Demanding Patients: Need Vs. Want

Demanding Patients: Need Vs. Want

Past president and an accredited fellow of the AACD, Dr. Jack Ringer DDS, explains how to handle difficult and demanding patients through first consultations, setting realistic expectations and getting written approval at various stages. Jack also shares personal experience using Uveneer, a direct composite solution created for efficient aesthetic repairs in the anterior region. Join Dr. Jack Ringer at Keating Dental Arts July 14th for a hands-on digital CE course on a live patient. Go to for more information.

Full Transcription:

Shaun Keating: Hey, everybody. Shaun Keating here. I'd like to welcome you to this week's Dental Up podcast here at Keating Dental Arts in beautiful Irvine, California. Today we have our best buddy, Dr. Jack Ringer. Man, what's up?

Dr. Jack Ringer: Dude, good to see you, man.

Shaun Keating: You're so busy. You're always, man, every day of the week this guy's got something going, and we've got to do more podcasts together. I need to come on in. Monday's your only day off, but it's like by Monday I'm usually trying to get my head together by Tuesday or Wednesday, so I've been doing them mostly on Thursdays or Fridays.

Dr. Jack Ringer: We can work something out. Just got to get a little planning to come down or whatever.

Shaun Keating: That's awesome that you're so busy, though, dude. So what about our hockey team? Our Ducks? We haven't talked to you since they kind of got knocked out, and now Nashville's playing the Penguins, and they're down two to one.

Dr. Jack Ringer: Play tonight.

Shaun Keating: Play tonight. That's going to be a good one.

Dr. Jack Ringer: In Nashville. Yeah. It's surprising I think to a lot of people, they were the 16th seed.

Shaun Keating: Aw, Jeez.

Dr. Jack Ringer: They've, as you saw, they took care of Chicago for straight, which was incredible.

Shaun Keating: Yeah.

Dr. Jack Ringer: The Ducks, you know, it's just one of those things.

Shaun Keating: The goalie, what happened to the goalie?

Dr. Jack Ringer: Yeah, well their goalie, Pekka Rinne, he is their ace in the hole.

Shaun Keating: Yeah.

Dr. Jack Ringer: If he is playing his game, you can't beat these guys, and they're scrappy.

Shaun Keating: Yeah.

Dr. Jack Ringer: There's no question. Obviously tonight will be a big turning point.

Shaun Keating: I think they've been two to two.

Dr. Jack Ringer: Two to two, so it's anybody's series.

Shaun Keating: Yeah. Sidney Crosby, that kid, I remember he was like a teenager, wasn't he?

Dr. Jack Ringer: Yeah.

Shaun Keating: Like a phenomenal star athlete. He's been in the league, what, how many years? He's still only like 25 or so.

Dr. Jack Ringer: Yeah, he started when he was like three.

Shaun Keating: Yeah. That's crazy.

Then we got our basketball. The darn Cavaliers, man, are getting handled by the Warriors. I mean last night frickin' Durant got a triple double again and so did Curry. Then Klay Thompson's been off the last several games.

Dr. Jack Ringer: He went off last night.

Shaun Keating: He went off last night like 22 points or so, and even Draymond Green or whatever got like 10 or 12 I think, but man.

Dr. Jack Ringer: But when you think about it, Kevin Durant, when they added him to that team, if it wasn't for LeBron, he would be number one.

Shaun Keating: Yep. Absolutely.

Dr. Jack Ringer: He's been the number two guy with everything behind LeBron.

Shaun Keating: Yep.

Dr. Jack Ringer: Now you have the second best player in the world right here on the team that has Curry and all the other guys. I really don't know how Cleveland is going to handle this. Everyone thinks it's going to be a seven game series.

Shaun Keating: Yeah.

Dr. Jack Ringer: I don't know.

Shaun Keating: Dude, last year they were up two games and then the Warriors ...

Dr. Jack Ringer: They didn't have Kevin Durant.

Shaun Keating: Yeah that's true. Then they went up three to one, and then they lost three in a row.

Dr. Jack Ringer: Yeah.

Shaun Keating: I will say don't get too cocky yet.

Dr. Jack Ringer: No, no. I just don't think ...

Shaun Keating: Anything could happen when you got LeBron and Kyrie Irving and Love.

Dr. Jack Ringer: Sure. Everything gels. The depth of the Warriors ...

Shaun Keating: Unbelievable.

Dr. Jack Ringer: ... it's unbelievable, and look. Anything could happen.

Shaun Keating: Yeah.

Dr. Jack Ringer: Look what happened with Nashville.

Shaun Keating: Yes.

Dr. Jack Ringer: No one ever in their wildest dreams thought, right?

Shaun Keating: Exactly.

Dr. Jack Ringer: Particularly right from the get go when they just hammered Chicago.

Shaun Keating: Oh absolutely.

Dr. Jack Ringer: The number one seed, you know. That's what makes it fun to watch. Right, dude?

Shaun Keating: Hey, I'm looking forward to Wednesday now that I have figured out we got Monday night. I always love Monday night football in football season, but you know we got hockey tonight.

Dr. Jack Ringer: Yeah, 5:00.

Shaun Keating: Hockey tonight.

Dr. Jack Ringer: What's the biggest story in sports this weekend?

Shaun Keating: Uh ...

Dr. Jack Ringer: Albert Pujols.

Shaun Keating: Oh yeah. Got 600. My sister-in-law was at the game, got season tickets, and she said it was just awesome. Something like 23-year-old kid from like Costa Mesa caught it, and I guess he brought it back. I don't know how.

Dr. Jack Ringer: I don't know. I didn't get the story about the ball.

Shaun Keating: I don't know how it works because I heard he could sell that for four or five hundred grand or something.

Dr. Jack Ringer: Who knows what he could do?

Shaun Keating: Who knows?

Dr. Jack Ringer: I was there on Friday hoping it was going to happen, but the interesting thing is he hit it with a grand slam.

Shaun Keating: Oh yeah it was a grand slam, too.

Dr. Jack Ringer: Only guy that's ever done that.

Shaun Keating: Can you believe that?

Dr. Jack Ringer: And he's the 4th youngest to hit 600.

Shaun Keating: Yeah.

Dr. Jack Ringer: If he can stay healthy, he's gonna ...

Shaun Keating: Especially with the DH they got in American League. I mean, he's not as fast. He's always had problems with his plantar nerve or whatever in his foot.

Dr. Jack Ringer: Yeah, foot surgery.

Shaun Keating: Lot of foot surgery. I used to, I was a season ticket holder for years, and then I kind of stopped. Last year we moved away, a little bit farther away, so it's kind of a long drive, but I'd see him just waddling to first. I'm like, dude, this guy is getting a quarter of a million dollars, a quarter of a billion dollars, but he strikes out a lot but he hits a lot of, jacks a lot of homers, but at the end of the day, man, it's a lot of money. I think we got him a little late. I think with St. Louis he was there, he was just ...

Dr. Jack Ringer: He was there for ten years with St. Louis.

Shaun Keating: You know.

Dr. Jack Ringer: He's worth every penny because he's a draw.

Shaun Keating: He really is.

Dr. Jack Ringer: Look, the numbers that this guy has, he's putting up. We have guys playing in the league who are batting, you know, a buck and a half, and they're getting paid a couple million dollars.

Shaun Keating: Yeah. Yeah, ridiculous.

Dr. Jack Ringer: Isn't that ridiculous? Yeah, he's well worth his.

