American Dental Association President, Dr Brett Kessler Pulp Podcast Ep 5

And I, I made a call to the Michigan Dental Association well-being program to ask for help. And I attribute that phone call to the beginning of my recovery and what ultimately saved my life.

Love, I love being a dentist. I love it. Absolutely love it. I'm so proud of the work that I've done. I'm so grateful for the relationships I have with my patients.

DSL model also works very well for many women. Where, unlike most men, women will have a life. You know, they'll have kids and stuff. So having a situation where they can work two and a half, three days a week. I have to really, you know, invest in myself in all ways. And if I, you know, physical, mental, emotional, spiritual, social, all those buckets for me. We're going to get you on the Huberman podcast. So Dr. Huberman, if you're listening, Dr. K, ready for you. Andrew, I'm a huge fan. I listen to every single one of yours and I get mad at the oral health stuff that you're putting out. I'd love to be. We knew you were an endurance athlete, but this is next-level stamina. I think this is an ultramarathon, guys.

Welcome to the Paul Podcast, where we talk about all things dentistry and non-dentistry from a generational perspective. I'm joined today by my co-hosts, Dr. Anne Cotch, who's joining us remotely, and Dr. Para Shahiti, who's uh here in the studio. And we have a very special guest again. We've been very lucky, Para. Back-to-back, we've had the president of the American Association of Endodontists, and now we have the president of the American Dental Association. So why don't you go ahead and introduce our special guest?

Well, we're so lucky, Dr. Kesler, to be joined by you. I mean, you don't really require an introduction, but, um, if you don't mind, uh, I know you're modest. I'll introduce you. Dr. uh, Brett Kesler is, of course, the president of the American Dental Association from the 14th District and the past president of the Colorado Dental Association. He's an amazing human being, really a visionary. He's a catalyst, a seeker, a writer, a leader, a mentor, and an adventurer. He's an endurance athlete. Speaking of the Boston Marathon here this weekend, he participated in two Ironman uh, world championships in Hawaii. Oh my god, that's incredible. And of course, he is the leader of our uh, national organization for all things dentistry. Um, and so we're so lucky to have you, Dr. Kesler. Please welcome.

Thanks for having me, everybody. It's awesome to be here. It's an early Saturday morning in Denver, Colorado. And, uh, gosh, we got some snow this uh, last night. And I'm going to try and go skiing tomorrow for a final day.

Nice. So being Jewish, Easter doesn't mean much to me.

No, just kidding. That's fine. That's fine. That's a good one. Yeah.

So Andy, why don't you go ahead and ask the first, uh, first question?

Well, I think the first question we were kind of talking about this before, uh, is this, with all these changes coming down the pipeline here in terms of funding, uh, and certainly affecting schools, how is that leeching out into affecting the administration of daily policies with the ADA?

Yeah, we are in a very volatile political environment right now. And, uh, you know, everything is being challenged. Um, the norms, which is not necessarily a bad thing, but, but, you know, when you challenge true science, uh, that, that is a concern to me. It's a concern to the American Dental Association. Two of our core values are science and evidence-based. And, uh, when, when there's a threat to that, we have to act. And, um, so, you know, there, there's a threat to lose NIH funding. There's a threat to lose NIDCR to be folded into, you know, the head department. And, and that, that's really going to, um, affect the funding not only for us at the American Dental Association but for pretty much every single university and every single dental school. We, uh, you know, merged with the foresight institute a few years ago. And, um, so it's now called AHI, ADA Foresight Institute. And, um, we've got a lot of, uh, of grants through, through the government that, that are doing research. And, um, so we are looking at alternate opportunities. And, um, you know, but what, what concerns me about that loss of funding is it's going to, we're going to lose progress. We're going to lose progress in innovation. And, you know, we need, we need innovation right now to drive dentistry forward.

I'm just going to talk about a bunch of things, if that's okay, tying this all together. Um, through our Health Policy Institute, we know that the dental field, we are the profession, we are at 90% capacity. And so if, if we were to get, let's say, a, a big boost in, in government funding for access to improve access, we wouldn't have any capacity to, to, to see more patients. Really, a very modest amount. And so technology is going to be a big driver, uh, for efficiency and efficacy. And if we're not pushing and, and progressing the new materials, new techniques, new delivery methods, we're going to be kind of stuck.

