yes. Um so fear, the last name, you know that's it's so funny. Um I remember when I first met you I was like wow how's that going to work out uh when you say Dr. Fear? But I guess in some ways it really does work out well because you get the— if there's any kind of fear it's going to come out right away.

I— people think they've told me that joke for the first time and I always say if I don't think that's a funny name for a surgeon, I don't have a sense of humor. It is. It's a very funny name for a surgeon. Um I'm on more of those radio call-in shows. I have a Dr. Fear and it's like okay that's that's fine. But it is funny and it it is it is also memorable. Um the the part that's worked out better than I would have thought because I worried about it a little bit when I started. How how the heck am I going to be Dr. Fear? But after you've been around a while and people start to remember, then they remember who they saw. So they can go back and if we made it a good experience, then I'm the only one around. Well, I was the only one around. Now there are two. But it's it's it's been better than one would think.

What kind of name is Fear?

I have no idea. Um it's a Americanization of of something French, I think. Yeah, I I think by by ethnicity we're we're Norman French and so it was Fair or Far or something else and when my ancestors came over here they changed it. As far as I know there weren't any any actual F-E-A-R fears when we were still in Europe. Somebody changed it.

Interesting. So now your daughter decides to become an oral and maxillofacial surgeon. What were what were your thoughts and at that point in time how do you how do you feel like that came about? You know, it was pretty cool.

Um, I have three kids. Um, one's an attorney, one's an interior designer. They're the two older older kids. And she always wanted to be an oral surgeon. Her mom, my wife, is a general dentist. Um, but she always just wanted to be an oral surgeon. Uh, from the earliest take your daughter to work day that I remember. She she just liked being around and like liked doing it. And she knew that's what she wanted to do. So, she started undergrad with the idea that that unless she changed her mind. I always told her, "Change your mind. If you don't want to do it, don't do it. Don't do it for me. Don't don't do it for any reason other than if you want to." Um, but she she persevered and she did the the even harder road than I did. When I when I was in training, it was four years of dental school and three years of surgery. For her, it was four years of dental school, two years of medical school, and four years of surgery. So, much longer route.

Your program changed though in Michigan, right? Yes. Now it's a dual degree. It wasn't a dual degree program, right? Was it?

Well, when I started it, there were no there were no dual degree programs when I was a resident. You could go to dental school and then decide to go to medical school or decide to do oral surgery and then decide to go to medical school, but they were all separate. You couldn't combine them in any sort of a coherent program. Uh, and then as I was going through my residency, there started to be what we call dual degree programs where you would do dental school and you would get some credit toward your medical school, usually two years of credit for the dental school you did. So, they would combine them into two years of medical school and the residency in four years. And that's where the six-year programs came from.

Got it.

And now in the United States, it's about 50/50. About half of the oral surgery programs are still four-year programs and about half are dual degree programs. And you don't have to go do a whole medical school, which would be a lot of duplication, right? To go through a full dental school program and a full medical school program, you'd be doing a lot of duplication of effort. That's not really useful. Yeah. It's a waste of time, right? Yep.

Um and I mean, let's face it, in your program, you've got general surgery, you have anesthesiology. I mean, you're doing— I mean, a lot of people don't realize that that's outside of uh anesthesiologists, you're the only only specialist that can actually put somebody basically to sleep for a surgery. Yep. Um how is that from um from a nerves standpoint? I mean, I guess at certain point in time, we always talk about flow state on the show. One of the things we've never talked about is flow state and anesthesia. That's, you know, when you're managing anesthesia on top of managing the surgery with a patient, uh, you got to kind of be in a rhythm, I would imagine. Um, talk a little bit about that if you would.

Well, we've got several things going for us. One is our training, which is the most anesthesia training of any non-anesthesiologist profession. In other words, if you're an anesthesiologist, that's, I believe, still a two-year residency, but our our folks are doing six months as part of their oral surgery training. Nobody else does that. Even if you want to do anesthesia in a practice, the mo— the most you do as a medical student or as a a general surgery resident. So, the anesthesia is is an integral part of our training. So, it's not an add-on. It's it's what we do.

We're also in a in a really good position because our surgery is going on right in the airway. So, we can see what's going on with patients faster than any machine can see what's going on. We're obligated by our our licensure and our um credentialing to have all of the same equipment in our office that you would have in a hospital setting. No, no other surgical specialty will have more both safety and and functional equipment and and training than than we do. We have to do um anesthesia recertifications every couple years as part of our licensure requirements and we make sure our staff is is well trained in anesthesia.