Shaun Keating: Yeah, he is at the end of the day. I really liked it when he came on, and then they brought in the dude from Texas that was on the drugs. What was his name? Hamilton?

Dr. Jack Ringer: Oh yeah.

Shaun Keating: Yeah, he kinda. Then the owner, Arte, just said, "You know what, I owe you a hundred million. Just go ahead and leave. I don't want you here." He went back to the Rangers.

Dr. Jack Ringer: They dumped him now too.

Shaun Keating: They dumped him.

Dr. Jack Ringer: But the Angels are paying.

Shaun Keating: Crazy. Then Trout's out. The messed up thumb. He's got a cast on.

Dr. Jack Ringer: For another month.

Shaun Keating: He was just the greatest guy to go watch. You could watch him every game and just keep your eye on him.

Dr. Jack Ringer: He's a phenom. Once in a lifetime player.

Shaun Keating: Totally awesome player.

Dr. Jack Ringer: Once in a lifetime player.

Shaun Keating: What else we got? We got the Belmont coming up Saturday.

Dr. Jack Ringer: You're the horse guy. Not me.

Shaun Keating: Aw, man. I went to The Well again on Saturday. Couple races, you had to be there, Bob Baffert's got this horse, Vale Dori or something that was going to for sure win, and it was only a three horse race ...

Dr. Jack Ringer: ... and he's still running now?

Shaun Keating: He lost by a frickin' nose again. My wife says, "Shaun, you keep saying you're not going to do it, but why do you?" I swear, the favorites on the last five races I've bet on have lost. That was my whole thing. Bet on the favorite. Win. Don't even mess with it.

Dr. Jack Ringer: So did you ever watch Seinfeld?

Shaun Keating: Yes.

Dr. Jack Ringer: There was an episode with George where he decided to do everything exactly opposite the way he normally does, and he because amazingly popular and successful, so when you go from now on, whatever you want to do, do the exact opposite.

Shaun Keating: Exactly.

Dr. Jack Ringer: You'll be okay.

Shaun Keating: I should've, man. It was a horse one, two, and four, and I like picked one. I put like $500 just to win, and then we're waiting for a while for this one race, and there's only three horses, and so my wife goes, "How do you know that? Why don't you ..." and so I went to the lady, and I go what other bets? She said you can only do an exact bid because there are three horses. So I said, okay let's do the, I picked the one horse, so let's go one, two for some more money, and the frickin' two horse won. It's like, I lost both of those.

Even, too, on this Saturday, none of those, like the horse from California was computing, computer, whatever, whoever won the Preakness is not in it, and whoever won the Kentucky Derby is not in it, so I think nobody really. I think Gorman, he might not even be in it, but it's just such a crap shoot this year. The last few years, you win so much and so with American Pharaoh and California Chrome, those two horses brought a lot of money to a lot of people because you can put your money on it, and you'd only win, you'd bet a buck and you won a buck, but that's still good odds, you know? Bet five grand, get five grand back. Plus five grand, you know?

Dr. Jack Ringer: So did you win?

Shaun Keating: I won on those races. This year. It's just a little bit of play money. I'm not a big gambler, really, and I keep saying this every podcast. It sounds like I got an issue, but there's not a whole lot to do in our little beach towns. We got a little place on San Clemente. It's like OC Tavern where you can do live bets on Gulfstream, Saratoga, all these different race tracks. It's pretty neat. All these guys are up there with, you can do a trifecta or superfecta where you're picking four horses. You put $2 on a four horse, and they come in, you're winning thousands of dollars.

Dr. Jack Ringer: Wow.

Shaun Keating: It's just such a crap shoot, man.

Dr. Jack Ringer: That's what gambling is. A crap shoot.

Shaun Keating: It really is.

What else. Then I seen this thing, you know it's sad. I was growing up, you look like different people at different stages of your life, and I remember for a while there when I started my lab in 2002, I dyed my hair because my hair, I was gray in my 20s and going gray, and my poor boys. Well, not poor. I think it's cool, but they're already kinda getting gray all through, so I always kind of dye it out and my goatee I'd do it where it was all dark, and I swear to God, at that time back in the early 2000s, I looked exactly like Tom Arnold. It was the worst thing.

I used to always be the joke, and I actually went on his damn TV show, Best Damn Sports Show, and it was great. Got it on video. Tom's actually here because he wasn't there at that show, and they put me in the audience and put the camera on me and said, "Well Tom's actually here." Norm MacDonald was taking his spot for that show.

So I got a big thing on it, but I always used to get, "Well you look like Tom Arnold."

I'd go, "Well at least I'm not married to Roseanne. My wife's hot." Whatever. You know. So that's kind of weird.

Now it's like as I get bigger and wider and my hair gets longer, I get a lot of, "You look like Rob Ryan." You know? Rex Ryan, the football coach's brother?

Dr. Jack Ringer: Oh, no, don't go there.

Shaun Keating: Well he's got about 50 on me or so.

Dr. Jack Ringer: Bit more like Colonel Sanders.

Shaun Keating: Colonel Sanders, too. I get that. Shaun Sanders or Colonel Saunders or something. Anyway, I'm watching on my little phone a sports update, and there's ... well Rex got fired from being the Buffalo Bills coach this last season, and his brother was actually defense coordinator, so they both got let go, but it shows them in some bar and Rex has got on a St. Louis Cardinals shirt, and I think he lost a bunch of weight, and I think it's starting to come back a little bit. I don't know how, what kind of, what he did to lose all the weight, but he looked pretty big, and there's his brother, and they got in a brawl in this bar, and it's just like ...

Dr. Jack Ringer: With each other?

Shaun Keating: No. There were some little guys messing with them.

Dr. Jack Ringer: Oh.

Shaun Keating: It shows them holding Rob back, and he's like throwing blows, and I'm like dude look at this. Love it. I don't think they're coaching anywhere.

Dr. Jack Ringer: No, no, no, no. I think their days are done in the NFL.

Shaun Keating: I really got to know him and liked Ryan, Rex when it was that football show, Hard Knocks.

Dr. Jack Ringer: Oh yeah.

Shaun Keating: When we did the thing. We had Sanchez, UFC quarterback, but he was the quarterback at the time. It was pretty, the first time I ever watched that show, and it was pretty neat to see the whole making of the football team, what they go through, and Rex Ryan's a pretty good coach. He got them to the playoffs and stuff, but he just never can finish it. Anyway.

Dr. Jack Ringer: Have you ever watched the show Ballers?

Shaun Keating: No, I haven't.

Dr. Jack Ringer: Oh, I love it. It's a football show.

Shaun Keating: Oh, okay.

Dr. Jack Ringer: With The Rock.

Shaun Keating: Oh yeah, I think I've seen. I've never really watched it.

Dr. Jack Ringer: Yeah, the season will be coming up again pretty soon. You know, the summer. I think it's an HBO show or something.

Shaun Keating: Oh okay.

Dr. Jack Ringer: You know, it has a lot of pros on there with little cameos.

Shaun Keating: Oh okay.

Dr. Jack Ringer: You'd really like that show.

Shaun Keating: Aw, I gotta watch it now. I'm such a football guy, man. I wish it was like year round.

Dr. Jack Ringer: Hey, speaking of that, you heard about the stadium?

Shaun Keating: Yeah.

Dr. Jack Ringer: A year delay.

Shaun Keating: Yeah, what the hell? 2020, man. I don't know if I can be a Rams fan that long.

