Dr Dan Davidian has found a way to alleviate patient stress, save time in his day, keep his employees happy, and spend more time with his patients - buffered anesthesia. Today, Dan talks to host Ryan Vet about how it all works and what has happened in his practice since introducing this method.
Dr Dan Davidian is the founder of Anutra Medical and practicing dentist at Sedation Dental Care.
This episode of The Dental Experience Podcast is sponsored by Trident Lab. Dental Experience podcast listeners - that's you - you can write the code Dental Experience on your first case, and you can save up to $50. Simply visit tridentlab.com/dep for more details.
The Dental Experience Podcast is hosted by Ryan Vet and is edited by Earfluence.
Dr Dan Davidian has found a way to alleviate patient stress, save time in his day, keep his employees happy, and spend more time with his patients - buffered anesthesia. Today, Dan talks to host Ryan Vet about how it all works and what has happened in his practice since introducing this method.
Dr Dan Davidian is the founder of Anutra Medical and practicing dentist at Sedation Dental Care.
This episode of The Dental Experience Podcast is sponsored by Trident Lab. Dental Experience podcast listeners - that's you - you can write the code Dental Experience on your first case, and you can save up to $50. Simply visit tridentlab.com/dep for more details.
The Dental Experience Podcast is hosted by Ryan Vet and is edited by Earfluence.
Voiceover: Today on The Dental Experience podcast.
Dan Davidian: I take a carpule of that and inject that in, and then I inject lidocaine in there to get them numb.
Ryan Vet: Was never a strong chemistry student, but at 3.9 pH is like, what, citric acid? Like, lemon juice or lime juice? So that's why a lot of times it burns.
Dan Davidian: Some people get numb on the first shot, and some people take four or five shots.
So I would bring her to school with me in a backpack, and she would sit in my backpack all day, like in a pouch, so I could feed her every three hours.
Ryan Vet: I love that story. I think that's hilarious. I did not believe you the first time I heard it.
Dan Davidian: They are fairly gassy. And so, I think everyone thought I was the stinky kid.
Voiceover: This is The Dental Experience podcast. Here's your host, Ryan Vet.
Ryan Vet: Welcome to another episode of The Dental Experience podcast. I'm excited to have with me a good friend, and a practicing dentist, Dr. Dan Davidian. I have known Dan for quite some time and he's been a great influence in my life, taught me just about everything I know about the dental industry and has just really been an inspiration.
It's been way too long for me not to have him on the show, so I'm very excited to have him with me today. Welcome, Dan.
Dan Davidian: Thank you, Ryan. I appreciate the kind words. Yeah, you've had a huge impact in my life as well, so I appreciate you having me on the show today.
Ryan Vet: Well, thank you, and absolutely. Well, we're going to talk today about a lot of different things, but I really first want to talk about you and your practice and a little bit about your history, because obviously, like dentists, you went to dental school, but in dental school you had some realizations and some ideas that could really transform the industry, and you really invest your life in caring for patients that are high fear, and you've invested your career in really trying to provide tools and resources to help practices be as efficient as possible and to really provide the optimal patient experience, so I would love to hear your story.
Dan Davidian: Thank you. So I am the founder of Anutra Medical and a practicing dentist. The name of my practice is Dedation Dental Care, and what that means is I see a lot of high fear patients. And talking to a lot of high fear patients, I've kind of heard the same story over and over and over again. They became phobic because of failed anesthesia.
So they either hated the feel of the shot, or the shot didn't work, or they needed multiple shots, or they just felt everything, or they were kind of numb. And so, early on in my career, I realized, you know, dentists had to do things differently, and we needed something different. And I remember back to dental school when my father, who was a practicing anesthesiologist, asked me, "You know, why don't dentists buffer," and as the smart dental student I came up with all sorts of reasons about why the bicarbonate couldn't get air, and we had these little carpules that, you know, you couldn't get the bicarbonate in, dentists didn't like to mix drugs and things like that. But, as I, kind of, practiced and saw more and more high fear patients, I realized that we - dentists really did need to be buffering, and we did need to, kind of, be doing things differently. So, probably around 15 years ago, I transitioned my practice into a practice where we kind of centered around buffered anesthetic and giving a better patient experience, and kind of more staying with the patients because the buffered anesthetic was allowing us to get a patient numb in two to three minutes, as opposed to say 10 to 15.