It is the most important thing we do is keep people safe and to do what we do and not let people be asleep a lot of times is not safe. Um an uncomfortable patient is not a safe patient. So being able to provide whatever level of anesthesia is necessary to get them safely through their procedure actually makes me more comfortable. I'm I'm way more comfortable with a comfortable asleep patient than an awake uncomfortable patient. Uh and and everybody recognizes that.

Even the the anesthesia folks— one of my one of my better friends was the um head of the anesthesia society in Michigan and uh and it was the the chief medical officer in the big hospital system that we use. And I took all of her kids to out of sleep in my office. Um, and she looked at our training and said, "You guys do this better than we do." So, I think we could we as a profession can be proud of that. Not just not just me or my daughter, but just oral surgery does a really good job with anesthesia.

Yeah. You know, I always think like I guess I've just been around for so long that, you know, 30 years of healthcare later, right? Um, but the one thing I learned about oral and maxillofacial surgeons along the way and the wisdom teeth side of things, I didn't know. I mean, I had my teeth extra— I was referred to a oral surgeon. I had my wisdom teeth extracted. I didn't really know the difference. It was never really explained. It's kind of like most people don't really realize. It's like why would you have your wisdom teeth taken out any other place? I mean, why would you like why would you want to number one go under local for that? It's a pretty heavy-duty um procedure even when you're sectioning the lowers. Um but the reality is like u— there are a lot of people that just don't know that. They are not aware that you're not going to pay anything more. You're going to I mean it's going to be a much better experience overall for the patient. And yet you hear about patients I mean you have people probably call you up and say I had the kid in the chair for 2 hours and I can't get the teeth out. Can I send them over?

Uh absolutely. At least couple times a month we we get something like that. And I don't know why as a practitioner you would want to put yourself in a position to have to send a patient somewhere else to finish the procedure that you started. Um it it's always a difficult position for them to be in and we and we with diplomacy will take on anything that somebody has gotten started and it it's it's important that we do that. It's a part of the service that we provide.

But it I I I work with a lot of students and I and a lot of them ask, "Well, where where should I draw the line on what I do in my office?" And I'll say, "Just always be doing something that you're confident if it's not going well, you can finish it." If you can't handle the worst-case scenario of what is going to happen, you probably ought to think about not doing it. And I think there is no other training in dentistry that gets you to the point where you can handle all of that other than oral surgery training. Uh the there are other dental specialties and and general practitioners who are very good practitioners, but I I'm not sure it's the it's the safest way for patients to have things done.

Yeah. I mean, it's just not a great experience.

No, we want people to be happy. Uh I get a lot of people that had had some things done somewhere else and then they come to us and, "Oh, how long is this going to take, doctor?" "Oh, about 15-20 minutes." "What? I was in the chair for 2 hours the last time." Probably not going to take quite that long. And we're not rushing, but the the less time you spend on surgery, the better the outcome. There's no way a 2-hour operation is going to go as well as a 15-minute operation.

For sure. Um was having this conversation with u— someone about airline pilots and how you know they you know they have to retire at a certain age federally mandated. Uh it's 65 now but it was 60 at one point in time. It started with uh there's a political reason behind it and uh and we don't need to get into all that but you know you think about reps, right? The reps on um you know like how many wisdom teeth do you think you've extracted um in your career, 30,000 maybe?

Yeah. I've been doing this a long time. Yeah. And it it seems like a an absurd number, but when you think about the number of days a week and the number of weeks a year and the number of years I've been doing it, I I think that's a pretty close guess. And that's a lot.

And so now you can look at a cone beam. So for those that don't know, there's like a CT scan of the of the uh head and you can look in and see, okay, where's the nerve? What kind of what am I dealing with a case and go in and it there's got to be a flow state to that for you like you get in there and you're kind of like I know exactly what to do and how to handle this.

You you don't even really think about it but you you you really have to go through the same decision tree for everything that you do. And I I think that's not just true of surgery. It's true of of any developed skill. You you learn a way of looking at X-rays, a way of looking at patients, a sequence of questions to ask, a sequence of if this happens, what else is going to happen? And and it it if you do it for a long time and you do it, try to do it consistently, you're going to develop a a consistent approach that hopefully leads to to better outcomes.