Dr. Jack Ringer: With the rain we've had, they'd dig it out, and it caused a lake fifteen feet deep.

Shaun Keating: Yeah, yeah.

Dr. Jack Ringer: It's delayed it now a year.

Shaun Keating: Yeah, can you believe that? We're thinking okay, it's going to be 2018. Then it's going to be 2019. Now it's 2020. I don't want to go to the coliseum, man. The coliseum is such a ...

Dr. Jack Ringer: I don't want to go to any football stadium.

Shaun Keating: Yeah.

Dr. Jack Ringer: I only want to see that when it opens.

Shaun Keating: Yeah.

Dr. Jack Ringer: Nowadays, dude, you sit in a bar, and you have 85,000 camera angles.

Shaun Keating: Oh I know.

It's so nice. Even in our own homes with our 80 inch TVs.

Dr. Jack Ringer: Yeah.

Shaun Keating: In three different rooms. It's like we're too spoiled.

Dr. Jack Ringer: You go to these games you can barely see them. They're way down, you spend half the time looking at the big screen anyway, so what's the point?

Shaun Keating: I think, though, with that is the experience. For us, I see us, because I'm online to get six season tickets, all the best ones.

Dr. Jack Ringer: Good, I'll go with you.

Shaun Keating: We're going to make it a destination weekend. You go out there on a Sunday, we're probably spending the night because we're going to get a hotel and everything right there.

Dr. Jack Ringer: Sure.

Shaun Keating: You're going to make a little weekend of it, maybe, you know.

Dr. Jack Ringer: Yeah, the whole event, but the actual watching the game? You might as well sit in a bar.

Shaun Keating: I think it'll be so nice, though, the way they create it and design it and with, you know, look at Texas Stadium, how big it is. You know like our hockey stadiums. You know, it's not like you're looking that hard for it. It's a pretty neat experience.

Dr. Jack Ringer: I heard they spent 80 million dollars when they built Texas Stadium for the screen.

Shaun Keating: Only, yeah.

Dr. Jack Ringer: Just the screen.

Shaun Keating: Yeah, just the screen. It's just unbelievable. Then at first they're having problems kicking the, punting. The punter, kicking it.

Dr. Jack Ringer: Yeah.

Shaun Keating: Kind of crazy.

All right, dude, let's dental up a little bit.

Dr. Jack Ringer: Yeah. Good idea.

Shaun Keating: What do we got to talk about? I think you were talking a little bit about this Uveneer. It's been around for a little bit, but you've been doing it in your practice a little bit here and there. Tell me a little bit about this. It's for a direct chair site, right?

Dr. Jack Ringer: Yeah, yeah, yeah. So one of the biggest headaches for a dentist is working with direct composite to make it look good. There's just so many aspects about composite that don't make it very user friendly. In the old days when you were doing like a filling in the back with amalgam, you could train a monkey to put it in, but with composite, with adhesives and moisture control and curing and everything, it's a little bit more tedious. Now in the front, now you've got to add the element of aesthetics.

Shaun Keating: Yeah.

Dr. Jack Ringer: So companies throughout, who knows how long now, have been trying to develop methods, techniques, devices to make that process a little bit more simple.

A few years ago I was at an ACD meeting, and I was walking around the exhibit hall, and I came across a booth, and there was a lady there with a product called Uveneer. Not Y-O-U, but U-veneer. She asked me to come over and have a look at it. What she designed was this matrix system. This is for anteriors, from cuspid to cuspid, upper and lower. They've built it out of a very rigid beautifully smooth material. Comes in various sizes.

Shaun Keating: Yeah.

Dr. Jack Ringer: So you can fit it to different teeth. The process basically is pretty simple. Patient comes in, let's say they have a big class 4 fracture. Could be an emergency basis. It could be that you want to treat this directly. Traditionally you'd have to sit there and sculpt and try to get the contacts and everything, and that's fine, but here you treat the tooth, create whatever chamfer lines that you want to do, etch it, put on your adhesive. Then load this little device with whatever composite. Squeeze it down.

Shaun Keating: It's like the reverse of a fingernail type thing.

Dr. Jack Ringer: Yeah.

Shaun Keating: It's just already small, medium, large.

Dr. Jack Ringer: Right, there are quite a few sizes.

Shaun Keating: Yeah.

Dr. Jack Ringer: When you push it down, all you do is remove the excess, cure through it because it's transparent, take it off, and in a lot of times you don't even have to finish.

Shaun Keating: Yeah. It's crazy.

Dr. Jack Ringer: It's so beautiful. When I first saw it, I thought what are the limitations with this? Or really what are the uses of it.

Shaun Keating: Yeah.

Dr. Jack Ringer: I look at it this way: I have a patient that wants to do something direct. They have some incisal wear. They have a diastema. They have a class 4. Well, nowadays it's costing us a lot of money to run our practices. Used to be a long time ago, your overhead if you were running at 50% you're doing okay. Today they say if you're running at 70% or more you're doing okay.

Shaun Keating: Yeah.

Dr. Jack Ringer: So our margin of profit is much less.

Shaun Keating: Yep.

Dr. Jack Ringer: If we can cut down cost and time, it's going to be better for our practices. So with this you save a ton of time.

Shaun Keating: Oh yeah.

Dr. Jack Ringer: That's our biggest expense.

A patient comes in. They say they have a class 4. You prep it. Prepare it, use this, they're done. Here's another cool thing you can do with it. Let's say a patient comes in, and they want to do some indirect. They want to do some beautiful Keating Veneers, and you want to create some sort of design for you, the lab, to follow to build. Instead of sending out for a wax up, you can just roughen up the teeth, take this, put this stuff on, cure it.

Shaun Keating: Do a mock up that they can see it.

Dr. Jack Ringer: They can see it right away. They can go home with it if they want. You can then take photographs, impressions, models, measurements, whatever. Now the patient, the dentist, and you, the lab guy, have a preview of what this patient wants.

Shaun Keating: That's awesome. It really is.

Dr. Jack Ringer: It's really quick and easy that way, but it's not just for that. Every one of us has got a call, "Oh, I gotta go to a wedding. My tooth just broke." Or whatever. You know? You can use this.

Shaun Keating: Yeah, you kind of just back load that. You'll just kind of get it on there.

Dr. Jack Ringer: Put it in, and it saves a bunch of time. You know, and then you can take it to the highest level if you want. You know me. I'm very involved with AACU accreditation, and one of the cases we have to do is a six unit full resin veneer case.

Shaun Keating: Oh, you're kidding. You gotta do it direct, huh?

Dr. Jack Ringer: Direct.

Shaun Keating: Really?

Dr. Jack Ringer: You could use this to create your form.

Shaun Keating: Yep.

Dr. Jack Ringer: Then you could cut it back and do your coloring and your layering.

Shaun Keating: Absolutely.

Dr. Jack Ringer: Dentists in the past have given courses on doing directs for dentists in the accreditation. They've shown them using putty stent matrixes to create the incisal edge, and the position.

Shaun Keating: Like Siltek matrix?

Dr. Jack Ringer: You'd make like a putty thing off of a wax up, and it works very very well. It's fantastic to do, but you could use this in place of that in where you place these all on it to get all your form and your shape and your lengths, and then you can just cut it back and start putting in your colors and your translucency and your incisal lobes or whatever you want to do and then finish and polish it. Today with our new polishing systems and these micro hybrids, these composites look great.

Shaun Keating: Oh yeah.