Just to follow up in terms of the schools, I've heard a couple of schools talking about under consideration of increasing that class size, you know, like every post-doctoral program take one more resident, take another 12, 15 students on the undergraduate level. Is this something that's kind of actively being discussed among the schools?

This has been going on for the last 8 to 10 years, actually. Okay. Um, but many, um, I've seen, you know, expansion in the, in the dental schools, um, but, but many dental schools are at capacity already. And CODA requirements of, of, of for accreditation, you have to have a certain amount of faculty, um, and, and number of patients to, uh, to be accredited. And we have a faculty shortage too. And so we, we are limited by that. But we are seeing growth. And that's why we're seeing, you know, several new dental schools open up as well.

Absolutely. So Dr. Kesler, um, you know, one of our, one of our philosophies here, I think, at the Paul podcast is to really look at things in all directions, at both, in both angles. And I think probably the single hottest topic in dentistry, um, and across even medicine maybe right now, is this, uh, the elephant in the room is is fluoride. And we are lucky to have you share your insights, but I, I want to play the role a little bit of of devil's advocate for those listening who may have a different opinion than probably most of us here. In, in the early 1900s, uh, Frederick, Dr. Frederick McKay and G.V. Black blessed us with the advent of fluoride in dentistry. And, uh, later, 40, 50 years later, in Michigan, they saw the implementation of it. And now fast forward to last week, uh, you know, you spoke about what happened in Utah becoming the first state to ban fluoride in public drink, in, you know, public water. Miami-Dade County just voted against it on Tuesday. And, uh, now more and more states are thinking about actually banning public community-wide, um, water fluoridation.

Let me just interrupt there. The, the beauty of the work we're doing to advocate is the Miami-Dade, Miami, Florida, Dade County, um, their city council voted to remove the fluoride, but the mayor said, "Hey, this is not going with true science," and she vetoed it. So, it got saved.

Interesting. Interesting. So, we're really excited about that. Um, but, but, but the, but community water, uh, fluoridation in Florida is in jeopardy because of Governor DeSantis. He wants to get rid of it. Yeah. So, so I guess the, the, uh, point or question we'll, we'll go to you on and to hear your perspective is, why don't you tell us your stance on fluoride, especially from the ADA's perspective, and maybe get ahead of some of these, um, these comments against fluoride in our community water, and how you guys are trying to combat that or understand it?

Yeah. So there's been a, a, a growing anti-fluoride movement for several decades. And, um, you know, and I consider it, you know, pseudoscience or junk science. Uh, the studies that show that it's, uh, it's dangerous are not applicable to what we have with community water fluoridation here in America. Most of them are, uh, first of all, they're not well-designed studies, and the fluoride levels are much, much higher, two to three times higher than what we have here. And too much of anything is a bad thing, of course. Um, what we have here in America is over 70-plus years of a successful modality to help reduce cavities in our populations. As I said before, you know, ADA, two of our core values are science and evidence-based. And, you know, maybe 10 years ago, so the EPA recommended to lower the, the water levels, the fluoride levels in the water, because of multiple sources of fluoride that our patients are getting. And, uh, and, you know, we saw the science, and we absolutely agreed with that. And, you know, uh, seven parts per million is where, uh, we think it should be, and science proves that. Um, the problem right now, though, is that people are challenging science, um, and, and not believing in science.