And so that's transferable to every to anyone, right? If you think about it, that sort of same sort of notion of you have enough reps at doing whatever it is that you do, you kind of develop your own sort of mental checklist that takes you into that flow state around whatever it is that you're going to do. And you can take that sort of same framework and apply it to anything that you would do in any kind of profession.

Well, I don't I don't think it's unique to surgery. It it's got a little bit more of someone's health in the moment online, but the the thought process and the decision-making process is the same um for for anything that that is detail oriented and not just throw it out into the wind and see what happens. You if you're looking for a for an outcome, you you ought to have a way of processing the information that you need to decide how to approach that problem in a consistent way so you don't miss anything.

Yep. You know, as you think about like another thing, another procedure that you do are dental implants. And they have changed. I mean, shoot, since I've been around oral surgery, I guess that's 15 years now. They've changed dramatically. They've they've got seemingly— I mean they were fine back then, but they seem like they're getting more and more advanced. The anguh— angle of the actual uh threading, the coatings, the implants themselves have changed a lot.

Our ability to position them accurately is probably what's changed the most. The implant companies kind of work around the edges of changing the angle of this or changing the threading on that or changing the surf—. But the— I've been around long enough to have participated in the first implants that were placed at the University of Michigan, which was in 1985 when I was a resident. And one of our faculty members went to Toronto and took a course with the gentleman who basically developed the successful dental implant, Professor Brånemark, and came back and said, "This looks really cool. We should do some of these."

So I I didn't place it myself, but I was I was there when they put the ver— very first ones in and it was a— you just sort of put them where the bone was and hope for the best and let the dentist figure out how to put the teeth on them. I mean, that's kind of what what implants were like. Our ability now to put them in exactly the right place and to design everything around where you want the teeth to be instead of putting the implants wherever you could and then making the dentist figure out where to put the teeth. We can now put them exactly where they need to be to have the teeth be exactly where they need to be. And that's that's really cool.

That is really cool. And it it it kind of— the interesting thing about oral maxillofacial surgery is that bridge between medicine and dentistry because you really are dealing on the medicine side a lot. Um you know obviously be the trauma side of things reconstructing somebody's face doing a lot of the procedures that you do then when you're working with general dentists who have a patient has a a tooth that's failed or failing dentition where you're replacing all the teeth with um what they call I guess all-on-X. I guess you have four implants for some of them. Somehow I used to call it all-on-four but sometimes you need five and sometimes you need six and I would just make it X.

Yeah. So that was— Nobel came up with the all-on-four treatment concept and that was their um kind of claim to fame and that was on the four and then there was other companies that came along and said okay well let's do you know this more to make it more stable for those people that had less and then you have all these things like zygomatic and pterygoid implants and things that are where you have like like no bone to work with. You're putting the implant all the way up into the cheekbone uh area, which is wild to think. How do people lose that much bone? I mean, how does that actually happen? You can see people once they've lost their dentition, they get that recessed look. Mhm. And it's really pretty dramatic, but how do you lose that much bone?

The way I explain it to patients is your jaw exists to support the teeth. And if there aren't teeth, your body doesn't really see any reason to keep bone there. And the the whole conservation of energy sort of idea— if you're if you don't need something, your body's going to get rid of it. And so if you lose your teeth, especially if you lose all your teeth, the bone will start to deteriorate. And it deteriorates in a fairly predictable way. In the the lower jaw, it collapses downward and backward. In the upper jaw, it basically just collapses upward.

And unfortunately, your lower jaw has a nerve running through it that supplies the feeling to your lip and your chin. And if you start losing very much bone, that nerve gets closer and closer to the surface, making whether it's going to be putting in implants or wearing a denture more and more problematic because the nerve is getting too close to the surface. So you in the lower jaw, if you can plan out getting the replacements in early on, it's a much easier and safer procedure.

