The Group Dentistry Now Show: The Voice Of The DSO Industry

Dr. Josh Adcox, Clinical Director for Remote Care of Smile Doctors, and David Fitterling, Business Development Director of DentalMonitoring, join the podcast to unpack artificial intelligence in dentistry.

Dr. Adcox and David discuss:

What AI is exactly and how dentistry uses it.
How to determine which AI is actually worth implementing in your practice.
How AI will impact practices in 2022-2023.
How AI and remote monitoring impacts care for patients.

To find out more about DentalMonitoring visit – https://bit.ly/3tkXbgu or email David Fitterling – d.fitterling@dental-monitoring.com .

If you like our podcast, please give us a ⭐⭐⭐⭐⭐ review on iTunes https://apple.co/2Nejsfa and a Thumbs Up on YouTube.

Our podcast series brings you dental support and emerging dental group practice analysis, conversation, trends, news and events. Listen to leaders in the DSO and emerging dental group space talk about their challenges, successes, and the future of group dentistry. The Group Dentistry Now Show: The Voice of the DSO Industry has listeners across North & South America, Australia, Europe, and Asia. If you like our show, tell a friend or a colleague.

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Full Transcript:

Bill Neumann:

I’d like to welcome everyone to the Group Dentistry Now show, I am Bill Neumann, and as always thanks everybody for listening in, whether it’s Apple, Google, Spotify, or anyone of the number of listening platforms we’re on, we really appreciate you. If you’re watching us on YouTube, thanks for watching us today. Or you find us on groupdentistrynow.com. Without an audience, we wouldn’t have a show. And of course, without great guests, we wouldn’t have an audience. So, I’m going to introduce you to two great guests that we have today. No pressure, of course, but we have first off David Fitterling, he is with … And before I do that, thank you Dental Monitoring for sponsoring this podcast. David Fitterling is with Dental Monitoring. He is the business development director. I’ll give you a little bit of his background.

Bill Neumann:

He has nearly a decade in the orthodontics industry. His passion comes from a desire to connect providers with solutions designed for modern patient care. And we’ll talk about that today. Interestingly enough, he has been working in dental practices since he was young. Hopefully this wasn’t child labor. So, he wasn’t super young, but his dad was a dentist. So, my guess is he was probably in the practice when he was very young. And David, I want to see if I’ve got this right here. It seems like your father was an early adopter of Invisalign way back in 2002. Is that right?

David Fitterling:

Yes, absolutely. He’s always been on the forefront of technology, which I think is where my passion of technology comes from. He was one of the first fellows of [Panky 00:02:00]. He worked with Dawson. He’s 71 now, and … 72 now, and is in Spear curriculum. So, he’s always been just studying dentistry since I was a child. I used to come home from the office, he’d come home from the office at the same time, he’d go straight to the VCR. Yes, that was back in the day when VCRs were prevalent. He’d put in the Gordon Christensen type video. He’d sit there and watch another 45 minutes. We’d eat dinner, and then he’d go straight to the right side of the couch. He would have his TV tray with four or five books. He’d have his magazines off to the side table. He’d have his magazines to the left up on the couch with Post-It notes. And so, yeah. So, I’ve been involved in the dental industry since I was a wee little kid [crosstalk 00:02:51] back with the option of different technologies.

Bill Neumann:

I’ve watched some of those Gordon Christensen VCR tapes when I went through my training at [inaudible 00:02:58]. So, it’s funny. Yeah, they were on tape back then. That was 2003. So, we do have another guest here. So, we have Dr. Josh Adcox. I’ll give you a little bit of a background, and then I’d love you to fill in the blanks as well, just like David did. Earned his undergraduate degree from Brigham Young University, his DDS from the University of Southern California Ostrow School of Dentistry, orthodontic residency, and earned a certificate of orthodontics from Vanderbilt University School of Medicine. Right now, Dr. Adcox now leads the largest OSO, that’s the Orthodontic Support Organization Smile Doctors, as the clinical director of remote care. So, that’s pretty cool, clinical director of remote care. And we’ll talk all about remote care today. But Josh, thanks for being here today.

Dr. Josh Adcox:

Yeah, thanks for having me. I mean, OSO is a new buzzword, because the orthodontic industry is gathering more support groups, and we are the largest. I’ve been with Smile Doctors since basically the first year they incept it. The unique thing about me is I came in, as I say, a non-selling doctor, most of these organizations are compiled of selling doctors that make up the organization. I came straight from residency. And so, coming in, and learning, and growing from an amazing group of doctors has been monumental in my education and growth. And now I run the group with Remote Care, which like David, I’m super passionate about technology, love it, and have found this has been a great partnership with Dental Monitoring, with our organization, to just take the industry. And it almost sounds made up, remote care coordinator or director. We created a job role to push that, because it is the future of how we communicate with our patients.

Bill Neumann:

Yeah, really cool. Real quick, as far as Smile Doctors goes, do you have an idea of current practice count and number of states you’re in?

Dr. Josh Adcox:

Yeah. So, when I started, we were 10 offices. This was way back. And over the years we are currently over 250 and growing, offices with, I don’t know, like 150 doctors. So, honestly I don’t know the exact count because it changes week to week. Or we’re growing rapidly. And we’re over 20 states right now and growing.