What a well-executed public health initiative does is, you don't know it's doing it. It flies under the radar. My parents' generation saw polio. They saw the iron lungs. They saw the deaths. They saw measles. They saw the deaths. And so today, we don't see those. So because we don't see them, people are like, "Well, why do we need this vaccine?" Um, you know, it, it doesn't, it's not applicable anymore. But it's not applicable because it's working. Fluoride is working, and it has little to no side effects, uh, at the levels that it's at. And we've got, you know, 70-plus years in the field of, of, of proof of that. So, I'm starting to shift my narrative. So, we've, we've done all these press statements, and I'm getting more and more angry at the, at the challenge of science. If you can read my, my press releases, and, um, and I'm getting quoted, and our reach in, in the media has been in the billions. We've been quoted in the, you know, where people have seen the ADA stance on this in the billions. Okay. So many, you know, and, and not just in America, across the world. We're, we're definitely, you know, getting the reach. But, you know, I don't think we're going to win this battle in several states just because of, and, and I, I respect this, a libertarian type of mindset, you know, "Well, I should have my choice of what I get, what I don't get." And that's fine and dandy if you can afford that, you know, but, but what we're going to see if the fluoride goes away, according to science, we're going to see a 25-plus percent increase in cavities, especially in kids of lower income socioeconomic demographics. They have no choice. The arguments of, "Well, they can just use fluoride toothpaste." Absolutely, but many of them can't even afford that. And many of them don't brush their teeth, and many of them are eating poor diets. And so I'm starting to shift the narrative to, uh, to RFK Jr., quit vilifying dentistry. We are putting, you know, recommending fluoride in the water to help mitigate a problem caused by sugar, caused by ultra-processed foods. If you didn't have this diet problem, we wouldn't need, we wouldn't have a cavity problem, and we wouldn't need fluoride. Quit vilifying us for trying to help the problems that you all are creating. Okay? We'll stand with you against big food and the sugar consumption and the ultra-processed food industry. We will stand with you on that, but quit vilifying us. We're trying to fix it. On the other end, Medicaid is being challenged with a big, big cut potential. And so we're creating a problem over here that in two years, there's going to be no resources to fix. It's absolutely insane to me. Yes. Absolutely. You know, people don't want to use fluoride. That's great. Don't use fluoride. You know, increase your dedication, you know, better brush, better floss, use your holistic methods. There are some tried and true products out there that do work. Um, but as long as you're eating sugar, you are going to be vulnerable to cavities.

So that's, that's really an interesting point, Dr. Kesler, because to me, it seems like the incentives, if dentists were being selfish and they wanted to purely just, you know, get more, uh, cases, they would be against fluoride because fluoride is something that helps reduce the cavity. So this, in this case, it's a pretty clear public good that we're advocating for. But I also like what you said in terms of the sugar, cuz the sugar consumption is the one thing that keeps getting shoved under the carpet. People are vilifying, uh, fluoride, but then completely embracing sugar, which is the actual real cause of the problem.

So, to, what is, you know, I mean, from a public health point of view and access to care and all of these things, it seems to me like a campaign that's driven to talk about the cause of cavities, which is sugar, would be more even more helpful than just manipulating the fluoride level, right? Is there, is there anything like that, you know, such as like a taxing sugar at the highest level of just pure sugar entry into the thing, not specific companies, but just the sugar, and then using that money the same way we did for smoking to then run an, uh, educational campaign? Is that, is the ADA doing anything like that?

Absolutely. And, you know, we created a sugar task force a few years ago under Dr. George Shepley. These are the kind of things that we're addressing. And we have members of the medical field, um, as part of this task force, and we're developing advocacy narratives to start going, you know, to bringing this, uh, you know, above the line in our conversations. There are tried and true public outreach programs where, where the taxes are raised, the consumption goes down. We saw it in smoking. We saw it in some municipalities where they taxed, uh, the sodas. Consumption went down as a result of higher, of higher taxes. And that's how we're going to have to do it. That's one strategy. But follow the, the money, right? Big food industry is 10 times that of, of, of big tobacco. And, you know, we're going to be fighting a large lobby. And I think that they're going after dentistry because fluoride is a low-hanging fruit, and we're not as strong as big food. But, but, but look at the chronic illnesses that are in our society as a result of our, of our diets. Okay? And, and many countries in Europe have have banned a lot of the ultra-processed foods and poison-type of foods that that are creating the problems here in America. Imagine the money we would save if we cure diabetes. Okay, it's crazy. Absolutely crazy. So, you know, we, we in dentistry are are part of the delivery of, of health in America and, across the world. Oral health is health. And I think it's time for us to start, you know, advocating along that line.

I, I've got a question. I don't know if there's an answer to it. And that is, how do you combat the plethora of misinformation on the internet? And it has kind of like a mean-spiritedness to it. I mean, I'm over 75, so it's kind of a different generation. That's what the podcast is, three generations. So for me, you can disagree. Just don't disagree to be disagreeable. But the stuff has an edge to it, but it's misinformation. How do you combat that?