Ryan Vet: That's great. And I love how you've brought something based on your personal family experiences, your experiences in the practice, and just integrated that into what you're doing today. So again, to recap, buffering, it's mixing two anesthetics to make one more basic. So what, why even do that? What's the issue with anesthetic today?
Dan Davidian: Well, local anesthetic - it's acidic, it's very acidic. It's got a pH, or an accidity level, of about 3.9. And so, when you inject that into the body, it burns. So, clearly, just not having it burn, you know, bringing it up to physiologic pH is just going to have it be much more comfortable. But the real value in buffering your anesthetic comes from the fact that the anesthetic, when it's injected in acidic form, has to be brought up to physiologic pH by the body. And that's a very unpredictable type situation where some people's bodies just don't bring it up very quickly or don't bring it up to physiologic pH at all. So, buffering anesthetic really allows us to take the anesthetic, bring it up to physiologic pH before we put it in the patient, so it doesn't burn, but we're now not relying on the body's physiology to do that. So, you don't see the variability of some patients getting numb in five minutes, and some people take 25 minutes. And some people get not him on the first shot, and some people will take four or five shots. So, buffering the anesthetic or just taking the acid out of the anesthetic allows it just to be more predictable.
Ryan Vet: I love that. And for those of you who, who love chemistry and biology and understanding that Dr. Dan can go, go really in depth with that and talk about the PKA and the Hasselbalch equation or something, something along those lines. I was never a strong chemistry student, but in a practically speaking sense, you know, a 3.9 pH is like, what citric acid? Like lemon juice or lime juice? So, that's why a lot of times it burns, and then bringing it up not only is more comfortable for the patient, but there's some other benefits, both with time savings and efficacy and more just reliability. Could you talk about that in just a practical sense? Because every single dentists listening has had a failed block or has not been able to get that hard to non patient numb, and it impacts your schedule.
Dan Davidian: Absolutely. You know, it's funny you talk about the Henderson Hasselbalch, which is the equation you were referring to. And I always put that slide on when I teach anesthetic lectures and everyone gets kind of concerned I'm going to go into this in depth kind of chemistry, and I really don't. Like, I love to talk about it, but I don't in front of masses because a lot of people don't enjoy that. But, the basis around the Henderson Hasselbalch equation is basically, it's a logarithmic scale. And so, what people don't understand is that if you have one part of the active anesthetic that you need to work on the nerve at 3.9, at 4.9, you'll have 10 parts. And it 5.9, you're going to have a hundred parts. And at 6.9, you're gonna have a thousand parts. So, you're just basically going to have more of the act - you know, a thousand more at 6.9 than you will at 3.9 of the type of molecule that you need. So, that's the little chemistry part of that and why it works so much faster and so much better on the nerve.
There's more to it with the CO2 that's released and there's a lot that goes into it, but on a practical standpoint, it's just the fact that, you know, when I can give a block to a patient and get them numb within a couple of minutes, I can sit there, stay with the patient. I can talk with them. I can keep them comfortable. They don't get nervous because I'm there kind of consoling them without leaving the room for 10 or 15 minutes. Then, I can actually get my work done. If I'm doing a quadrant, you know, lower quadrant worth of dentistry, a lot of times I'm finishing in 25, 30 minutes, where traditionally it was taking me an hour.
So, it really allows me to practice much more efficiently. My patients really, truly do appreciate the time that you spent with them, and they really feel like you spent more time with them if you stayed with them for 25 minutes straight, than if they were there for an hour and you popped in three different times and spent cumulatively 40 minutes with them. It still feels like you spent more time in one specific block.