The upper jaw is even more complicated because it's basically hollow. If you think about your upper jaw, it's got your nasal cavity and your sinus cavity and your teeth and there's not much else there. So when the teeth are lost and that bone starts to shrink up, your nasal cavity and your sinuses again get closer and closer to the surface again making the placement of implants, if you're going to do it, more difficult. Doesn't mean we can't do it. There are all sorts of bone grafting techniques and bone repositioning techniques we can use. But having having a plan if you're going to lose— unfortunately some people still lose all their teeth. It's not unheard of to to have all your teeth lost by the time you're 30 or 40 years old. Uh having a a predictable way to replace that for folks is great. In some instances, if the the teeth are failing, take them out, put the implants in right away, put a prosthesis on right away, and and ultimately give people their teeth back without them ever having to go through that removable denture stage.

And I never seen anybody that liked their denture. I've never had anybody in my family have dentures. So, I don't— but I do know some people that have had people in their family who've had dentures. And that seems like such a— like the notion of denture cream or you know like adhesive that you're putting in your mouth and like trying to hold teeth in. People do that.

I made dentures only as a student but I've worked with folks with dentures for my whole career and I still don't know how people get along with them. Uh the idea of putting big plastic things in your mouth that aren't attached to anything seems like a problem. Um a lot of people do seem to get along okay with upper dentures. There's that the plastic across the roof of their mouth generates some suction which holds it up. Bottom dentures are terrible because your tongue's in the way.

Unfortunately, there's almost always a way to put some implants in the lower arch to stabilize a a restoration. Uh some answers are difficult but there there's always an answer for folks. And having the the long angulated implants, the zygomatic implants, the pterygoid implants, uh there are places even in in the most atrophied jaw where there is bone. And if you have the technology to see where those places are, which where where the cone beam imaging comes in and the computer programs we have available now where you can plan out exactly what size implant will fit in what space is just great. Yeah, it allowed us to do things we we couldn't have done 15 years ago. Uh we can do now. And I assume there are things that my daughter is going to be able to do 20 years from now that I can't even imagine.

The notion of actually um of being able to digitally completely digitally plan a case and see all of it and know where you're going in and and kind of work with the restorative partner. I almost think most of the time when I hear about these things, I say to myself, I don't know why anybody would want to do would want to place dental implants unless you're absolutely you've done a ton of them and you do a ton of them every single year because the— you don't get it right. Um it's not great for the patient. It's kind of like the third molar thing. Um uh it's interesting to see that. Um, and certainly there are people who are probably pretty qualified to do it, but I kind of like the way that that my career arc has gone because having started out when it was less technologically dependent and we had to kind of figure it out on the fly in in the mouth in work forward. This is what I can do. How can how can the dentist make what I can do work? I think there's value in that. But now being able to add the technology on top of that kind of background, less technologically advanced training.

I don't know if there's a lot of people that have had more experience with this than I have. And uh that's a nice place to be. I I like to be able to to uh explain the way I do things. My daughter is is came into the training or came into the practice with way more technology-based because she her training is later. So, she's got the the technology end and and I've got the the experience end and it's a good good combination.

Yeah, that's I mean what a what again I mean you may be the only father-daughter team I've at least that I've ever heard of which I think is really cool.

I don't know another one but there probably are.

Yeah. Not not that I'm familiar with. I know a lot of father-sons. You're right. Yeah. It seems that seems to be more common. Um but I think one of the cool thing about um female oral surgeons are a certain number of patients. It's really clear really feel comfortable uh working that sort of like that dynamic works extremely well for them.

It's been a— I'm sure there are people that are more comfortable seeing her just because of their preference for female practitioners than than I might see if it was was just me. It's been a— and she's she just adds her own personality which um which people like. Uh we we get a— one thing with with social media is you get a lot of feedback and if there's negative feedback out there, you're going to you're going to get it. But we we get the vast majority of feedback we get is positive and that that that makes you sleep well at night doing what we do because it's certainly possible to not like your experience with a dentist.

Uh there are a lot of people out there. We treat a lot of little kids. Little kids, four, five, six year olds. Uh because we have a good relationship with the pedodontists in the community. And I always tell parents that I— one thing I don't want to be is a bad experience is I do not want to be that first bad dental experience that your kid had. And that's one of the the things that's nice. I've jumped off topic here a little bit. It's one of the nice things about having anesthesia options is we let these little kids be asleep for things that they would otherwise have to be held down for. And I I won't hold a kid down. Just won't do it. If we've got to come up with a way to do something safely and comfortably.

Yeah. And she's really good at that.

Oh, Elena is great with little kids and and it's been been good for me to to kind of watch another way of— I was in a big group practice before we started our our own practice. But you never really work with your your co-workers. You you are in different places doing things in a different schedule and being being in one place and having us both there together, she can I can use her strengths and she can use mine.