You know, all we can do is keep shouting from the rooftops, you know, everything that we know is right. Right. And I don't know if you've ever gotten into an an argument on Facebook. You never win. I never win. I, I stay away from those those toxic conversations because you can't, you know, type your way out of a feeding frenzy. Um, and so we, you know, we're, we're trying to, if they go low, we go high. And we're just trying to, you know, stand for, for the truth, stand for true science. And because we're an evidence-based organization, if, if the evidence shows something different, let's, let's change it. Absolutely. And we're calling on RFK Jr. to help us fund a study to prove the efficacy of fluoride. Um, I know you want to talk about one quick thing. You know, Utah, we lost it in Utah. And, you know, and Governor Cox, he waited like three or four weeks before he signed the bill. I thought we were going to get him to veto it. I kept writing him in letters and, and, you know, there was, we're holding out that he would change it, but he caved and and went towards the, you know, towards the dark side, per se. Um, but, but we have people in place right now setting up baseline studies to to look at, you know, what, you know, the, what's the level of fluoride in the water, what is the caries rates among different demographics. We want, we need baselines right now, and they're ready to count and they're ready to watch over time to see the efficacy and see the effect of that.

I, I just want to, I want to talk about this whole point of evidence-based because I think we talked about the root cause, which is sugar. I think you're trying to maybe talk directly to the, to the folks maybe coming against fluoride, right? The RFK Juniors of the world, the Gary Breakers of the world, and to some extent the Dr. Hubermans of the world who are, um, you know, talking about this pretty prevalently. So it'd be it would be interesting to play the role that put on their hat for a second and talk directly to you as a leader of our organization. Some of those folks talk about sort of this idea of choice. And you, you talked about how it's great to have a choice with fluoride, um, if you have the access and the means to do things that can, you know, compensate for the, for non-communitywide fluoridation. So toothpaste, food. And people talk about fluoride as a neurotoxin. And I think most things, right, and at a high level, are probably neurotoxic. So I, I guess that argument goes away. But in 2024, right, in October 2024, Cochrane did their study. And a lot of these folks who talk against fluoride refer to this study. And the study, just for context for our viewers, talks about, um, before 1975, in 5,78 children, um, that had been the recipient of communitywide fluoridation in in immature teeth, um, on average had a, you know, reduction in two or so cavities or caries per individual. And then after 1975, uh, about 2,98 children, um, were in that study in across the UK and Australia. And there was a reduction in 0.24. So about a quarter cavity per individual. So per baby tooth. And so they point to this study and they say, "Look at the effect that fluoride is having in our dentition. It's only a quarter cavity per individual." So they say, "Why would we have this neurotoxin in our body in a communitywide systemic way if we necessarily don't see significant, um, reduction in our disease model based on that?"

Yeah. So, um, that, that's a, I think the only study in the Cochrane review that was worth anything, if you ask me. Um, but it, it did prove that, uh, that we know this, that, that there are multiple sources of fluoride now that we're getting, you know, we're getting in toothpaste, we're getting it in, uh, bottled water and milk, etc. And, um, but not everybody has access to that. I, I'm just, it's the bottom line, you know, and that's, you know, those, those communities are different than than in America. Until we see it here in our communities with our lifestyles and our, you know, tracking our habits, I don't believe that study applies here. Look at Calgary, Canada, okay? When they lost their cav, they lost their fluoride, they immediately went up 25% immediately. And Canada is much more congruent with American lifestyles, um, than, than the UK and, and Australia. So, um, you know, one small study in the Cochrane Review really said it was tough for them to find any new studies. Those were all old studies. And, um, you know, and so it, it really wasn't applicable to, to our communities.

Makes sense. I, I, I guess, I mean, I, I'm curious to to see what, what you guys think. I mean, Dr. Nasa, we, we sort of talked about this, and you, you mentioned this really good point about sometimes how if there's one counterpoint against an argument, it's easier to go and shout that from the rooftops, as Dr. Dr. Kesler says, because, um, one, one thing that spreads negatively across the media and all of our social channels can be so tough to combat. I, I wonder, I mean, what's your take on, on the fluoride situation we have?