Dr. Jack Ringer: I'm just actually, when I met her, the lady with this Uveneer system, I kind of liked it, so I did actually a webinar with them.

Shaun Keating: Okay.

Dr. Jack Ringer: This was about three years ago, and now Ultra dent has picked it up, so they're under the Ultradent umbrella now.

Shaun Keating: Yeah.

Dr. Jack Ringer: I'm going to be actually doing some hands on programs with her in San Diego starting in September. We scheduled three.

Shaun Keating: Oh perfect.

Dr. Jack Ringer: She's going to do some of that. I'm going to do some indirect stuff on veneers and smile design, so it'll be very comprehensive.

Shaun Keating: Okay.

Dr. Jack Ringer: That's a very cool product.

Shaun Keating: That is. You know, it sounds like we had it to where we would get these silicone little forms of posterior teeth and it would help us wax them up faster, so it's basically to about the middle third of the prep is what you get, and it gets the perfect Peter K. Thomas type anatomy, but it saved us so much time because what we'd do, say we were working on a molar on number 30, and to build up a gold crown for full contour is what these were for, so I ran a really big gold department. We used to do so many units.

It takes you a while to get the wax build up, build up, build up, so what you would do is you would just dip the coping just so you got a foundation of wax to the margin, and then you would build it up a little bit more, just the table, so you're about halfway up the prep, but then you would get the little rubber silicone little sized molar for that fit. What you would do, we would get a eye dropper, and we would go into our wax, and we would take the eye dropper, and we would just fill up the occlusal of this pattern, and then we'd turn it over and put it into on top of where we dipped it, and we'd put the crown into occlusion so we could kind of get the right occlusion, and it was just so much time saving that then you just filled the point A to point B to fill in the gaps, but you have the whole occlusal scheme built in, and then your marginal ridges, you kind of adjust them accordingly. It's in wax, but it saves so much time. It went from like a ten minute wax up to about a two minute wax up.

Dr. Jack Ringer: Wow.

Shaun Keating: It was just bitchin' that the different lengths, you know, you had different sizes. For the kit alone, I remember way back, to get three for each posterior unit. You know, three number fives, three number fours, three number 30s. They're different sizes, so they kind of fit every mouth. It was like $1200.

Dr. Jack Ringer: Whoa.

Shaun Keating: So expensive, but it saved us so much time when we were just crunching out the ...

Dr. Jack Ringer: Which you made up in a couple of days.

Shaun Keating: Yeah.

Dr. Jack Ringer: Just in your time saved.

Shaun Keating: It was crazy.

Then all of my waxes, they were like, "I want a box. I want a box." We got to keep one box under lock and key because a lot of people were wanting to keep the little rubber, keep them at their desk. No, no, no, you've got to put it back because they're so expensive. Pretty neat.

Dr. Jack Ringer: When you mentioned that about $1200 or whatever, I think that the dentists who are listening to this should understand that they shouldn't be too short-sighted when they look at a product's cost initially. You should look at the long term of what it's going to save you.

Shaun Keating: Absolutely.

Dr. Jack Ringer: Like with digital impression as an example. Yeah, you're paying $15,000 if you're getting the true def. People are like, "Whoa, $15,000?" But every time you do an analog impression, you're paying about $60, and every time you have to redo an impression or your lab sends it back and says blah blah blah, that very very quickly that adds up. Plus the time savings.

Shaun Keating: Just what helps is, if a dentist could really crunch the numbers on ROI, it's going to take a little bit to get it back.

Dr. Jack Ringer: Sure.

Shaun Keating: What it's not telling you is just the consistency and the streamline of the production of the whole thing. It just helps so much, a lot of these products.

Dr. Jack Ringer: No human.

Shaun Keating: Working smarter working not harder, but we work smarter, so kinda neat. It reminds me, too, of what I did. Coy's come here several years back, and he did a seminar for us, an all day seminar. I remember picking him up in John Wayne airport and took him over to the little hotel, and then he spent the night. In the morning I went and got him, and he's just the nicest guy in the world. He had this things where they are like stick-on teeth in your anteriors, like you know how we do a mock up, a wax up to show the patient?

Dr. Jack Ringer: Right.

Shaun Keating: Well what he had, same thing, three different sizes, and for lengths, widths, and everything else, he had a bleak shade, and I think it was a B1, like two different, like light light and then like a B1 or so. These things were the neatest things, and I used to buy them, and they were a couple hundred bucks a box, but I would get like 20 boxes and give them to my top guys to try because to put them in the mouth with the patient, and they stick to your teeth. They go all the way from 4 to 13. It's kind of neat. Sometimes you'll clip off four and five, and you know 12 and 13 and just go 6 through 11, but depending on their gingival heights. Like that, you might have to do some lengthening of the tissue, but to put them on, and the patient could instantly see it. It was such a sales. Not sales. Just to really show them, you know?

Dr. Jack Ringer: Sure.

Shaun Keating: Better than on a computer or better than looking on a model. You stick these darn things right on them. I got a bunch still in my room there. It's just a neat thing there. They see it instantly, and they're like yes, and they take a couple of pictures. Give me your phone. I'm taking them on your phone so you can go home and show your husband or whatever. That's kind of a neat thing.

Dr. Jack Ringer: Yeah. For sure.

Shaun Keating: Little tools like that. You know, it really helps.

Dr. Jack Ringer: It turns out there, you know, it's a different world in dentistry when you're talking about what somebody wants versus what they need.

Shaun Keating: Exactly.

Dr. Jack Ringer: You know, they need a filling done in the back. You're not going to find too many patients who are going to look at it at the end of the day and say, "Oh, you know it doesn't match exactly." Or whatever. They want it to feel good. They want it to be relatively inexpensive. They want it to last long.

Shaun Keating: Absolutely.

Dr. Jack Ringer: What you get up here in the front, it's a whole other ball game, and you need to be able to have tools at your disposal that you can get into their head.

Shaun Keating: Exactly.

Dr. Jack Ringer: So that.

Shaun Keating: Remember back in the day it was an intra-oral scanner to show the cracked mal gums and everything, and they got their little TV in the corner. I remember Dr. DiTolla had that way back in the 90s.

Dr. Jack Ringer: Yeah.

Shaun Keating: Go into his office before he started working at Glidewell. He's like, "Shaun, look at this, dude." I had all mal gums. I was a little navy brat, and they just filled them all with silver, and so he's showing you. It sells to you. Again, not say sell it. It just educates the patient truly how high def this is on that TV and this little camera showing this is cracking your enamel. See how it's all cracked here?

Dr. Jack Ringer: Yeah.

Shaun Keating: We need a crown here.

Dr. Jack Ringer: Yeah, but you know, I agree. It's a great educational tool and diagnostic tool, but it's also a double edged sword because a dentist is showing an image blown up 100 times, and you see a crack, and a lot of dentists scare the patient.

Shaun Keating: Okay.

Dr. Jack Ringer: That crack may be totally superficial in reality.

Shaun Keating: Yeah.

Dr. Jack Ringer: On a big thing, it looks like death.

Shaun Keating: Oh, it looks like you gotta cut that thing off.

Dr. Jack Ringer: Yeah.

Shaun Keating: Yeah.

Dr. Jack Ringer: It does, unfortunately, sell a lot of unnecessary dentistry. Unfortunately. For those dentists who want to exploit a patient. Really the message is patients should be getting more educated, and if a dentist recommends a lot of work, and their not 100% happy with their diagnosis, get another opinion.