That that's a unique scenario. You think about it coming at from a patient angle coming into that uh this sort of notion of a father who has tons of experience and a daughter who is really well-qualified and that sort of uh you know combining it's like uh it's got to bring a lot of comfort to patients that you've got the kind of the best of both worlds.

I think they appreciate it. I I was in the the big group practice arrangement and you you lose a little bit of the the the personal touch when you're in a different place on a different day with different people. Uh having the same staff every day, the same support staff every day, um the same location every day, um the same partner every day, uh who I trust implicitly. The uh that's that's been a wonderful change. I I I'm it's a night nice way to spend the these uh these last few years of my career and it's been a real it's been a real career. I mean you've placed a lot of implants, you've done a lot of trauma surgery, you've done a lot or that you like it's a it's a lot.

Um, so for kids that are thinking about a career today, the world is changing now. We have, you know, this the new robotic stuff that's coming out and all of that stuff. What would you say to somebody who's considering a career in healthcare?

Be prepared for it to be different. Oh, in a couple of ways. The the things I learned in my residency are really important building blocks for what I do now, but there is relatively little of it that I do the same way. In other words, don't think by going to school and finishing your residency that you're done because if you stop right there and just do what you learned as a resident, you're you're going to fall behind very quickly. So, you need to be willing to adapt new technology, new workflow, new new everything. And that's that's positive. There's nothing negative about that.

If I was going to look at a negative thing, it's that our independence is being cut back on a little bit. Um, insurance companies don't necessarily have the patient's best interest at heart. They don't they certainly don't have our best interests at heart. Having to navigate the limitations that the American insurance system puts on your ability to take care of people. You you've got to be willing to navigate that if if you're not you're not the king of the castle. You you are functioning in a system that doesn't always work for everybody's best interests. And for a lot of folks, your independence as a practitioner is different than it was.

When I started in practice, almost everybody was in what they call private practice where you owned your own practice. You worked for yourself. You had your own employees. You set your own rules. Nowadays, a lot of healthcare, more so in medicine than in dentistry, has been congealed into big corporate entities. You have the hospital owning the doctor's practices and the insurance company basically owning the hospital. They and that's not always a happy way to practice. If if you want to be independent, you have to you have to work at it. You have to have something that's unique enough to have value without having to enter into one of these big corporate partnerships. And that's one of the reasons I I was so happy to to do what we're doing is we've been able to maintain our independence completely. We we answer to ourselves and to our patients and not to any other entity. And I I for me that's important for Elena that's important.

It's a big deal. I mean, I think now more than ever, we're starting to see people waking up on the health insurance side of things and they're really they're really saying to themselves, hey, this is not— I mean, I haven't had dental insurance for over 10 years. Um, I see zero point in that whatsoever. I wish they wouldn't even really call it insurance.

This is one of my— dental insurance is not insurance. It is an assistance plan, right? And if people would understand that, I think it would be easier for them to make good decisions about what to do. It's it's very frustrating to have people defer necessary care for a year because their insurance is going to roll over in a year and then they can get it covered. They think of insurance as being I reach my deductible max and then all everything else is going to be covered. Dental insurance works exactly the opposite way where once you've you've spent enough money they won't pay for anything else and it does not matter whether it's necessary or not.

So we we spend a lot of time— dentistry is expensive and and we are always trying to be respectful of of the limitations that finances put on people because money is important but you also can't let insurance coverage drive your recommendations because you you need to offer people the best care that you can provide for them and then try to get there in a way that makes economic sense for them. But insurance doesn't always help with that.

Yeah. It's just not for me. It was something that I just I saw zero value in. I just decided, you know, I've also been a person who's taken my dentist really seriously. And um you know, realizing that the body's a system. Uh digestion begins here. Um and if you don't have if you're not taking care of your mouth, if you're not taking care of your teeth, there are a cascade of problems.

Sure. Um, and the first one is the obvious stuff. I can't chew my food, so I can't digest. I can't get the nutrients. So, um, you know, and we've lived in this sort of hyper-palatable processed food world, um, that is now also seemingly coming to at least a level of awareness where people are like, hey, I don't want to do that anymore. Um, and now people I think are waking up to the fact that, hey, if I've got to come out of pocket to do something that's going to actually make it possible for me to actually save this. The longer you can save your own personal dentition, the better off you are. Uh, for now we get into the things that are starting to emerge. A lot of talk around um, you know, the the notion of uh, bacteria in the mouth and how that affects uh, cardiovascular system.