It's, it's a, as put it best, it, uh, it is a challenging situation because you're trying to weigh out a couple of different things. There's no question that fluoride changing hydroxyapatite and enamel to fluorapatite makes the enamel more resistant to caries, right? So it has a net good effect in terms of preventing caries. Sure. I think the big picture of it will have to be kind of weighted out in terms of figuring out whether the idea of a kind of a mass fluoridation in an environment in which you have alternative modes of providing fluoride to those people who want it. On one level, it's kind of an ethical question of, so if somebody doesn't want it, they have to have it, you know, it's a question of choice. But as Dr. Kesler said, it best, is like, you know, you have vulnerable communities that don't get to exercise that choice, and they're going to have to be taken care of. Um, on some other level, then you have to look at it as well, if some people are going to avoid to drink tap water because of the fact that it has fluoride in it for those reasons, then is a net effect of now having more plastics as a result of plastic bottles being, and all of the energy and the environmental cost of having all of that other energy put into the water? How's that playing out as a total harm situation? Right? I mean, nobody, I don't think anybody has the answers because there's so much information missing from the big picture of all of this stuff. But what we know as dentists is what basically Dr. Kesler said is that, uh, you know, there is a known, you know, improvement in the caries, uh, score once you apply fluoride. So whether there is enough already in the environment for all people, or because of the fact that some communities don't have access to it, does it justify that all people get it at the risk of then some people moving away from tap water as an inexpensive source of water and then have to go through all of these other additional expenses and potential environmental issues? I don't know. I just, that's essentially where the debate lies, I think. Don't you think Kesler is that that were?

Yeah. And, and, you know, people can use reverse osmosis filters in their, in their home if they want to remove it from their tap water. Um, again, another part of that study, you know, there's so many other variables in people's lives versus, you know, than just fluoride or no fluoride. Okay, there's, you know, so many other variables, and it's, how do you check it? Um, how do you test that? Public health has great, uh, you know, studies and study designs that that can prove, you know, the efficacy of this, and we've got 70-plus years again of, of efficacy. And again, you know, we saw that it was too much, and, uh, but we need to show studies here in America to decide in America if we should lower it or remove it. Absolutely, if that's the case, we should.

Annie, yeah, I have a question. Thanks for recognizing me over here. She's been trying to jump in. As exactly, I've been holding it. You, you know me too well. You know, one of the things with with the price of dental sealants and more importantly, the lack of access to dental sealants for marginalized communities, has there been any outreach to insurance companies? Because this would be a thing where you would think insurance companies would have an interest in this because at the end of the day, it makes them more profitable. These people are not having, you know, a ton of carries, right?

Well, look at, okay, let's talk about there's an economy attached to a tooth when you have that first filling. Okay, so that first filling, you know, my parents' generation again, they had fillings in every single back tooth. And so one small filling turns into a bigger filling over time, which turns into a bigger filling, which turns, you know, eventually cracks the tooth and it needs a crown, then maybe needs a root canal, then maybe needs a new crown, then then the root cracks and an implant, and then another crown. There's a whole economy attached to that first filling or, and, and dooming that person to a lifetime. Okay. And so lifetime of dental problems attached to that tooth. And so, you know, there, you know, so, so sealants, the ultimate, uh, you know, fluoride and sealants are the ultimate preventative strategies in dentistry. We're trying to put ourselves out of business, right? You know, we're being vilified for it. So dental insurance plans absolutely pay for sealants, and it's one of the quality measures that we can, we can measure, especially in kids, you know, as best practices, um, especially in the marginalized communities. There are alternate, like materials out there and modalities. So I speak about this a lot, um, Curodont. I don't know if you've heard of that, but it's a, it's a remineralizing, it regrows the enamel in the teeth, okay? And some insurance plans are paying for Curodont procedures at the same level as a one-surface filling.

That's exactly what I'm talking about. Right. Yeah. And, and so I'm going to, you know, take this out to the technology again. Yes. AI, which is really starting to grow in the radiographic world, uh, in dentistry, the radiographic part of dentistry. And, you know, in my eyes, I can see 12 shades of gray. Um, but AI can be programmed to see 156 shades of gray. And so what if you see a defect through, you know, that's that's detected in AI at the earliest possible stage, and you paint Curodont or paint hydroxyapatite on there, and it remineralizes, and you never have to have that drill touch the tooth, and it avoids that first small filling, right? And, and so, yeah, and so, so Medicare, Medicaid programs are starting to to pay Curodont as a one-surface filling, which is, you know, again, profitable for the dentist and best interest of our patients.

Are you getting any buy-in from pediatricians?

Pediatricians stand with us. Yeah, on this. They should, absolutely, on this. In fact, well, the AAPD, the pediatric dentistry, uh, and, uh, Scott Smith, president of AAPD, and myself, we co-wrote an article that will be published in JAMA, Journal of American Medical Association, uh, next month. I just, I just, uh, submitted it, uh, yesterday. So, um, and, and pediatricians stand with us on, on community fluoride because they see it.