Bill Neumann:

Really cool. Yeah. It’s always one of those questions we get here is practice count, and number of doctors, and number of states. Thanks for that, Josh. So, let’s talk about technology, and specifically let’s talk to AI, and this is certainly a buzzword right now, and I think it’s a buzzword that goes way beyond the dental industry. It’s everywhere. AI seems to be in everything. It’s in our phones, it’s everywhere. So, maybe start from the beginning, a little bit of a brief explanation of what AI is, how it works and why all the buzz.

David Fitterling:

Yeah, I’ll take that one Bill. Thanks. I think to me, AI is an umbrella term for a range of technologies and approaches really. They often mimic human behavior. And so, in regards to AI, there’s multiple different types of applications. There’s everything from machine learning, supervised learning, convolutional neuro networks, deep learning, and what have you. And so, I think it’s important to understand that AI is just like an umbrella, and under that umbrella there’s just different types of AI applications. Are you guys familiar with the CAPTCA? So, have you ever logged into a website, you put in your username and password, and there’s that little CAPTCHA that hops up. It’s like, “Please click on all the motorcycles, or all the boats within the picture,” kind of-

Bill Neumann:

Drives me crazy.

David Fitterling:

So, that’s like an understanding of how our technology works within the AI umbrella. And so, really dental monitoring is a CAPTCHA where since inception of Dental Monitoring, we’ve analyzed a billion photos using neuro networks. And what we’ve done is we’ve basically had clickers, which are people that would go in and click on the images. We have a staff of dentists and orthodontists that work for us, and they go and they click on all the different images that are coming through to really train the AI to how it works. And so, once you start building the AI, and building the neuro network more specifically, that allows us then to use that application to really start tracking what’s happening. And I think to me really why there’s so much buzzword around AI is, Bill, I believe you were just saying AI is everywhere now.

David Fitterling:

And maybe it was 2011 or so, we started really seeing convolutional neuro networks be applied to the medical industry in general. More radiologists are using AI, not to replace a radiologist, but really to speed up the process to confirm what is happening within an x-ray. And so, I think in today’s society when you look at technology, whether it’s Amazon, whether it’s Uber, Door Dash, all these different types of applications are using AI. So, I think it’s just becoming more prevalent today.

Bill Neumann:

Great. Yeah, it certainly is. And I think there’s a lot of confusion, because there are so many … You talked about it being like an umbrella term. So, let’s just do this real quick here-

Dr. Josh Adcox:

The way I like to think of the AI, Bill, if I have you, is there’s another term that’s commonly used, computer vision. Because a lot of people ask me like, “How does that even work?” I’m like, “Well, just think of how you learn, you see things, you process it, the more you see it, the more you learn.” Well, that’s what the computer’s doing. It’s the computer vision, and like you just said, David, over a billion photos analyzed. That’s a ton for the computer to learn. And so, it just gets smarter, and smarter, and smarter. And that’s how I like to think of it, and view it in simple terms. David’s pretty smart.

Bill Neumann:

Yeah. Makes a lot of sense. So, let’s talk about applications specifically to dentistry. I mean, you talked a little bit about it, David, already. And I guess the big question is we know Smile Doctors is paying attention to it. So, there are some DSOs, and probably some clinicians at the DSOs, and some non-clinicians that are paying attention to it for various reasons. But why should the industry, and maybe be somebody that is fearful of it, for whatever reason, because it’s changed for sure, why should somebody pay attention to it?

David Fitterling:

Josh?

Dr. Josh Adcox:

So, here’s the deal. I was attracted to it for multiple reasons. One, I believe in technology. So, I was in a spot in 2019, I’ll go through a brief history. In 2019 in my practice, where we were seeing patients five days a week, a over 3,000 patient load per year at any given time. And so, we were seeing over 150 plus patients a day. And so, the difficulty of that was just the decision fatigue that happens on a day-to-day. You can only make so many decisions, and have the bandwidth to continue to move forward. And you start to make mistakes. We’re human. By the afternoon I’m spent. And that’s when you start punting stuff, or you miss stuff, and the patient experience, and the team and doctor experience does goes downhill.

Dr. Josh Adcox:

And you don’t have gas in a tank for … To go home and tend to your other responsibilities. So, for me, it was a total necessity. I needed to find a way to offload unnecessary tasks that could be automated so that I could focus on the vital few things in front of me, which were my patients, my team, and also my own health. So, 2020 hit, we partnered with Dental Monitoring, and it was an amazing opportunity to focus in once COVID hit, on all right, what really matters? And what can we automate and sift down so we can focus on what’s really important? And so, that’s where it came in for me. And we just developed and partnered with Dental Monitoring to figure out, “Hey, how can we automate the process?” And we just, we’ve continued to improve that as gone on.