Shaun Keating: Absolutely.

Dr. Jack Ringer: You do that with your body. Why not your teeth?

Shaun Keating: Especially dentists who say, "You got this this and this, but we could probably get away with this for now." That's the best way.

Dr. Jack Ringer: Sure.

Shaun Keating: When they see that and hear that, they're like, "I feel like he's not trying to push 30 pounds on me or five pounds."

Dr. Jack Ringer: Give them options. Sure sure. As long as they say that. It may go, it may not go. It's blah blah blah.

Shaun Keating: Yeah.

Dr. Jack Ringer: It can be reactive, you can be proactive. You know, there's no. I could look at your teeth today, Shaun, and say everything looks good, and tomorrow something could break.

Shaun Keating: Yep.

Dr. Jack Ringer: Okay?

Shaun Keating: Absolutely.

Dr. Jack Ringer: No dentist can say to a patient, "Oh you've only got three months and that tooth is going to break," but they play that kind of scare tactic.

Shaun Keating: Yeah, I bet.

Dr. Jack Ringer: I think patients should be kind of careful of that, and dentists should look at their conscience.

Shaun Keating: Yeah, you got to.

Dr. Jack Ringer: You know?

Shaun Keating: A lot of these guys, they are good dentists, and they really want it. I've had some guys who are total cutters.

Dr. Jack Ringer: Yeah.

Shaun Keating: It's, the patients see that nowadays, and I think it's just the way it is with this whole social media. Everyone can talk about everything instantly and this and that.

Dr. Jack Ringer: Yeah.

Shaun Keating: I think you gotta cross your Ts and dot your I's very carefully nowadays.

Dr. Jack Ringer: Yeah for sure.

Shaun Keating: All it's going to take is someone to go in and say, "Hey, check out this work I got here," and well I don't know. You got to treat them like it's your mother, and you'll be fine. It's like going in your mother's mouth, and you'll be fine. If you think that as a dentist, you'll be fine.

Dr. Jack Ringer: Yep. I agree with you.

Shaun Keating: You got any tough patients lately or anything? Little bit?

Dr. Jack Ringer: Yeah, kind of like what we're talking about. It's something that fascinates me in my practice. We were just talking about it a second ago. Stuff in the back. Very few patients are that critical. Every one of us have had that weird patient that even on a second molar that you put an all-ceramic restoration, turn around and say it doesn't quite look exactly.

Shaun Keating: Give me the mirror. Let me look. It's 31, and they're. I get patients like that all the time.

Dr. Jack Ringer: Yeah.

Shaun Keating: Shaun, man, it's an A35 of the gingival third, but then we got A3 at the middle third, then it's got some hyper calcification on the mesial buccal cusp with some modeling of some white.

Dr. Jack Ringer: Yeah, and you're talking 31.

Shaun Keating: It's a frickin' 31, dude.

Dr. Jack Ringer: Yeah, exactly.

Shaun Keating: You know what, they pay our bills. It's almost like you got to police those kinds of patients religiously.

Dr. Jack Ringer: You have to.

Shaun Keating: You gotta sometimes in football, you gotta punt on a third down when it's so bad.

Dr. Jack Ringer: Yeah.

Shaun Keating: Or whatever.

Dr. Jack Ringer: I've had patients ask for a magnifying glass.

Shaun Keating: Can you believe that?

Dr. Jack Ringer: You're right. There's another little pearl for dentists. When they have patients come in, and they have an opportunity to have a big case, and a lot of times the dentist, the eyes are lighting up because of the revenue they can generate. Let alone maybe end up having a beautiful face, but they need to spend time with that patient talking and getting into their head because if that patient said, "Yeah, I've been to like five different dentists,"

Shaun Keating: Time out. Red flag.

Dr. Jack Ringer: You do one of two things as far as I'm concerned with patients that are going to be incredibly demanding. You either say to them, "I'm sorry. I can't help you. I don't have the skill set or whatever to make you happy," or you price it so high that that patient either leaves or you've given yourself so much room money-wise that you have time to redo stuff.

Shaun Keating: Absolutely.

How does that work with you? Do you have a special sheet? Some guys have them sign something at seating before you ...

Dr. Jack Ringer: Oh yeah.

Shaun Keating: What do you do for that? When you get the okay, because sometimes we gotta cut them off. I can't tell you how many times they submit them, and maybe the underlying opaque layer something masking out. Maybe something was a little too much show-through, but God once you submit them, man, you gotta cut those things off.

Dr. Jack Ringer: Yeah.

Shaun Keating: Where the patient comes back two days later saying I really don't like the colors here, here. That could kill. That's just tough.

Dr. Jack Ringer: Yeah, so, look, there's always a couple.

Shaun Keating: Legally I'm not sure how much room you got to stand on with signing off and this and that.

Dr. Jack Ringer: There are a couple things. Everybody in this game will have a patient or patients that fall through the cracks, that you've covered all your bases everywhere, and I got one that I still deal with all the time. This is a patient that drives me crazy. Comes in every couple of months for an adjustment.

Shaun Keating: Is it a denture case?

Dr. Jack Ringer: No.

Shaun Keating: They're fixed?

Dr. Jack Ringer: He's fixed, he loves his teeth, everything. Look, this guy is a nightmare.

Shaun Keating: Yeah.

Dr. Jack Ringer: It's a continuing nightmare in a sense, he knows more than the dentist. He knows more than the lab. He knows more than everybody. So you do get a couple that fall through the cracks. In general what we have to do is you have to be incredibly thorough firstly before you work on them as far as interviewing them.

Shaun Keating: Vetting them out.

Dr. Jack Ringer: Exactly.

Shaun Keating: That's a new word I learned here recently. Wiki doctor with Mr. Trump. Vetting.

Dr. Jack Ringer: Yes exactly.

Shaun Keating: Better vet those people.

Dr. Jack Ringer: Yeah. Oh yeah I remember all about that one working in the academy. Vetting candidates. Vetting vetting vetting.

Shaun Keating: Oh yeah.

Dr. Jack Ringer: So you want to really do a thorough, thorough consultations with these patients to see if this is a person that you feel comfortable treating. Once they give the A-okay to go forward, then you have to be incredibly thorough on these cases in designing.

Shaun Keating: Yes.

Input at the front end so they don't think, especially too, I get doctors. We do things so fast with some of these patients, they can't believe it. They're going to come in this week, and we work out the times and all that, but they come in on this Tuesday, and then impress them, and then on Thursday we're seating all these crowns. Well, it's 30, 40 grand later for them, but it's so fast that they don't perceive the value as, oh hey it's so quick. That's a weird thing too. Not rushing it too much and having them sign off on each step of the way.

Dr. Jack Ringer: Sure.

Shaun Keating: On a bigger case.

Dr. Jack Ringer: When you get the patient who is, call him normal or whatever, and you do good work, you can go through those cases more efficiently and a little more rapidly, and everybody's going to be happy, okay?

Shaun Keating: Happy.

Dr. Jack Ringer: If you have that patient who is very nitpicking, number one you have to set realistic expectations. You don't let them set the expectations.

Shaun Keating: Yep. Exactly. You gotta be in charge of the show.

Dr. Jack Ringer: Okay? You have to be in charge, and you have to let them know. "You only have X amount of room, Mrs. Smith. I can't create the room. If you don't like it, I'm sorry. We can't help you."

Shaun Keating: Yep.