So Dr. Kesler, having talked about all this, um, all these nuances in fluoride, I, I'd love to hear your message to the RFK administration, the Trump administration on fluoride. What can you say to the administration?

First of all, that fluoride works. We've got 70-plus years in the field that demonstrates that it reduces the amount of cavities in all populations, but especially among kids. Um, and it's got little to no side effects. Absolutely none. Okay? It is safe. It's been safe and, uh, and it, it, it needs to remain in the water. Quit vilifying dentistry for trying to mitigate a problem that's caused by sugar. Go after sugar. Go after ultra-processed foods. They're the ones that are causing this problem. We're just trying to help. Thank you.

That's, uh, well, that's for sure. I mean, it's funny. My, you know, my toxicology professor in school used to say, "Nothing is a poison, and everything is a poison." This fear about, like, it has to do with the dose, right? So, I mean, all the question here is that we've already had a reduction in the dose of fluoride in the water, as you mentioned, it went from what was it, 1.3 to, uh, um, 0.7. Yeah. So it is, we've had that reduction. It's historically been been safe. And this, once a fear is driven through a misinformation campaign, as Annie was saying, online, then it catches a certain catalytic chain of reactions that kind of leads to a hysteria around it. So, I mean, it's funny because if you think about it, chlorine, which we put in our water as well for disinfection, as well as in our pool water when we go swimming, you know, chlorine gas is also a poison, literally, right? Right. But it's, or, or iodine in the salt. Why, you know, why isn't anyone going after iodine in the salt? Okay, that's forced medication. I'm not sure, you know, and that's, that seems to be safe right now, which is it's a great thing. It helps, you know, helps our thyroid, you know, uh, um, health and and keeps us overall healthy. But, but why it's the same argument. Sure.

Well, from the Paul podcast, and next, you're you're going to go. We're going to get you on the Huberman podcast. So Dr. Huberman, if you're listening, Dr. K, ready for you. We, Andrew, I'm a huge fan. I listen to every single one of yours and I get mad at the oral health stuff that you're putting out. I'd love to be to meet him and, uh, he's a huge, uh, influence on me and, uh, yeah, that's great to hear.

So, so we've talked about this, this topic of fluoride, and, and I think a big thing that, that you guys are doing at the ADA, and we've been talking about this, uh, internally a lot with Dr. Nasa, Dr. Cotch, um, is, you know, you put out the editorial regarding, um, the state of dental insurance. And we would love to dive a little bit deeper and have you sort of break down where you think, um, especially with the Medicaid Advantage program that's coming, that you talk about in that, in the, uh, piece you put out, um, break down from a top-down perspective, uh, kindly, Dr. Kesler, the state of dental insurance, um, as a whole.