The same bacteria that that are in your mouth and cause dental problems are also the bacteria that can cause heart valve problems. Um, endocarditis is is often attributed to unrealized dental infection that's that's gone into the bloodstream. Uh, some of it's not clear. Uh, there there's there's some evidence that it contri— can can contribute to to atherosclerosis with narrowing of the arteries. Some it's not real clear, but it's not good for you. Um if the the portal to your body is not healthy, then then you're entering a lot of unhealthy things into your into your system. And just intuitively that that doesn't make sense to allow that to happen if you don't have to.

And and we're I think people are getting smarter. We can argue about the value of social media things and and everything being online, but there there's there's some bad information out there, but there's some good information out there. And and more people can learn about things from sources that they trust, then then perhaps more they're they're willing to come in and and and listen to what what we can give some evidence-based recommendations for.

Yeah. I mean, it's it's amazing to me. I um I I I worked with somebody um and I'm not going to name name him because he's passed away. True. Um and I just I just don't think that's right. But um you know, brilliant mathematician and um he basically, you know, had his his mouth had gotten to the point in time you just couldn't even talk. You know, he needed distance because the um breath was so bad. And you think about that and know we're talking about gut microbiome and you know all these types of things. It's just it's amazing to me that people either aren't aware or you know didn't have the right education, didn't have access to— I think a lot of times too it has come comes down to didn't have the right access to dental care or wasn't weren't educated. You know, mom, I can just hear my mom every night if I like, you know, there will be times, admittedly, end of the day, I'm tired. I'll go home, put my head down for a second, fall asleep, wake up, it's 8:30, 9:00, I got to get up, got to go brush my teeth. Um, the the other part that that I I really think is is more important than we give it credit to is is just anxiety.

Sometimes it's finances and often and in— and dentistry can be expensive, but preventive dentistry is certainly less expensive than replacement dentistry. So that place where people go from having their own teeth in pretty good shape as kids to completely coming apart as adults, often the the the thread is is anxiety. Either a true bad experience or a— what we get a lot of is is parents that are transferring their dental anxiety to their children before their children have even had a bad experience. One of the smartest things that we do is we have parents leave the room when we're going to treat their kids because we don't want parents sitting in the room making the child anxious, which they often do.

But I I had a gentleman just last week who is needs to have some heart surgery and fortunately the the cardiologist kind of asked them if he has any trouble with his teeth and he basically said, "I don't know. I haven't been to the dentist in 20 years." And this poor gentleman when I saw him needs all of his teeth out. They're all grossly decayed. He's got multiple abscesses and a big cyst around one of his impacted wisdom teeth. None of which had to happen except that he had a bad experience 30 years ago with a dentist and he wouldn't go anymore after that. So, we need to do— we as dentists need to do a better job of not generating anxiety in our patients.

And that it's one of the— I would not want to be a general dentist who had to treat people wide awake for everything that I did for them. I think I would have anxiety if that was the case. Being able to provide anesthesia for folks that we can confidently tell them you will be comfortable while we do this, I think can go a long way. And the fact that we can do it for little kids so they don't have a bad experience that first time they have to have a tooth out, it— it's cool. It's it it puts us in a position of being able to help folks in a way that can can minimize that that trauma that that goes along sometimes with having to go to the dentist.

Well, I talk about trauma. I mean, the one thing that people, you know, sort of like this this thing that rides underneath that no one really talks about. Uh, well, I'm sure people talk about it, but it does, I don't think the general public is really aware. When you go to see your hygienist, you go to see your general dentist, which is typically where your hygienist is to have your teeth cleaned. You know, you're going to have some x-rays once a year or something like that or once every two years, whatever the whatever the preference is. Um, but they're checking you for oral cancer. We know the interesting fact about this is you catch oral cancer early, probably not that big of a deal. You catch it late, 5-year survivability rate on that is not good.