And you know, I've been trying to preach to dentists for years and years and years that uninterrupted work is so much more efficient, but we've built the system more around thinking we have to go check hygiene, or thinking we have to schedule three patients at a time because our anesthetic's so unpredictable, you know, we have to have something else to do while that patient's getting numb.
And so, I've been trying. For years to really help people understand that you can be more efficient by just staying with your patient.
Ryan Vet: That's great. Well, I think you probably just caught the ear of so many listeners saying that you can stay with the patient and your appointments that you used to schedule for an hour, you can get done in as little as 25 minutes, including the anesthetic time. So, so that's huge. We're going to take a quick break. And when we come back, we're going to talk about exactly how you can do that, how there's even cost saving opportunity right now in the midst of COVID area with PPE and other things. And then, Dan had an exotic pet through dental school, and so we will finish with that. We'll be right back after this break.
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And we're back to talk more about just the impacts of COVID on practices, how you can stay with your patient, how you can save money on PPE equipment and many other things. We're here with Dr. Dan Davidian, a practicing dentist, and also the founder of Anutra Medical. And Dan, I just want to ask you, obviously, all practices have been impacted to some level by, by COVID-19. And I want to ask you both personally and kind of globally, what advice do you have based on your own experiences or the experiences you've seen and what strategies can practices employ to navigate this time a little bit better, especially when it comes to being with the patient?
Dan Davidian: Yeah. I mean, we've all been trying to navigate these waters and it's been a long road because there's been a lot of guidance that's come down through the ADA, or lack of guidance, through the, the different health organizations and, you know, we've had to manage trying to get protective equipment, 'cause it's just not easy to get right now, and when to use it and how to use it, and do I take the same PPE or protective equipment from one patient to another, or do I take it all off and then go to another room, put some more back on and then take that off and - switching back and forth.
And so, that's been really difficult waters to navigate for a lot of dentists. We've been kind of lucky because for the last 15 years or so, we've been kind of much more stay-with-your-patient and be finished, so we don't have to kind of transition through all the, the protective equipment as much as a lot of other practices, because we've kind of had that established in our practice.
I have seen with Anutra, we've seen a huge insurgence of people that really are starting to understand the benefit of buffered anesthetic and staying with their patient. You know, prior to COVID, you know, we saw a lot of doctors that, you know, really embraced buffered anesthetic because it was just more comfortable experience for the patient, but they really would still go try check hygiene in between and still try to go see a bunch of patients, and still weren't changing their scheduling. Now, we're seeing a lot of doctors understand the, "OK, hey. I do have to schedule different. I can't schedule three or four operative appointments with aerosols and risk contaminating patient to patient. I need something different." So, we're seeing a lot of doctors using it to its fullest where yes, they're going to give a better patient experience and that's great, but it's really much more about now is how do we conserve PPE? Not just from a financial standpoint, we just don't know if we're going to have a shortage, so we have to have - save as much PPE and the protective equipment as we possibly can, just because we don't know what the future holds. And so, now we're seeing a lot of doctors that really do want to stay with the patient, get their work done, and then, you know, move on and not have to kind of contaminate and risk contamination of protective equipment.
Ryan Vet: Right. So you've, you've mentioned two big things. One, the idea of staying with your patient, the second you brought up the idea of cost of PPE, and I know there's cost concerns around buffered anesthetic as well, traditionally. So I, I want to address both those, but let's first talk about this idea of staying with your patient.
You know, I'm thinking here, if I were to be doing three interviews at the same time, and, you know, hopping back and forth between the interviews. While, while someone's answering a question, I wouldn't be listening to the question answered, the interview would be not as effective. It would be very - it would just be inefficient.
And yet, that's essentially how dentistry has built their schedule is, "Hey, we're going to check on this hygiene patient. We're going to then check on the other hygiene patient. Then we're going to go after, you know, we've been waiting for this person to get numb, now that they're hopefully numb and the block wasn't missed, then you know, you go through."
So, obviously the schedule is inefficient, and I just want to go back to - can we talk, before we get into the pricing and cost savings and things like that, can we talk a little bit about your average appointment times for various procedures and how that might be different or even surprising compared to what many practices do just based on, you know, the tradition and what has always been done?