Okay, there. So I'm going to talk about private insurance and public insurance. Private benefits and public benefits. So the advocacy work that we're doing around the private, let's start there. This is what, uh, is on every single private practitioner's mind every hour of every day they see patients. We all take it, and we all hate it. Okay? And it, and, and but yet we all take it for, for, you know, I'm 30 years into practice now, and, and, and the bottom line is we all did really well with it. We did really well. We hated it, but we took it, and we did well. We have great lives. We have great salaries. We've got houses. We got vacations. All that, but we hated it. The dental benefit industry is a completely unregulated industry. They've been able to do whatever the heck they wanted. Um, when the Affordable Care Act came out in the Obama administration, they left adult dental benefits off. They put kids in as, as an essential benefit, and, uh, and, and around that, they, they created regulations around the insurance industry. Dentist, dental benefits, you know, stayed, uh, stayed independent of that. We were very happy about that at the time, but I think we missed an opportunity. Um, so, so we're trying to change the, the, put some regulations and constraints on the dental benefit plan to make it better for our patients, because we all know it doesn't, uh, really do anything comprehensively. And, um, and so the, the, the standard plan, $1,500 max, 100% for preventative, 80% for minor dental procedures, 50% for major dental procedures, uh, is, is what we see. Less than 6% of people with a $1,500 max ever reach their max. And this is a stat that comes from the National Association of Dental Plans. It comes from their own industry, and it's year after year after year. The plan design, the plan is designed to not work, to not be utilized. We, as a profession, are not very good at at illustrating the value to our patients, especially when it gets to the high dollar restorative, major dental, dental work. And patients, you know, when it gets to a certain threshold, they keep the money in their pocket. They don't want to pay that high co-pay, and they go away, or they, they delay it until the following year when the insurance resets itself. So, less than 6%, 94% of the people don't get to maximize that that $1,500 max. Okay? And so, so we're pushing dental loss ratio across the country, trying to get some kind of laws around that. Dental loss ratio is basically, um, it was defined in the Affordable Care Act. It's, it's how much of the premiums they're collecting is going towards actual care, dental care. And, you know, we think 80, 85% is the, is, is what we'd love to see. That 85% of the premiums should actually go to dental care. Um, the first state that, uh, that passed the transparency law was about, uh, was in California about 12 years ago, and all they did was want reporting. And, you know, and we, they found that there were several, uh, benefit plans that were in the 80 to 85 percentile range, you know, felt like they were good players, but there were several in the 20 to 25% range where 25% of the premiums were actually going towards dental care. The other 75% was going towards administrative costs and, you know, is what they would hide behind. But the insurance commissioner said, "Hey, bad players, get out. Clean up or get out." And they did. And, so if we can get some kind of DLR law passed around the country, and there's 50 states with 50 insurance, uh, acts that have to be, uh, addressed. Um, you know, we hope to see increased utilization because if they don't meet those thresholds, they'll have to give money back. And we all know the insurance company, the insurance industries, the last thing they like to do is give money out. So, so if they're truly to, you know, uh, you know, dedicated to their mission of helping the communities, they want to improve utilization. So, let's get that passed first. Second thing passed that I think needs to be changed is the 100%, 80%, 50% model. When it gets to the 50%, utilization goes way down. We want to shift it to 100, 80, 80. Okay? Okay, because we've done some modeling at the ADA. If the, if the, the percentile went from 50 to 80%, the co-pay of 20% utilization would go way up, and then go after that cap. That cap is absolutely ridiculous. Insurance, the definition of insurance is to guard us against catastrophic loss. That is not an insurance plan when you have a $1,500 max. Okay? And so we, we want to see, uh, it go away because oral health is health. We know that by improving the state of the oral cavity, we can improve the overall health of our patients. And we need to reconnect the mouth to the body with the systems. And, uh, so to remove that cap, like in medicine, we, we will create a huge impact in the communities we're serving. And so that's the, the, the long plan. Now, it doesn't happen overnight. It's taking us, you know, 12 years now. We're in the DLR advocacy world, and it's just starting to to catch on, and we got several states that either have passed or have bills in place right now. It's going to take a decade for this to happen. Okay. And, and there's nothing quick that we can do about this. So, okay. So, how do we make it go faster? We've taken, we take Delta Dental to court in a class action lawsuit that we filed in 2019, six years ago, to stop their monopolistic practices. Okay? Because we, we got fed up. Whatever. There was a couple entities that did. We jumped on this class action lawsuit. Six years in, we still have no, it hasn't been heard. We're all in discovery. It moves really slowly. Um, at the federal level, we have, uh, an ERISA potential law that we're, uh, we're putting into place that hopefully will get introduced next week. And, uh, so we do all these things about, you know, creating regulations at the state level. If the plan is administered federally, they can bypass all the state rules that we're putting in. And so this ERISA law will close those loopholes and make them play along the lines of the state laws. Okay? And that's hopefully going to get introduced, like I said, next week, and that'll hopefully change some things. We also have a letter, an amicus brief that we sent to the Supreme Court, the US Supreme Court, challenging some previous rulings on Amicus laws, because we've had, uh, federal courts who said, "Yes, ERISA plans must abide by the state laws." And we've had rulings that say it doesn't have to abide by the state insurance regulations. And so, who can fix that? We're challenging the Supreme Court to make a ruling on that. We think we've got a pretty good chance to get that heard. So, you know, we're doing it in the, you know, in, in the legislative area. We're doing it by trying to sue them, and we're doing it judicial and trying to change, uh, through the, through the courts, okay? It's a slow process, and there, there's no way to accelerate, but, but every day we're working hard on that. It's just slow, and please be patient, but we need everybody on board, and we need everybody's voice to help push that forward.