Dr. Josh Adcox:

Now, the problem here that some doctors or teams have is like, “Oh, whoa. Are we going to be replaced?” And that’s where I think the myth is, is like, “Hey, is this replacing what we do as orthodontists?” Or as an assistant, a clinician chair side, “Hey, am I going to get replaced here?” And that’s what my team thought at the beginning, like, “Whoa, I want my hours. I need to work.” So, over the course of a year, I told my team, “Don’t worry, you’re going to keep your hours.” But we were able to essentially take our team from working five days a week to four days a week. And from seeing 150 patients a day down to 80 to 100, that’s a sweet spot for me. And we’ve actually grown year over year by doing so. And the only way we were able to do that is to automate certain processes to limit unnecessary in-office appointments.

Dr. Josh Adcox:

And it actually decreased the need to hire more team members. We didn’t need to hire more by doing more. It was very interesting.

Bill Neumann:

Which is a huge challenge right now.

David Fitterling:

And I’ll add a little bit to what Josh is saying. Josh is looking at this from a doctor perspective and a staff perspective. I mean, he just talked about the ability to really automate the process, and with automation creates scalability. That’s why you’re seeing so many more companies that are going to automated processes today. And as Josh said, you’re not taking away from the staff. You’re just enhancing their work life balance, and you’re enhancing their workload. And to me really, I’ll take a it to the four C’s of orthodontics, and I’ve spoke about the four C’s of orthodontics for almost a decade now. And really those four C’s are communication, convenience, control, and compliance. And I believe it’s Chris Benson that once told me this, years ago, back in my Align days, said, “If you can manage four C’s of orthodontics, the sky’s the limit.”

David Fitterling:

And really, Dental Monitoring is just a digital platform that allows you to manage those four C’s. And, while Josh was talking about it from what it’s done for him and his staff, and his team, you also got to think about it from a patient perspective, or how dare I even refer to them as patients. They’re really almost consumers. And what is it that the consumer wants in today’s society? There’s a reason why direct-to-consumer is more prevalent than ever. It has nothing to do necessarily with cost. It’s really about the convenience and time associated with, dare I say, a commodity, as what is perceived by the consumer. But Amazon is where they are today, Apple’s where they are today, all these companies that are out there using technology, and AI, and automation are where they are today because of being able to manage those four C’s and really use technology to just enhance the consumer’s experience.

Bill Neumann:

It makes a lot of sense. Go ahead, Josh.

Dr. Josh Adcox:

I was going to say, I would speak to the team again. So, for instance, today, we call it a non-doctor day because is we’re able to half-time they’re working on some training, they’re doing some local store markets, some things that we don’t … We used to not be able to do, and we have way more time to reward them with some team building activities. The other thing I really worried about, so that was one myth that we totally debunked, it improved the team experience tremendously. They’ll never want to go back to how we used to traditionally practice orthodontics. The second thing is neither will patients. I have moms come in all the time when we traditionally treated their child bracket and wire with lots of in-office visits. And now we come in and they finish, let’s say we did an aligner case.

Dr. Josh Adcox:

We finished in like three or four in-office visits, literally. I had one mom just like, “We’re done? Are you kidding me? This was the easiest experience we’ve ever had. Why couldn’t we have done this with the other kids? That was painful?” I like to say we’re changing the way. It’s not a shiny tool. It’s a movement on how we communicate with our patients, and it’ll forever change how we practice, and communicate, and deliver the four C’s, like David was talking about, in a better way. And so, that’s what this is doing.

Bill Neumann:

Let’s talk a little bit about … We talked about AI being this umbrella for different types of technologies specifically in dentistry. So, how can you tell which AI is actually worth implementing in a specific practice?

David Fitterling:

I think that’s a great question. And I’ll actually twist the question in a way that it’s not necessarily about what AI is worth implementing. It’s more so a grandiose vision of what technology in general is important to implement into a practice. As a son of a dentist, as you’d mentioned earlier, I remember when we were … I used to do all the x-rays, I developed film in the practice, and whatnot, and I used to take impressions. And my father used to teach me all the little tips and tricks of how to get a really good impression. And I worked in the clinic when it was paper charts and what have you.

David Fitterling:

And I remember when we first transition to Eaglesoft, and my father said, “God, I wish I would’ve done that earlier.” Or it was when we went from a manual process with x-rays to a digital process. And the first thing that was said was, “Man, I wish I would have done it earlier.” When he went to a CBCT scan, and he went to the quarter facial CBCT scan, and was like, “Man, I should have done this earlier.” And then it was the full … I mean, you look at all these different technologies that doctors have implemented in their practice over the years, and the one common saying is, “I wish I would’ve done this earlier.” And so, it’s not necessarily even AI, it’s more of a technology mindset of what is happening in the practice today, and what type of technologies can we use to actually integrate into our practice that are going to change the work life balance, or change the behaviors within the practice?

David Fitterling:

So, to me, it’s more of a what are the right technologies more so to implement, as opposed to just the types of AI, because there’s multitudes of different types with Diagnocat, or Pearl, or Overjet that are using AI and applications or whatnot. But if they don’t make sense for you at this particular time, is it really still worth investing in and going to? And I can’t speak to their technologies, but what I can’t speak in regards to Dental Monitoring is every practice that we’ve onboarded since I’ve been with DM now for almost three years, every doctor will … Has a consistent message of, “I wish we would’ve done this earlier.” And I think that’s just speaks to the adoption of technology as opposed to just AI.