So, these people that are putting off going to see their general dentist, um, and then they show up having, you know, uh, you know, that cyst or whatever it might be, uh, that was went undetected, a spot on the tongue, something under the tongue, some sort of whatever it might be, something in the roof of the mouth. I remember when I had a a bump on the roof of my mouth, I went to see one of my best pals, uh, who was, you know, oral and maxillofacial surgeon. I said, "Chris, what's the what's the story?" And he's like, "I think you might have just like did something like, you know, something like that. Uh, but let's keep an eye on it." So, I went back to see him. There was nothing. But the notion that people could miss that and not get that taken care of, that's pretty serious. And, and I'm curious like what kind of oral cancer cases have you seen? Most of the time they send a general dentist send somebody to you for pathology and then you're making a decision where it goes thereafter. But talk about that. I mean it's a pretty serious thing and we need to bring more awareness to it.

Well, one of the things about oral cancer is especially early, it's usually painless. There's no— it was sort of what I was when we started this off when I was talking about pancreatic cancer. It it's one of those conditions that it can become fairly severe before you as a patient will know you have a problem. And physicians, unfortunately, don't always look in the mouth, or— and I love my doctor, but they don't really know what they're looking at inside somebody's mouth. So your dentist and the hygienist are the first line of defense for any oral pathology whether it's malignant or benign. The the job of the hygienist and the dentist is to look and if they see something suspicious, it's perfectly reasonable to say, you know, "Come back in a couple weeks and let's look at this again." But if whatever it is that looks unusual hasn't gone away and doesn't have an obvious traumatic reason for being there, a sharp tooth edge or something that can cause a sore, get them to see see an oral surgeon, and then it's our job to to make a determination whether this is something that needs to be evaluated with a biopsy or some more imaging or something like that or just watched.

And sometimes we will just watch a lesion if we're convinced it's benign and there's no real reason to do any sort of surgery for it. But I have seen huge oral cancers that the patient didn't know was there until the dentist pointed it out that it was there because it was painless. We in our practice don't treat big oral malignancies, but we have relationships with the University Hospital and we can get people in to be seen right away. But some things look pretty innocuous, but it's just a suspicious enough that that we think it needs to be biopsied and and I have seen some very benign looking lesions turn out to be malignant. So you— one of our jobs is to have a high index of suspicion that something needs to be investigated more fully and then we're in a position to to do that biopsy right in the office. You don't have to go off to the hospital. You don't have to go have 65 different tests beforehand. We can we can take care of it and and and make the right recommendation right away.

Yeah. I mean, it's uh I think what people don't realize is there's a lot more oral cancer. And what's interesting, too, is it's not always like, oh, I don't smoke. I don't use smokeless tobacco. I don't do this. I just read an article, you know, they were talking about these u— you know, Zyn pouches, the nicotine pouches, and how they've kind of pivoted. Um I'm curious what your thoughts are with regards to that because the nicotine has vasoconstriction capability obviously vis-a-vis just the mechanism action of nicotine. Um what do you think what do you think about that?

Anything that's an irritant that you place somewhere in your mouth and leave it there repeatedly is going to have some effect on the tissue. I think the the evidence for whether that what percentage of that becomes something malignant, I don't know. My my experience has been that if you've got somebody that does snuff or chewing tobacco or these nicotine pouches, if there's something there and you can get them to stop and not put it there anymore for a while— and I don't mean two days, but you know, a month or six weeks— most of the benign changes will go away. The things that don't go away after staying away from the irritant for an appropriate length of time probably should be biopsied because there there is certainly a percentage of those things that does turn out to be malignant.

The other thing that that those irritants can do is mask an underlying malignancy. This is pretty common with some of the dermatologic conditions uh that folks can have in their mouth. Lichen planus, pemphigus, pemphigoid. These— you don't have to memorize those names, but there are some dermatologic conditions that make the inside of your mouth look weird. And those particular conditions are benign, but they hide other things that may be unrelated to that condition that are are developing. So, you've got to see your dentist. You got to see your hygienist and and when something looks suspicious, you should should see an oral surgeon.

Yeah, without a doubt. And I mean, I just think the notion of keeping your teeth super super clean, keeping your gums gum line clean, making sure your pockets are not, uh, you know, receding um, super important. And that's the funny thing about it. When you think about it, people get all upset about how much it costs to go to the dentist. People spend uh more than that on a night out at, you know, it's insane to me.