Dan Davidian: Yeah. I mean, I think you hit on a few good points, Ryan, when you talk about bouncing from patient to patient and trying to schedule two or three patients at the same time, we're not going to be at our best. We're not going to be focused on what we're doing. So, it's not just the inefficiency that's created, but it's, you know, it's the mistakes that can happen when you're not 100% focused on the job in front of you.
So, you know, I always talk about one of the biggest costs for a dental practice is literally the mistakes. And so, just eliminating mistakes is huge, and one way we've really been able to eliminate the mistakes is, you know, our appointments aren't dragged out to the end. We're not usually running behind at all.
So, you know, when I get a patient numb, you know, I'll sit down and chit chat with them for a little bit, get them numb, and within a couple of minutes, I'm starting to, you know, do my work. And, and so, a lot of times a lower quadrant. I said earlier that, you know, it can take me 25 minutes to do, you know, two or three, you know, MOD or, you know, fillings on the, on a quadrant. And then, you know, we do a lot of, Saranac and same day crowds. The efficiency for that is huge as well. So, when I sit down and I numb a patient, by the time I've taken all my pre scans and everything else, I'm ready to prep the crown. Then, a lot of times I'm walking out of the room within 20 minutes, 20, 30 minutes, and that crown is being milled as well.
So a lot of time - a lot of my doctor time that used to be consumed with just waiting for the patient to get numb is, is, is now eliminated. And it allows not only myself to have a better mental space and be more relaxed because we're not running late, but it allows the assistants to truly get their chart notes right, to set up for the next patient and to really - that extra time is just incredibly valuable for limiting mistakes.
Ryan Vet: Yeah, and I do want to talk about staying with the patient again, and that the extra time. People inherently think it's less productive and less profitable to have just one patient scheduled at a time that you're staying with.
And, I would say, in any practices that fully understand the power of utilizing, essentially, and I'll say it, an instantaneous local anesthetic, it will transform your practice because the, really, schedules are built around the inefficiency of local anesthetic. So, you know, from your experience in your own practice or other practices that you know that employ buffered anesthetic, are you seeing them to be less profitable, equally profitable or more profitable, and why do you think that is?
Dan Davidian: Oh, it's far more profitable. Yeah, I can't imagine ever going back to the old system of scheduling multiple patients, multiple operative appointments. It's unfathomable to me. I mean, I can definitely schedule more, you can feel comfortable talking someone into, or not, not talking them into, but you know, recommending additional treatment during the appointment, at the beginning of the appointment.
So, a lot of the increased production comes from a couple different areas. It comes from our ability to see - to create the time so we can see more emergencies. So, it's not just, "OK, hey. I can do three fillings in 25 minutes and I'm going to schedule patients every 30 minutes instead of an hour," it's the, "Now we're not running late, so our patients are happier. If I add an emergency, I have time to see the emergency. If I add an emergency and I can get them numb. I can just go ahead and do it at that time, at that moment in time." I'm not getting pullback from my staff cause they know, you know, prior to it to, you know, buffering. I mean, sometimes my anesthetic was just so unpredictable that it could take me 30 minutes to get a patient numb or 15, 20 minutes to get a patient numb. And you know, when you're coming towards the end of the day, if you can't predictably get the patient numb, you can't add that emergency without the staff being kind of having the pullback. So, just being able to add the emergencies, being able to add a filling here or there without having this, you know, creating this turmoil in the health of the mental status of the practice is huge as well. But, you know, it is - it's dramatic. And I, I talk about a lot about, to my staff about scheduling, you know, any kind of missed moment today is going to be gone forever. So, you know, we want to maximize today's production and the today's appointments. And so, you know, we have a pretty strict policy that if someone calls with an emergency, we'll see them. And we couldn't do that in the past because we were kind of always running behind.