Bill Neumann:

Absolutely. And I think a lot of it has to do probably with the onboarding process as well. Once you get past that that change, which there’s … I think as human beings we’re just built resistant to change. I mean, there’s some people that are outliers that aren’t, but in general. So, once you get past that, I think then it’s like how can you be onboarded? How can you be trained? How can you be made to feel comfortable as you bring something pretty different into your practice?

Dr. Josh Adcox:

I want to add something as the orthodontist looking at this. For me, when I look at, “Hey, which aligner system, or which bracket system I’m going to use?” Or how do you make those decisions. For us, for me when I look at Dental Monitoring, but that one they’ve been a fantastic partner for us as we send an idea, like, “Hey, could you implement this in the software?” Or whatever. And they take action and they create it. Two is, I look at like you have, what, over 200 patents on the technology? Over a billion scans. And so, it’s just proven and it’s vetted. And it’s just developed in a way that just works and flows very easy. So, not only does the AI work really well, but how the whole system integrates the flow to make it more automated and seamless for the experience, the user, the doctor, the team. That’s what you got to look at when you’re looking at these technologies, in my opinion. And we settled in on Dental Monitoring as being a partner for that for us.

David Fitterling:

Yeah, great points, Josh. With Dental Monitoring, there’s 137 different observation, oral observations, that the AI is trained to look at. And so, if you want to speak in regards of technology as a whole of what type of remote monitoring system should we be implementing into our practice? AI then becomes a major talking point to that. Whereas, I was looking at Josh’s data the other day, and I think it was something like 45,000 clinical triggers this year that have been detected on the patients that he’s monitoring, of which the AI we have customized and built out to send roughly 30,000 messages to patients that might say, “Hey bill, this is Dr. Josh Adcox. Just wanted to let everything looks great. However, your teeth haven’t fully expressed. You might just need to stay in your liners for a few extra days, no big deal. It’s great that we caught this. We’ll see you in a few days for your next scan,” thus allowing the teeth to fully express before they switch to the next aligner. But all of this is through automation, which is the scalability component.

Bill Neumann:

Really cool. Yeah. I think back to when my kids were in braces and doing it the old fashioned way, so-to-speak. And you’d bring them back, and things weren’t exactly where they should be, and you still had that appointment. So, then you’re coming back in, there’s an extra appointment that you didn’t figure into your schedule. So, yeah, that would’ve been really handy. So, that leads into the next question, which really relates to what we were talking about a little bit about what type of technology to use in a specific practice. But what should we really know about the AI? You talked a little bit about Josh, and what he has, and what’d you say? 35,000 messages that were sent back to patients? Which is amazing, but talk a little bit about what else we should know. What is going on with Dental Monitoring, and what kind of information is Josh sending to Dental Monitoring, and what is being sent back to Josh and his team?

David Fitterling:

Josh, you want to start with that one?

Dr. Josh Adcox:

Yeah. So, let’s just take a liner cases at the beginning. What that’s essentially doing is a patient will start their monitoring. And instead of doing the old fashion, “Hey, where them a week each and come back and see me in X amount of weeks,” there’s a lot you don’t know when they come back. And it’s just very a blanket statement. What this is doing, they take an initial scan the first day, and I tell patients, “You’re going to scan weekly and we’re going to customize this for you.” On the weekly scan, the computer evaluates, the AI evaluates if the teeth are tracking, that specific tray, and if the teeth have moved enough the automated message will go to the patient, like David just said. “Hey Bill, you’re ready for your next tray. Great job. Go to the next one. And we’ll see you in the next week for your next scan.”

Dr. Josh Adcox:

And it goes like that. Now, if there is a challenge, if the teeth haven’t moved enough, then the patient would get a message to say, “Hey, you’re going to go ahead and stay in this tray for three more days, scan again. And we’ll evaluate that.” So, it’s customizing the approach, thus eliminating surprises. The other thing is we don’t actually schedule an in-office appointment for my patients. We call it a landmark appointment. When they hit a certain landmark of a tray reach, that the end of the trays or in the middle, then there’s certain things they’re triggered to do. So, really I’m only involved when it’s not going according to our plan. So, I get an alert that says, “Hey Bill, for the last two scans it’s not following. What should we do?”

Dr. Josh Adcox:

And we can make those decisions based off of the information we have. But we know when there’s a challenge we can pivot, and change and customize the approach, and thus reduce the amount of extra trays we need later, the treatment efficiency, and length of time decreases, I’ve noticed. And the patient experience, the communication’s amazing. Not to mention I love the feature, David, that we have, that the patient can see the progress, they can see it before and where they’re currently at. And that is super motivating for them to see that it’s working, and they rest assure, and the communication pieces are awesome. Then we have the chat feature. There’s so many features in the app that it just allows us to communicate regularly without having … And it’s on their own time, and it’s regularly. So, they know exactly where they’re at, at any given time. Braces are a little bit different. Do you want me to talk to braces a little bit?