Dr. Jack Ringer: Okay, you have to accept that. Once you have a design, you want them to, we were talking about mock ups. Different types, whatever it is, if it's a difficult case, a lot of money involved, you want to make custom provisionals.

Shaun Keating: Absolutely.

Dr. Jack Ringer: And you do not want to go to a final impression until they A-Okay that.

Shaun Keating: Yeah, exactly.

Dr. Jack Ringer: And you have photographs, models, measurements, everything that you can duplicate. Not guess. You can't say to the patient, "Well it's going to be kind of like this." It must be exactly like that as far as shape and form and fit, right?

Shaun Keating: Yep.

Dr. Jack Ringer: Then when it gets to the optics now, like you were saying, something could be a little too opaque or whatever. You have the patient wear this.

Shaun Keating: Oh, so you go temporary cement maybe? Or no?

Dr. Jack Ringer: If it's crowns, yes. Veneers, no.

Shaun Keating: No, yeah, you have to.

Dr. Jack Ringer: Then what we would do is try and pace, and we will have the patient sit in our ops under ...

Shaun Keating: Let everything hydrate maybe.

Dr. Jack Ringer: Hydrate. Color corrected lights. Go outside and look. Look under fluorescent lights and let them sit.

Shaun Keating: Yep.

Dr. Jack Ringer: If they are 100% happy, we pull out a form that they agree.

Shaun Keating: Yep.

Dr. Jack Ringer: I had one lady, this was several years ago. This is a funny story. I called her mini-mouth. Remember back in the day with mini-me?

Shaun Keating: Yeah.

Dr. Jack Ringer: She was this lady about 4'2" who's had more plastic surgery than you can imagine, and her mouth was so tight, so we called her mini-mouth. It was almost impossible to get in. She had no elasticity.

Shaun Keating: Oh. Poor husband.

Dr. Jack Ringer: So she was doing 20 veneers. She wanted to do ten up, ten lower. We did them, and it was hard to do, and she loved them. A year later, I see her on my schedule.

Shaun Keating: [inaudible 00:35:19]

Dr. Jack Ringer: I said, "What's the problem? Is there something broken?"

No, no, no, everything's great. I just want them whiter.

Shaun Keating: Oh. "Well then for 30 grand I'll make them whiter there, lady."

Dr. Jack Ringer: That's exactly what I said. I said, "You know what? I'm sorry, but there's no way of whitening without taking them off and making them again, and in your type of situation, it's like I'm doing it for the first time." In fact, it's actually a little harder.

Shaun Keating: Little harder to get it cleaned up.

Dr. Jack Ringer: ... to get them off. Yeah. I can't really, you know, really do anything other than give like a little bit of a ...

Shaun Keating: A discount?

Dr. Jack Ringer: Little bit because you're a patient of record as a courtesy. She said the money's not the issue. I just want them to be Hollywood white.

Shaun Keating: Can you believe that?

Dr. Jack Ringer: I've had patients, and I had an interesting one which ended up in a whole court thing with a ... I'll go through this quick story. There was this young girl, well not young. She's in her 30s. Comes in with her mom. Her mom is her mouthpiece.

Shaun Keating: Yeah. I hate that.

Dr. Jack Ringer: She tells me she had some veneers done and they don't like them. I looked and I see they weren't done terribly, but she wanted them a different way. We went through all these steps, and the mother was there the whole way barking at everything. Eventually we try them all in, and she says yes we really like them. They signed. Comes back a while later. I don't know, six months. We don't like them now.

Shaun Keating: Jeez.

Dr. Jack Ringer: I said, "Well, there's really not much I can do. My lab's certainly going to have to remake them. They're going to charge you. I can't do this for nothing."

Well, they left. Didn't want to see me again. They went to another dentist, a friend of mine. He says, "I can't help you either."

Shaun Keating: Oh good.

Dr. Jack Ringer: Unless you want all of this. Eventually they went to a guy, he cut them all off, and he made Cerec crowns on teeth that had veneers.

Shaun Keating: Oh, Jeez.

Dr. Jack Ringer: Cut them all down and milled everything.

Shaun Keating: Oh, monolithic straight toilet bowl way, huh?

Dr. Jack Ringer: It was, to me, biological malpractice to cut these teeth down. All of a sudden I get a letter from a lawyer, and I'm thinking uh oh. She's suing me. No. She's suing the other guy and wants me as an expert witness even though she already told me she didn't want anything to do with me.

Shaun Keating: Oh.

Dr. Jack Ringer: Anyway, myself and this other guy, we are accredited in AACD with cosmetics and everything, we go to court. This actually went to trial.

Shaun Keating: No kidding?

Dr. Jack Ringer: Went to trial. We looked. We get all the records, and we see this guy cut these teeth down to nubs.

Shaun Keating: Oh.

Dr. Jack Ringer: I'm on the jury, I mean on the witness stand or whatever, and the lawyer is asking me questions. I said, "Yeah, these teeth were cut down. They're not veneer preps. I don't think aesthetically they meet a standard that the industry today can do." And so did the other guy. We all went through this, and the lawyer afterwards for this girl was saying this is like a slam dunk. This is like the best. They've got this in the bag. So we leave. We get a call from him. The jury found in favor of the dentist who cut the teeth out.

Shaun Keating: Oh you're kidding.

Dr. Jack Ringer: So this girl.

Shaun Keating: Maybe 'cause she was just a psycho lady.

Dr. Jack Ringer: It's because of the mother.

Shaun Keating: Yeah the mother.

Dr. Jack Ringer: Mother messed it all up.

Shaun Keating: Yeah.

Dr. Jack Ringer: What's interesting was this patient and her mother ended up paying at least three times for work. The original, me, this guy.

Shaun Keating: Then to get it all redone properly if they redid it.

Dr. Jack Ringer: And they have to pay all the lawyers' fees.

Shaun Keating: Mama, keep your mouth shut, okay?

Dr. Jack Ringer: Yeah, so back to, you know, what you were saying about covering your bases, making sure mock ups this and that.

Shaun Keating: It's important. Especially the sheet you have signed. Have your lawyer look at it. Even, too, with our lab script, you know. If you ever looked at your Apple contract, you have to go through each time they do updates. Agree, agree, agree, and there's so much stuff, but it covers their butts big time, you know? Same thing as a dentist. Spend $500 or spend whatever it costs to go through your release form and make sure it's up to date and current. It'll save your butt so much, and get it updated because every year laws change, and especially with the public. You got disability acts, you got all sorts of little things. Get a top notch law firm to write you a bulletproof agreement because it'll save your butt.

Dr. Jack Ringer: Particularly if you've had a history of patients who are coming after your practice for some reason, even though you have insurance and you have lawyers and everything to help you, why have that headache? You know?

Shaun Keating: Yeah. Yeah, have a bulletproof there. Even on your own skills, know how to weed them out. There's a lot of people out there with a lot of issues. We all got issues in life.

Dr. Jack Ringer: Sure.

Shaun Keating: It's just, it's hard. I get too many dentists through the years that have just got nightmare stories of patients, but you know what? If you're diligent enough from the upside from the beginning, you can alleviate a lot of these patients.

Dr. Jack Ringer: Yeah, yeah.

Shaun Keating: You're going to have some that fit, you know, come through the cracks, but ...

Dr. Jack Ringer: It's another interesting aspect of this, too. Talk about a patient this last week. We started work on this patient. When I saw the mouth, when I was first presented with it, it really was not a pleasant thing to look at. Horrible restorations in the lower. Chipped, discolored teeth. The patient won't smile normally. I watch patients carefully when I interview them. I talk to them, and they hold back the smile. When they start to smile, they quickly cover up.