Ryan Vet: I think that it, mentally, like, removing that that stress is a huge - you know, knowing that they'll still be able to get home to their kid's soccer games, your team. And when you can fit in that emergency patient, I mean that, that four o'clock patient comes and, you know, the procedure is only gonna take 25 minutes maybe, but getting them numb traditionally could have taken 45 minutes or longer, especially if it's an absence to their hot tooth or something that you know is going to take longer to get numb.
So, I think that mental burden that you're alleviating from your team is absolutely incredible.
Dan Davidian: Absolutely. Absolutely.
Ryan Vet: Have you been able to do anything extra in your practice as a result of employing buffering, anything special for your team? I mean, obviously the, the mental reprieve is huge, but is there anything else you've been able to do for your team?
Dan Davidian: Well, yeah. I mean, it is much more profitable, so, you know, when the practice is more profitable, you can share, kind of, the - share the wealth in a way, in a sense. So, you know, we are able to do a fairly robust profit sharing through our 401ks. We're able to give a lot more bonuses, which are very, very helpful for the, for the staff.
And it helps keep the same staff around, which is, you know, helps to kind of keep patients happy. One of the biggest things that I've seen, and the biggest benefits is, is that intangible - we should always run 20 or 30 minutes late every day, right? So, you know, we used to always run late. And now, many days were 20, 30 minutes early on a day.
And so, you know, there's been days when we've all decided to go out and hit golf balls, just take off early and go hit golf balls or go get pedicures together, and that kind of team building - when you actually have the time to really enjoy the people around you, it's amazing how that parlays into so much more success in the practice because now that the staff's happier, they're getting paid an appropriate amount, they have extra time; patients feel that. And so patients feel that confidence, and then you sign more cases. And then, you know, as you sign more cases, the practice does better, and then, so you can reward your staff more and it's this weird - I had underestimated, really, the intangible piece of it, where you know, I thought it was going to be much more about the efficiency of just that single patient in front of me, but it really boils over into so many different aspects of why it, it just it's, it's almost exponential, when you start creating more time in your life, how much other - how many other things kind of fall in place.
Ryan Vet: Yeah. That's, that's amazing. And now I feel silly even asking you about the cost of it, because it seems like it, it shouldn't matter. I mean, that's almost a priceless - buffering seems like a priceless resource that every practice should have, but reality is most people are price conscious. And especially now in COVID, with uncertainty and increased PPE costs and other things.
So, price is a big deal. And a lot of people say, "Oh, this is going to cost me more per patient," or they have other concerns with disposables or whatever it might be. If they just heard the last three minutes, they shouldn't be asking that question. But, I know someone right now listening probably is. So, could you talk a little bit about costs about whether or not it costs more? If it does cost more, what's the return on that? And things like that.
Dan Davidian: Yeah. Yeah, absolutely. So it's, it's a little bit more. It's about a dollar and - maybe a dollar, dollar and a half more per injection, per se. But, when you actually look at it at a holistic basis, on a yearly basis, because on a maxillary tooth, I'm using about a half mil to a mil per tooth.
Ryan Vet: So let's put that in a carpule standpoint. What is that in a carpule?
Dan Davidian: A little bit more than a quarter carpule to a half carpule for an upper tooth, and then, for a lower probably two to three mils, which is maybe a carpule to a carpule and a half. And so, the difference that you really see with cost is that you're using a lot less anesthetic, and you only draw what you need, so you're not wasting a lot. So, if I want to draw a mil, I just draw a mil. If I want to draw two mils, I just draw two mils. When you look at - throughout the year, I actually just use less anesthetic, so the cost isn't really there. And when you start layering in the fact that, you know, I used to have to have a lot of bailout shots and gosh, you know, there was a period before we buffered that I would use Citanest plain to keep the burnout.
I'd take a carpule that and inject that in, and then I inject, you know, lidacaine in there to get them numb, so I was two carps in. And sometimes that wouldn't work and I was a third carp in almost all the time. And so, when you look at just the volume of anesthetic and the amount of shots that I used to give, it was just so much more.
So on a standpoint, financially, it's a neutral decision, in general, when you look at a yearly cost, not a per shot cost. But then, once you start really factoring in the other components of it, which are the intangibles, and now with the PPE and the protective equipment, the protective equipment alone for some of these dental practices, I mean, it's, I mean, people are estimating anywhere from $10 to $20 per patient.