David Fitterling:

No. It’s funny that you just brought that up because as you were talking, you were talking about the landmark appointments, and the AI from the aligner perspective. I was sitting here just thinking that’s fantastic, because people think Dental Monitoring is just … It’s fantastic for aligners, don’t get me wrong. But when you think about the challenges faced in orthodontic treatment, COVID helped exacerbate what the real challenges are. And those real challenges we all know are more so geared on the braces component of treatment, whereas aligners are pretty straightforward. It’s a compliance factor. And Dental Monitoring really helps keep patients’ teeth on track. We know that there’s two main reasons teeth don’t move, it’s compliance or biology.

David Fitterling:

And so, instead of telling mom, “Hey, we use this technology to manage compliance,” we’re rarely telling mom, “Hey, we use this technology to really manage Johnny or Sally’s unique biology, to make sure the teeth are fully expressed.” But when Josh was talking about landmarks and appointments, it really got me thinking about proactive verse reactive. And in orthodontics, and in dentistry in general, over 50, 60, 70 years, everything’s been a reactive approach. Everything has been, “You come back in 10 weeks, we’ll see what happens,” and then we’re going to react to it. Or you get your teeth cleaned every six months. You come in, in another six months, something else has happened in between that six month time span. And now we’ve got to react to it. Whereas with Dental Monitoring and all the different oral observations that we can detect, we look at images at a pixel dot level.

David Fitterling:

We look at tooth movement and we can monitor tooth movement up to one 10th millimeter movement. And so, when we use this data, it allows us to really focus on the patient and be proactive in their treatment. For a great example, and I don’t know, Josh, I don’t know your exact numbers right now. But I remember when I ran some of your data earlier this week for you guys in Smile Doctors, there were lot of open clips. Well, if a clip is left open, and that patient is out, gone for 10 weeks, you’ve lost 10 weeks. Whereas with the AI, having the ability to detect an open clip, now, Josh, all he has to do is go in, annotate the photo or circle the image, point out, “Mom, press the arch wire in, close it with your fingernail,” and we’ll just keep right back on track.

David Fitterling:

There’s nothing more frustrating, and Josh can speak highly on this, there’s nothing more frustrating than when a patient shows up to the practice and they’re scheduled for a 20 minute appointment. And next thing you know it’s three broken brackets, you got to do a repo. You’re having to go out and tell mom, “Sorry, mom, it’s going to be another 30 minutes. We got to fix this. We got to do this.” Or the staff is concerned. And they know that there might not be enough time. So, it might be, “Mom, we need to have you back in another week or two weeks to fix this issue.” With Dental Monitoring every single week, having ability to see, “All right, this patient’s bracket is broken. We need to call mom, get the appointment time changed.” So, that way when a patient does come in, we know what they’re coming in for, why they’re coming in, and exactly how long they need to be there. So, it maximizes the efficiency for both the staff, and the patient and parent.

Dr. Josh Adcox:

Yeah. I love that part. I want to add one thing to that. The other thing that data that, David, you’re referring to has really opened my eyes. So, we all think we’re really awesome at our trade and our craft. Well, what I noticed is our upper left sevens are always coming off. That data showed us that, that those are of the most common brackets that break. We notice that there’s some open clips on certain teeth. So, obviously we need to pay more attention to those. We noticed that certain attachments come off more prevalently than other ones. The data is showing us that certain teeth tend to not track really well. So, it’s opening my eyes up to how can I improve my craft on my ClinChecks, or how I’m developing aligner cases, or how we’re placing, or isolating for brackets.

Dr. Josh Adcox:

And so, it’s a training opportunity for us as well. So, it’s helping us improve our craft for our patients, as well as educating patients. The other thing I love about braces with the AI is the hygiene. We’re able to really track and encourage hygiene on a weekly basis. So, it’s decreasing decalcification surprises from that front. And my team loves it, because we know what we’re getting when they come. You nailed it. That alone for my team has been monumental. So, if you think about this for a second, it’s to say I have 15 … Let’s just take 1,000 active braces cases. If I can eliminate one visit, Bill, with is one visit in their treatment, that’s 1,000 appointments. If you equate that to how many days worked, that’s probably a week, week and a half or so, of appointments for me.

Dr. Josh Adcox:

So, just little things like that go a long way in how what we will be thinking about this long term, and what we’re testing right now, and really playing and around with is there’s a capability of measuring when the arch wire is passive. And so, we’re going to more of a as needed basic scheduling, we call it just in time scheduling where I’ll let a patient go, and we’ll keep monitoring it. Whether so much time goes by or when the arch wire is passive, then we invite them to come, and schedule, and come back in rather than just like, “Okay, well we think it’s going to be about eight weeks. So, we’ll just see you. Oh, looks like your wire still needs work. So, we’ll just pat you on the back and let you go.” We’re trying to eliminate those unnecessary visits even with braces. And so, it does make sense with braces as well for many reasons.

David Fitterling:

And it’s funny that you brought that up about hygiene, Josh, because again, going back to the start, and the height of COVID when practices were shut down, practices reopen, and obviously every practice wanting to get their braces patients in first, because those have been the ones that haven’t been seen, and there’s challenges and whatnot. Where aligners, you can just let them go. But one thing I noticed over the last couple years in states like Washington, or Oregon, where they’re … And Canada even, our neighbors up north, they’re still not allowing family members into the clinic. And I can speak from experience over the years that … And being that problem child, as much as I don’t want to admit it, I was that kid where it’s like I would come home from school and mom would ask me how my day was, or after … At a certain age, I’d go into the office after school and do lab work, and what have you.