Shaun Keating: Yeah.

Dr. Jack Ringer: They subconsciously know that they're not happy with it. I always use this. When somebody goes and gets a beautiful suit or their hair done, and they love it, they flash. If there's something that looks horrible, they're not too quick. Yeah, exactly. Exactly.

Shaun Keating: Let's go around the back now.

Dr. Jack Ringer: This is what this mouth looks like. The desire was to look natural, which is a very subjective word because some people natural is Hollywood white Chiclets, and other people it has little characteristics, whatever.

Shaun Keating: Yeah, stains, cracks. Like the Europeans.

Dr. Jack Ringer: Yeah, exactly. So I went through the whole consultation. Explained to the patient. You know, we'll do a design. We'll do a simulation, but you have to understand, you're looking to look natural. This is going to be a 180 degree change.

Shaun Keating: Yeah.

Dr. Jack Ringer: This is not going to be something that is going to be subtle because then you're still going to look like crap.

Shaun Keating: Yeah exactly.

Dr. Jack Ringer: The patient understood. We went and prepped 20 teeth, upper and lower, and put them in custom provisionals based on our design, based on the typical parameters we look at as a dentist. Height to width ratios, length of centrals, golden proportion, and incisal edge contours, [inaudible 00:42:08] all of this. It fit beautifully into this model. It didn't have a lot of uniqueness to it in the sense like maybe a rotated tooth or whatever, but it had all the characteristics that when people look at a smile like your beautiful pictures up here on your wall, that's what it looks like. Okay, in the provisionals, with the provisional that this is a bit of an opaquey material. It's monochromatic. We're not looking for it to have the beautiful color now. We're looking for shape, size, position, and color family.

Shaun Keating: Maybe a little bit of function too.

Dr. Jack Ringer: Function. Speech. To look, is that the color range you're going to be comfortable with. She comes in the next day, and she's like, "This does not look natural." This and that and they're so big and it feels weird. So I said okay. Let's go through a couple of things here.

Shaun Keating: Uh oh.

Dr. Jack Ringer: Yeah, I said number one, we're in a provisional now. Okay? So nothing has been made. In fact, I haven't even taken your final impressions yet. We can change it. I can make it go back to the way you looked before.

Shaun Keating: Yeah, we can throw out that lateral over here. Change it up. Whatever you want.

Dr. Jack Ringer: We can do anything you want. Okay? But I have to know what's in your head.

Shaun Keating: Yeah.

Dr. Jack Ringer: I can't guess. I've given you something that kind of fits into what I think and the public perceives as when they look at this, "Wow, that's pretty."

Shaun Keating: Yeah. Exactly.

Dr. Jack Ringer: Her first thing is they're too big. Well she started with teeth that were about seven and a half millimeters long.

Shaun Keating: Oh Jeez.

Dr. Jack Ringer: Okay?

Shaun Keating: So she's not used to ten and a half, huh?

Dr. Jack Ringer: Yeah. So I done a lengthening for her and lengthen the incisal edge, and it flows nicely with the edge of the lower lip, and they measured out at I think about 10.2. It really was ideal.

Shaun Keating: Yep.

Dr. Jack Ringer: I said look. I can shorten as much as you ...

Shaun Keating: May go to 9.5 or something.

Dr. Jack Ringer: Whatever you want, but I want you to live with it.

Shaun Keating: Yeah.

Dr. Jack Ringer: Because virtually every patient I've had in my career who've had a massive change have a similar reaction to you like, "Whoa, they're so big." Because they've never had it before.

Shaun Keating: Yeah.

Dr. Jack Ringer: Shaun, if you took a hair and put it on your tongue or on your tooth, you can feel it. Very acute tactile perception on teeth and tongue. And your lip. You take your teeth and add a millimeter to it. How many hairs is that? You can feel. That's a radical change physically that you feel. That's the first thing they have to realize. It's going to feel different. So I said live with it for a few days. We're not on any time restraints here. So she came in earlier this week, or last week after we had done this. Oh no, I love now the shape.

Shaun Keating: Oh really. I wonder if it was her husband or someone at home.

Dr. Jack Ringer: Well she had people look at it, and she started to get used to it and started to understand and look and see and get the comments and realize these are beautiful teeth. It isn't.

Shaun Keating: It's just a psychological thing I think.

Dr. Jack Ringer: Of course it is because they prefer her whole life she's been living with this mess, and that was her reality. Now this is her reality. She said, "Well it feels a lot of off." Well a couple of bite adjustments I'd have to do. "Oh no now it feels great. Whatever, whatever."

So I said look, I want you to still wear these. I want you to be 100% because whenever I'm ready to go to the finals, whatever they are, I'm going to take measurements, photographs, models. My lab is going to duplicate that now in that beautiful smooth ceramics. You won't have these connected provisionals.

Shaun Keating: All glazed beautiful. I mean night and day.

Dr. Jack Ringer: They can do the best job, but if it's the wrong shape and size for you, we're screwed.

Shaun Keating: Oh absolutely.

Dr. Jack Ringer: So you have to be sure. It always goes back to that kind of statement I always tell dentists to understand you have to separate need and want.

Shaun Keating: Yes.

Dr. Jack Ringer: Every dentist has been trained to treat the need.

Shaun Keating: Yeah.

Dr. Jack Ringer: The want is another thing, and you as a lab technician are stuck really in a hard place.

Shaun Keating: Exactly.

Dr. Jack Ringer: Because you have to make the dentists happy.

Shaun Keating: Yep.

Dr. Jack Ringer: They're paying your bills.

Shaun Keating: He's trying hard as hell to keep the patient happy, so ...

Dr. Jack Ringer: Yeah, and if there's a problem it always goes back to you. It's always the lab's fault. They messed it up. Then you have to do that song and dance whether you redo it for free because you want to keep the dentist.

Shaun Keating: Exactly. Moreso than not.

Dr. Jack Ringer: Yet that particular person could have messed it up.

Shaun Keating: Pretty good. We're going to do it for free because at the end of the day, you know, it's a learning experience for him maybe on certain patients.

Dr. Jack Ringer: Yeah.

Shaun Keating: Even for us, not maybe asking for more information. Stuff like that. It's a fine line, but you know you just really gotta look out for those patients and just kind of, you know, like we said, vet them out and get a good agreement on it because sometimes they will get a little, it's like car remorse. You buy a car, and they call it ...

Dr. Jack Ringer: Buyer's remorse.

Shaun Keating: Yeah, buyer's remorse and all that good stuff.

Well hey, dude, man. I want to thank you so much. It's a, time flies when you're having fun, huh?

Dr. Jack Ringer: I know. This is cool. I love talking to you. We should be doing this over a beer, though, and not sitting here in your place.

Shaun Keating: I need to give my liver a little break.

Dr. Jack Ringer: A light beer.

Shaun Keating: Very good.

Dr. Jack Ringer: I don't even like beer.

Shaun Keating: What do you drink? Like a harder drink?

Dr. Jack Ringer: Well look, when it comes to a drink, if it has to be alcohol for me, my only purpose for alcohol drink is to get a buzz. I'm not a social drinker to have a glass of wine. I hate wine. I hate beer. So it has to be a drink that I can't taste the darn alcohol.

Shaun Keating: Okay.