And so, you know, being able to save any protective equipment at all is huge. And, you know, I used to use this argument a lot with - before the protective equipment - is that, you know, we'll use a $20 endo file and not even think twice about it, we'll use a dollar and a half Isolite or optragate and not think twice about it because it makes our lives easier. I challenge anyone that - if you look at your daily practice when you're not buffering your anesthetic, the most stressful times in our practices were when you had failed in anesthesia and the patient wasn't numb, and you had a patient in the other room that wasn't numb and you just needed someone numb and hygiene's buzzing you and you've got - you're running around like crazy. And so, just having someone numb is important. And if you look at my worst days, it's usually were due to failed anesthesia.
Ryan Vet: Hmm. Well, I love how you've talked about now that patient comfort is, is so much higher. Your team's mental stability, which obviously impacts your, your ability to, to lead well, lead the team well is just in such a better place. And then, obviously, your efficiency can add patients or at least reduce waste from having to discard PPE equipment multiple times. So, I love all of those things. Now, I did promise the listeners a fun fact at the beginning of this, and I know you, you have tons of fun facts.
That's one of the things that I love about you. Every time we meet, I found out something crazy about you, but I still think that the most interesting one was what you brought to dental school. Every day.
Dan Davidian: So, back in dental school, my - I was, I was dating my wife, currently now, and she - for her birthday, I bought her a, a Wallaby, which is like a little miniature kangaroo.
And so, when you get a Wallaby as a baby, you pull them from the pouch a month early and have to bottle feed them. And so this, this Wallaby had to be bottle fed every three hours. So, I would have to bring her to school. So, I would bring her to school with me in a backpack, and she would sit in my backpack all day, like, like a pouch so I could feed her every three hours. And so, she would sit beside me in lecture and in the backpack, and she was a quiet little thing, and so she'd sit beside me during my lectures. And the unfortunate thing about bottle fed wallabies is they do, they are fairly gassy. And so, I think everyone thought I was the stinky kid, but she would go around with me and, you know, even - I don't know if I should admit this - but even when I had clinic, I could, we had a very strict person who we used to check out all the instruments from and everything else, and, you know, she was always, you know, a very hard nut to crack kind of thing. But even her, she would, she babysit my Wallaby while I, while I went to clinic and so, it was a, a really fun journey.
Ryan Vet: I love that story. I think that's hilarious. I did not believe you the first time I heard it and, but the story gets me every time, so I appreciate you sharing that. Well, Dan, I really appreciate your time on the show today. Do you have any closing thoughts, and how can people get in touch with you and talk to you about anything in their practice or get in touch with Anutra?
Dan Davidian: Well, I mean, obviously the easiest way is to go to the website and anutramedical.com, and people can reach out to me personally. I do love to talk dentistry. I love to talk science, and I love to talk about, you know, how, you know, my practice has transformed. So, you know, they can contact me directly.
I mean, my email is dan@davidian.me, and I'm fine if someone wants to reach out and just kinda say hi. But the best way to get, you know, Anutra, you know, as a product is just go to the website and give them a contact. And we're doing virtual training now where we can do most of the training, or all of the training, virtually. So, it's not a lot of training, but we do like to walk a doctor through in the beginning on just how to set everything up and make sure they have a really smooth experience.
Ryan Vet: I love it. Well, Dan, thank you so much for your time. And listeners, thank you so much for listening to another episode of The Dental Experience podcast.
Please, if you liked this episode, share it with a friend, share it with a colleague that might benefit from buffering in their practice. And if you have a minute, we strive for five here at the podcast, and we'd love for you to write us a review. Thank you so much.
Voiceover: Thank you for listening to The Dental Experience podcast. For show notes, to ask a question or for more information, visit www.thedentalpodcast.com. The ideas discussed during this episode are the opinions of the participants and do not serve as legal, financial, or clinical advice until next time, this is The Dental Experience podcast.