David Fitterling:

And I’d always go and find my dad, and dad would say, “How was your day at school?” And it was like, “Oh, it was great.” “Well, what’d you learn?” “Nothing. Things are great.” And you saw that during COVID especially, and even now with offices not allowing parents in. There’s nothing more frustrating that when Johnny comes into the clinic and Josh is hounding him on hygiene. “Johnny, you got to do a better job brushing and flossing, or we might have to pull your arch wire, which is going to delay treatment,” or what have you. And Johnny then walks back out to the car. He’s got his little report card of his hygiene. And next thing you know mom says, “Well, how was your appointment with Dr. Josh?” And Johnny says, “Oh, it was fantastic.” “Well, what’d doctor have to say?” “Nothing. Things are great.”

David Fitterling:

Now mom having the ability to have the app on her phone, she gets all of the communication from Josh’s practice saying, “Johnny, we noticed that you’re having issues with brushing and flossing in this particular area, you’ve got to do a better job of this or else we’re going to have other issues,” or what have you.

Dr. Josh Adcox:

Well, what’s cool is you can see it, you can see it. It’s very visual. So, it’s easy to train and it’s just obvious. And so, it’s a win-win, and I love just the chat feature alone, just to communicate with the parents. They didn’t come back. My clinician just taps a little message in, “Hey mom, this is the update. You can see from the photos this is what’s going on. This is where we’re at.” Simple, it’s easy.

David Fitterling:

And you’re bypassing the front desk. There’s nothing more frustrating when you call up a business, whether it’s orthodontics or you name it, you call it up and it’s like, “Oh, hold on a second. I got to go find the person that can answer that.” Or what have you. With Dental Monitoring, you have direct communication to the practice, clinicians, and doctor. So, you bypass having to call up. “Hey, Johnny got hit in the mouth with baseball. We’re not sure what’s happening.” Now it’s a message. “Hey, Johnny got hit in the mouth with a baseball. Here’s a scan,” doctor then can evaluate the scan. He can then report to the front desk. “Hey, we need to call and schedule Sally,” or whoever, “For 40 minutes. This is what’s happening. This is what we need to repair.” And now we just increase efficiencies for everyone.

Dr. Josh Adcox:

Well, [inaudible 00:34:47] one more thing is we use this a lot for our on-call emergency style stuff. So, on a weekend or in the evening, whoever’s on call, one of my clinicians, they have them scanned and I’m able to evaluate remotely and see what’s needed to do. And it just facilitates everybody’s communication tremendously.

Bill Neumann:

Let’s talk a little bit about the future. It seems like you’re already using … You went from looking at AI during COVID maybe out of necessity, because you couldn’t see … Patients just couldn’t come in. 2022 and 2023, what are you thinking? How do you build on this success, and what things are you looking forward to?

Dr. Josh Adcox:

Oh, for me, it’s just to continue to find ways to automate, and simplify the process for my patients, my team, and myself. I went through a time where I didn’t love what I was doing because I was so overwhelmed with the responsibilities and the day to day. And like I said, decision fatigue. It affects us in different ways. And for me was it started affecting my personal relationships with my family. So, what this has done for me is I want to continue to focus on what’s most important, which is my family, my children, my team, my patients, and be present with them. And so, by continue to hold those principles true, by finding ways to simplify the process, focus on the vital few things in front of me that are most important, and offloading the trivial many things that technology can do for us will always be my future focus.

Dr. Josh Adcox:

And that’s what remote care is. Now, keeping in mind the number one thing that I care about is delivering, we call the ultimate patient experience. And you can do that with technology if you do it right, by not letting it feel, I guess, robotic, if you may, because we want to make sure we have the right touches. So, that’s what I continue to strive for this next year, is how do we make it best in class experience, even remotely? Because we try to do that in the office. How do we do both? And Dental Monitoring’s great partners in that. I keep asking for, “Hey, I need this feature so that the communication pieces, and the experience for us and the patients is even better.” And that’s what we continue to push the limits on.

Bill Neumann:

Yeah. That’s a great point, Josh, that leads into something. When you’re bringing in a new patient, and you start to talk a little bit about Dental Monitoring, and the way you’re going to have this communication a little bit different than maybe they experienced with an older child. So, what’s the initial feedback? And then, so the initial feedback, maybe from the parents and the patient, and then what does it look like afterwards? What’s the result feel like?

Dr. Josh Adcox:

I was worried about this actually at the beginning. I think a lot of doctors are. Doctors want us to think that they’re the most important people in the room, and that’s just not true. Nobody wants to go see the orthodontist all the time. I mean, just be real. And once you can get over yourself and know that, “Hey, it’s not all about you,” that’s where you can have a lot of fun with it. So, this is what I do in a consult. My treatment coordinator, it’s a team process, it’s not just the doctor, treatment coordinator, the records, our concierge, our clinicians chair side, all know what we can do with this technology. Now, the message is this. It is simply, “Hey, we have an app, Dental Monitoring app, that allows us to communicate with you week-by-week. So, how the process will go is you’ll use your app in conjunction with a scan box.”