If you get a Starbucks every day, you more than paid for your every six months dental cleaning. Um yeah, that and and you just feel better. I I'm I I know I'm biased, but um if if your tooth tooth is sore or your gums bleed when you brush them or your spouse says your breath's funky, you know, there there are answers for that. Uh and and they're not— preventive dentistry is not expensive. Um I—

You know what's so funny? I think prevention starts in the home because I for me it's like I floss maybe more than I should. Um but I just I I have some contact points. Overdo it is better than underdoing it. Yeah. Well, I I floss, you know, sometimes— well definitely twice a day. Um and you know it's sometimes just to get food out. I just I don't know, man. I'm a weirdo like that. But uh I go to the dentist. I go to the hygienist four times a year.

Good for you. Yeah, I definitely and I think it's money well spent. I mean, it's kept me from having a lot of issues that um I think you know people who ignore that stuff. But I then again I like going that and I like my hygienist. My hygienist is absolutely phenomenal. She's like this one of—

Well, that's a big step and and that is a— as a one of the things that that you need to be as a dentist or a hygienist, you got to be a people person. Uh if if you're not making your patients comfortable, then they're not not going to want to come back. And and if you've got to do something that's uncomfortable, at least do it with a smile and be be polite about it and respect people's anxieties because um our job is to make people want to go and get things taken care of, not want to avoid it. And I— in the profession we're in, we see a lot of people that have been avoiding it. And that's— you're you're flossing your teeth too much. It's okay. Good.

This is a great place for us to kind of leave off. We covered a lot of ground, but the one last piece I want to talk about is in the pathway to peak performance is you could be a great surgeon, you can know a lot of stuff, but relating to people— and we've all seen the doctors who can't. Yep. They simply can't do it. They could be phenomen—, you know, brilliant, right? I often say like hey we have the best product in the world but nothing happens until a sale is made. The same thing is in healthcare and uh you kind of alluded to it in a different way. It's like hey you have a bad experience but talk about developing a bedside manner along the way and what were some of the things that you learned along the way in working with patients? You get a whole in your world you see an entire variety. You get people who have tons of money and you have people have no money uh and everybody in between. So, what's that like for what we do?

You have to have a good team. You— because I'm not the first person in our practice that interacts with patients. It's the the folks that answer the phone. It's the folks that greet them at the front desk. It's the folks that talk to them about cost. And a lot of that happens without me ever having even a chance to talk to them. So, if you don't have a good good team, doesn't matter what you do because they'll never get to you. You also have to be able to to read people quickly.

There's a a book, Malcolm Gladwell— and I'm not advertising his books— but he wrote a book called Blink, which I enjoyed because it's it's it's about making quick decisions about your interactions with people, how to read people, how to interact with people based on what you've picked up on quickly. And we have to be able to do that especially in in surgery because most of the patients we treat we're meeting for the first time. And then you have to meet them where they are. Uh and that's that's hard for us sometimes because we know we know more than they do. And it's hard to avoid throwing that at people that "I'm smarter than you are." And that doesn't help. It doesn't doesn't help anybody to be told what a stupid decision they made that led them to be where they are.

So you have to kind of figure out what's going to get them to understand what they need without forcing it on them. And and I I think that that's been a an an evolution for me. It it's hard sometimes to not— to learn to not tell people what to do, to steer them in the right direction, but not not make them feel bad on that journey. Uh because some of some of some people come in and think they need one thing and they really need six other things and doing the one thing they want isn't really going to help them. And maybe you have to start there and then kind of work up to the the more complicated things. You develop develop some trust. You you need to trust the patient to to to follow your instructions, but they need to trust you that you you've got their best interests at heart.

Yeah. I I mean I I think that's one of the things that is so important, more difficult in a specialty like yours where you're not necessarily working with them uh the same way where you know over years of working with the general dentist you develop a relationship with them. Oftentimes for me it's just the hygienist, right? When I'm not really talking I stay away from the dentist because he might have to do something to you and I try to avoid that wherever I possibly can.

So that's why you floss twice a day. That's that's right. That's right. Yeah. My wife like she likes the uh the clean breath, but on top of that, I like the notion that I'm not going to lose my teeth um or wind up with uh something else. Well, Dr. Fear, you are uh you know, you are you've always been a great guy. I've always we've always had a great uh rapport.

Well, I'm glad to be working with you again. This is uh it's going to be a pleasure.

Yeah, it's been great to have you in.

Thank you.

All right. Thanks.