Dr. Jack Ringer: So I'm like the foo foo guy. You know? Sweet mojitos. Or strawberry margaritas or something where I don't taste the booze, but I get the buzz. When I go to watch sports or whatever. If I'm driving, I like just a Diet Coke or an iced tea.

Shaun Keating: There you go.

Dr. Jack Ringer: But I don't see how people can drink scotch.

Shaun Keating: Neither can I. My dad was a scotch drinker, and it just. I tried tasting it, and like I can't drink hard alcohol. I get it to where my punching bag back there. If it touches, it likes to come up. I can drink beer. I drink beer like, but it bloats you up. It's just so heavy. But I could sit and drink with my buddies. If we're out at a sporting event, I mean 10-12 beers is real easy.

Dr. Jack Ringer: No, so I'll tell you one quick thing before you want to go here. Several years ago when I, my dad had a heart attack, and I got really scared, and I went on this ridiculous health craze. I mean, way over the top, but I learned a lot of things that I still follow today. Our body is a machine.

Shaun Keating: Yep.

Dr. Jack Ringer: It needs so much energy to run per day.

Shaun Keating: Yep.

Dr. Jack Ringer: Calories. If you or me required, let's say we required 2,000 calories a day to maintain exactly our weight.

Shaun Keating: Not just 2,000 calories for lunch. You're talking the whole day?

Dr. Jack Ringer: Whole day.

Shaun Keating: Okay.

Dr. Jack Ringer: Most of it is. That's about it. It's about 18-25.

Shaun Keating: That's what I've heard.

Dr. Jack Ringer: So if you are sedentary, you're basically sitting at a desk. You're not doing too much, you're going to basically have to stick in that 1800, 2000. If you're pretty active, a lot of your day to day work is walking, running, whatever, you could go up to 2500 or whatever and still maintain. Let's just assume every day you have two Shauns. Shaun one, every single day of his life, pretty much, sticks in that range. At the end of the year, he'll weigh the same.

Shaun Keating: Yep.

Dr. Jack Ringer: If he exercised more, he'd lose, right?

Shaun Keating: Yep.

Dr. Jack Ringer: Now you take Shaun two.

Shaun Keating: That's where we're at right now.

Dr. Jack Ringer: Shaun two, who doesn't change anything.

Shaun Keating: Doesn't exercise and gains ten pounds a year.

Dr. Jack Ringer: All Shaun two does, is every day he does exactly the same thing as Shaun one but has an Oreo cookie. Just one.

Shaun Keating: Can you believe that?

Dr. Jack Ringer: Just one a day and doesn't change anything else. How much weight do you think they'll gain in a year?

Shaun Keating: I don't know.

Dr. Jack Ringer: 12 pounds.

Shaun Keating: Really?

Well I'm eating like a bunch of Twinkies and Ding Dongs. That's crazy. Can you believe that?

I don't know about that, dude.

Dr. Jack Ringer: I'll tell you why. I'll tell you the math. It's very simple.

In order to lose a pound of fat, not water weight, you have to burn approximately 3000 to 3400 calories. You have to burn that.

Shaun Keating: That's where your 10,000 steps come in.

Dr. Jack Ringer: Whatever it is.

Shaun Keating: Whatever it is.

Dr. Jack Ringer: Whatever it is. You have to do that to burn that one pound. If you eat 3000, 3400, you will gain a pound. One Oreo cookie is 100 calories.

Shaun Keating: Jeez.

Dr. Jack Ringer: In a month, that's 3000. There's a pound.

Shaun Keating: Yeah, what about my beer? Is it 1000 calories? Or 100 calories?

Dr. Jack Ringer: There ya go.

Shaun Keating: No, there's 1000 calories just in a beer.

Dr. Jack Ringer: Right.

Shaun Keating: But that's only a couple of days a week.

Dr. Jack Ringer: But add it up. That's why you keep patting the old belly there because you're not getting rid of it.

I think you're about ready to pop. You're ready to have those kids.

Shaun Keating: I gotta do that eight month pregnant.

Dr. Jack Ringer: The person that consumes extra calories, it's not a problem as long as they are burning it off.

Shaun Keating: 'Cause you got to work it off. Exactly.

Dr. Jack Ringer: Unless they don't mind about gaining the weight.

Shaun Keating: When, I found that golf is my favorite sport because it's the closest thing to sitting. So I golf, and then I take up drumming, and what do I do there? I go sit down there.

Dr. Jack Ringer: But when you golf do you take a cart or walk?

Shaun Keating: Oh I've never walked. I take that cart on places where you're not supposed to to get my damn ball or I say that ProV One. It's five bucks. You can have it. I ain't going over there because I like to move when I golf. I'm done in three hours. Let's not mess around, guys. We need to get up to the club to drink 3000 of calories of beer and a frickin' patty melt or whatever. Nah, my time has come to start working a little bit.

Dr. Jack Ringer: Enjoy your life, but moderation.

Shaun Keating: All your life, you push it. Me, I've always been an athlete, you know. Gymnastics, football, I've always been in great shape, but you know after you work 30 some odd years, it's good to enjoy life a little bit, but you got to find the right medium.

Dr. Jack Ringer: You want to enjoy life a lot longer.

Shaun Keating: Yeah, that's true.

Hey, I've lived a full good life so far, and I pray to God I can live more, but yeah I gotta start kinda watching it a little bit.

Dr. Jack Ringer: It's your only body.

Shaun Keating: I look like Rob Ryan, man.

Dr. Jack Ringer: It's your only body. It's your only body.

Shaun Keating: Hey we'll just go get our lipo sucked out. That'll be gone quick.

Dr. Jack Ringer: Nah.

Shaun Keating: That ain't gonna happen, huh?

Dr. Jack Ringer: That's not going to change your lifestyle. Or your heart.

Shaun Keating: Yeah exactly.

Dr. Jack Ringer: Anyways, that's a nice side talk. Don't forget about the live course.

Shaun Keating: Oh yes.

Dr. Jack Ringer: We should talk about that.

Shaun Keating: We have a live CE course here at Keating Dental Arts on July 14th. It's a Friday. It's from eight to three. Eight in the morning to three. We get credits out, and we're going to do some digital stuff, we're going to have a live patient, Steve Tappy. He came in, and we're going to do a crown live. We're going to have everyone be able to scan the case, show them how that works. It'll go off to the lab and one of our different mills, we'll figure out what we're going to use as a product, but it's going to be a great day. A great day of learning here at Keating Dental Arts.

Dr. Jack Ringer: What's very cool about it is anybody who gets involved in this type of work in their workflow are going to notice tremendous savings and beautiful work that they can get.

Shaun Keating: Absolutely.

Dr. Jack Ringer: It's a little bit different from our traditional way.

Shaun Keating: We're excited. We'll get more info out on our website. You can go up to Keating Dental Arts. Check that out, and for any of you guys if you could, subscribe to us for Dental Up on iTunes. Leave us a review. We haven't had a review in a while, guys. They keep asking us, and I looked, and I was like I think we got ten reviews, but no one's been to a review since like 2015, so I think our 20 people who are listening to this, if I can get one of them, leave a review. All right?

Dr. Jack Ringer: Yeah.

Shaun Keating: Good or bad. I want to thank you all for listening in, and Dr. Ringer.

Dr. Jack Ringer: Good seeing you, bro.

Shaun Keating: We'll see you soon. Thanks, guys. See you next week.

Dr. Jack Ringer: Take care.