Dr. Josh Adcox:

We show them what it is. We demonstrate it to briefly in the TC room, helping them understand that we’re going to be able to update them weekly on their progress. Now, if it’s aligners, we’re going to help you understand when to change your trays. And I tell them, “You’re getting a weekly update on that progress and when to change week-by-week, and you even have to come back.” And I’m like, “What do you think of that?” And they’re like, “Wow, that’s really awesome. You mean I don’t have to come back every month or two to have you check?” I’m like, “No, I’m going to give you all your trays, and we’re going to have weekly updates. And I’m going to check in on you on certain landmarks, like you would come to the office, but I’ll just send you a video back through the app, and you can watch it on your own time. Anytime you need something, you can reach me through the app and we’ll be right on it.”

Dr. Josh Adcox:

And they’re like, “Yeah, that’s awesome.” And so, I also tell them, I’m like, “Now, remember these messages you’re getting back, I’ve made all the decisions. So, I’ve made the decisions. The technology’s helping me communicate it back and forth to me. So, when I jump in is when something’s going not according to the plan. That’s when you’re going to hear back from me personally. If not, you’re going to hear some messages back. They’re from me, but it’s automated. It’s an automated process, and I use a few comparisons.” And when people get more interested, then I’ll dive into more what the technology really is and isn’t, but people are very used to this already, especially in a COVID world. And I use a few examples. I’m like, “Hey, we do this for you because what happens if …” In Texas here, we had a snowstorm and we were all snowed in for a week.

Dr. Josh Adcox:

I’m like, “What happens when we have that snowstorm again, and you can’t come in the office? Well, this is a way we can still communicate. Or what happens if we get quarantined again? Heaven forbid that happens, but what if? Well, we have a way to continue to communicate with you, and progress your treatment.” And they get it.

David Fitterling:

And to add a little bit to that, Josh, you hit the nail in the head of those weekly updates. And the way I look at it is a couple different ways. You have compliant patients, and you have engaged patients. And those are two totally different. And the ultimate goal is really get patients engaged in their treatment. And when they become engaged in their treatment, then they become more compliant. And so, one question I often will talk with treatment coordinators about, and parents, and what have you is, does your kid do a better job in school when they have a short quiz at the end of every week to stay on track with their learning? Or are they a kid that wants to just go through class every day for a semester, and then just have one big final exam?

David Fitterling:

And I think we all can probably agree that kids that take that weekly quiz are more prone to stay on top of the learning aspect. And really that’s what Dental Monitoring is doing is having kids do that weekly check-in, or that weekly quiz, thus allowing Josh to manage the compliant component, but then the feedback and the communication back, as Josh mentioned the ability to see the images of the before with the current, and that’s when the engagement comes into play. So, now we’re tackling the engagement side by keeping the child on top of their treatment. Thus, everyone wins.

Dr. Josh Adcox:

Yeah. I have an analogy I often use with other doctors that it’s like a pilot. The pilot knows how to fly the plane and do all the things, but there’s autopilot. And so, when things are not going according to plan, you jump in and you make adjustments. So, it’s no different in my normal practice when they come see me chairside. At an actual physical appointment. I come over, the clinician suggests where we’re at, where we should do today, what we should do to the next visit. We’re very organized in that way. And so, and I just prove like, “Yeah, that’s what we should do.” And they do the work, we move on. Well, I have a virtual assistant, which is the AI that …

Dr. Josh Adcox:

And I’ve made all the decisions. So, they’re helping me remind me, “Hey, based off your decision you already made, due to your protocol here’s where we’re at, and here’s what you suggested to do. If it’s something that it should be just okay, go to the next thing, I don’t need to be involved and it’s just automated. And it’s something I need to have my eyes on. I’m alerted, and we’re on it, and we’re making decisions. And that’s the beauty of it.

Bill Neumann:

That’s great. So, as we wind things down here, because there’s a lot of great information here, really, really great information, make sure that we get some key points in the show notes too, for everybody. But let’s talk a little, and you’ve touched on this a bunch of times, Josh, but any other things about just how you feel personally about how AI, Dental Monitoring, in particular has impacted patient care. We talked a little bit about maybe cutting out appointments unnecessarily, unnecessary appointments from your staff’s perspective, no surprises. So, that’s great. Talk a little bit about patient experience, and then the overall care.

Dr. Josh Adcox:

Thank you. Yeah, I’m very passionate about this part. Having someone have a great experience. So, I always tell something, “Hey, we want to make you have a great experience, a fantastic outcome, and make it affordable.” That’s what people want. And by giving somebody the opportunity to have care in this fashion, it allows us to, in my opinion, give a better outcome in a better predictable amount of time, and do it the way key people like to communicate anyway. I compare this often to movements like Netflix or Apple. They changed industries on how things were done. This is what this is. It’s a new way to deliver care, and communicate with our patients. It’s in your phone. It goes where you go. I live in an area where we have a lot of active duty military. And so, we treat active duty soldiers all the time when they go on deployment for eight months to a year. All the time.

Dr. Josh Adcox:

Kids that go off to college, it’s changing the ability of how many more people I can treat because they don’t have to live in the same town. If I can see them once or twice, then it’s easy. For example, the way this really … The a-ha moment for me is my sister-in-law. She lives in Japan right now. My brother’s Air Force. They’re in Okinawa. I’ve seen her once for her care. I saw her for the records. I mailed her, her trays, and a scan box, and she’s done. I mailed her a retainer based off the last fitting tray. That was it. I mean, how much more simple can that get? So, we are literally revolutionizing how we’re delivering care. And I feel like it’s allowing me to even be more detailed.

Dr. Josh Adcox:

I remember the first day I got a notification that there was some recession on a lower incisor. And I had to really look and compare some photos. I’m like, “It is, but barely by maybe a half of a millimeter.” That’s how accurate this is. Or the first day I got a notification that an upper left seven bracket was off. I was like, “There’s no way it detected that.” I look closer, I’m like, “Sure enough,” the bracket was off. It’s detecting it on a more micro level better than my eyes. And when you see so many people a day, you miss stuff. Well, this doesn’t, and that’s what I love about it. And so, it’s changing that whole experience for the patient, my confidence of making sure I’m delivering great quality care. It’s just giving people more options. And then the direct-to-consumer market has opened our eyes in that way, too. People want this, they want that interaction and experience. This is how you give it in a really good way with an orthodontist involved.

Bill Neumann:

Excellent. Excellent.

David Fitterling:

I think that’s where Josh just drops the mic and walks away.

Bill Neumann:

I was going to say that might be the best place to end this. But David and Josh, any final comments as we wind things down? This has been really, really great conversation. And David, maybe before I forget, would you mind shelling out your email address so people have a way to contact you if there’s any interest? We’ve got a huge audience of emerging dental groups, three practices up to 25 or 30, and then we’ve got the Smile Doctors who already know who you are of the world, but maybe some other larger DSOs that don’t.

David Fitterling:

Yeah, absolutely. My email address is D as in David, dot F as in Frank, I-T-T-E-R-L-I-N-G @dental-monitoring.com. And the final thought I want to add to this, is when we talk about hesitations of implementing technologies and what have you, you’ve got to first ask yourself what technologies have I implemented over the years that I wish I would’ve done earlier? As I alluded to earlier in the call. And this technology’s not going away. Dental Monitoring, I don’t know if you’re aware, Bill, but Dental Monitoring just finished our final, or our next round of funding at 150 million dollars with evaluation of 1.2 billion. So, this technology’s not going away. We have 170 plus R&D engineers working on this technology. We have 7,000 dentists and orthodontists worldwide using this technology.

David Fitterling:

And I think what we’ve seen through the height of COVID, and over the last five years, that adoption of technology is happening faster than ever before. And if you’re not adapting, you’re dying. And so, you’ve got to really take into consideration what are these companies doing? Why is a company like Smile Doctors already ahead of the curve? And why have they started the implementation of this even before COVID started? Because they know where the industry’s going. As Wayne Gretzky says, “You skate to where the puck is going, not to where it is.” And I think that with today’s world, technology’s evolving faster than ever before. You’ve got to let go of the ego, and you’ve got to sit back and realize, “I’ve got to do something that’s going to be different,” and make a change. And that change has to start now. So, I can start working on my practice for 2023, 2024.

Bill Neumann:

Yeah. I think that’s some great points there. And I think, David, when you think about skating towards the puck, and sounds like Smile Doctors is there. I mean, it may be as a group practice, or a DSO that’s listening or watching this podcast, maybe the question you should ask yourself is do you have a clinical director of remote care? Because Smile Doctors does. I think when you look at that and you say, “Wow,” you said it sounded like a made up title. Or maybe at the time it was. But now that title is going to be, I would say, commonplace in the next couple of years. And so, what’s that next title that’s going to need to exist in order to continue to adapt to the change But really interesting stuff. And if you didn’t get David’s email address, we’ll have it in the show notes, so you don’t have to memorize it. But if you’re listening in, you’ll have it for sure. Josh, any final words?

Dr. Josh Adcox:

I’ll just leave you with this, Bill. Look, what this has done for me is it’s, like I mentioned before, it’s allowed me to take my life back. It allows me to practice orthodontics how I want to practice it, impact more lives than ever before. We’re growing more than we ever have on less. So, I like to say it allows me to do more with less, but do it better. Who doesn’t want that? And it’s improved my relationships with my patients, my team, and my own family, because I’m able to just focus on what’s important. And that’s what I want for everybody else. That’s what we want within Smile Doctors, our organization. We want really good relationships with our teams, our patients, our doctors, and that’s our focus. When you take care of people first and straighten teeth second, you do …

Dr. Josh Adcox:

Everything falls into place where, and this technology allows us to do that. And so, for us, it’s not going away. It’s just going to be continue to be a great partnership as we move into the future. We’re just scratching the surface. We’re just scratching the surface what we can do here. And so, I’m very excited to see where it goes.

Bill Neumann:

Great. Well, I thank you both. Thank you, David Fitterling from Dental Monitoring. We appreciate you being here today on the Group Dentistry Now show. Dr. Josh Adcox from Smile Doctors, thank you. And until next time, I’m Bill Neumann, and this is the Group Dentistry Now show.