Moving over to the public side, you know, as I said before, Medicaid funding is being challenged right now, and Medicaid is that benefits for poor people. So, if we lose that, it's going to be a problem. But, we've had some amazing wins in the Medicaid space over the last several years in different states. Um, I'll just talk about Colorado because that's where I'm from. Um, we have a great relationship with our legislature, and our fee reimbursements are paid at the 100th percentile on the ADA fee schedule. We're getting full fee for Medicaid. Full fee. So, we go back to the private insurance plan and say, "Hey, you're not even paying Medicaid fees. Pick up your game." Okay. And we're seeing improvements of that much quicker than the way we've been doing it through the private, you know, trying to regulate the private. And, uh, so we're, we're seeing that. We saw it in, in Ohio. We saw it in Michigan and several other states around the country. If we boost the public, we get a, a boost in the private, too. And so, um, you know, and we, as a profession, if we are to remain a profession, we must find ways for our communities to access care. That's part of what it means. And that's our social contract with the, with the community as, as professionals. Okay. And we know less than 50% of Americans go to the dentist. Okay. And so we need to find access for those other 50%, and many of it is because of the financial reasons and financial constraints. So we need to find, you know, a way to boost the public side as well. So we are working like crazy to, to, to make it better so that people can access care, whether it's in the public realm or the private realm, and that no matter what, uh, benefit plan we are advocating for, we must be paid a fair fee. We must have minimal administrative burden. We must, uh, have a, uh, patients to be afforded the opportunity to have comprehensive care, like in medicine. Minimal chance of, uh, of, of auditing, you know, no guilty until proven innocent kind of thing. And, you know, patients can have choice, and, and that's what we're advocating for in every realm. We, we are, are, are talking about this.

That's awesome. We knew you were an endurance athlete, but this is next-level stamina. I think this is an ultramarathon, guys. This is a 100-mile race. Holy cow. That is terrific.

It is an ultramarathon. But the problem is though, you know, this is an infinite game. This is a long game. Unfortunately, we live in a, in a world that demands, you know, uh, you know, constant wins, and we're not going to get constant and quick wins here. You know, we need patience, and we need consistency, and we need resiliency, and, and, and, and a unification of our message from all. And what I love, uh, that that's going on right now is that all the specialties and all the heritage affiliation groups and everything, we're all talking together. We're all listening to each other, and we're coming forward with unified messaging because that's what's necessary. If we don't, the insurance industry is going to drive this, and that is going to be a crime to humanity, as far as I'm concerned.

Yeah, those are great, great points, especially on the insurance side. It's funny because we call it dental insurance, but it's really not insurance. It's just a benefit because, as we were talking about, a $1,500 cap, which hasn't changed since the early '70s, right? Where it's been like 600% inflation since, since, uh, the early '70s, that's not really insurance. And to hear that it's actually not being utilized even in many of the cases, and insurance companies getting richer and richer. And in the many of the cases, they start as you, as you mentioned, they start in a, as a non-for-profit, and then they turn into a for-profit, and then all of a sudden there is, you know, it's an ethical question of, you know, gaining that momentum and, you know, getting that, becoming the snowball effect, but then all of a sudden the model changes, and now they're making a ton of money, and they're not passing it on. So I think these are really great avenues or directions at which ADA, and I'm so great to hear you say that you guys are really fighting the right battles and doing the right things. So it's really reassuring. Thank you so much for doing that.

Yeah, thank you. And we, when we talk about raising the cap, they're like, "Well, we have no reason to. No one ever reaches it. Why should we?" It's not the problem. It's the plan design is the problem.

Yeah, that's absolutely, that's that's so true. The administrative cost. I mean, it's so funny because what you say with what they're saying with this higher administrative cost that has caused the increase in the premiums, but not really in terms of of giving back in terms of benefits. It's the same thing in education and universities. Tuition's all gone up.

Yeah, but that also brings up another good point too, that is, is that, you know, cuz we, I know we're all big fans of technology as well, but eventually, it's one of the probably one of the main downsides of technology that increases the cost of care. So the fact that things are technologizing and we're moving in that direction, how is that going to square out with the reality that it's going to, as it by design, is going to limit access to care?

Well, I, I would agree with you to a point. When new technology is introduced into the market, it is really expensive. Okay, but look at digital X-rays. Okay, I, I started practicing in, in the era of, of film, and, you know, I would take an, an X-ray, let's talk endo when I used to do endo, you know, a working film, okay? I would take a film and I would go into the dark room and have a seven-minute meditation. Okay, dipping time. I'd come back with this. I come back with this little, this little rectangle card and hold it up to the light, and hopefully my developers were at the right temperature and not too, you know, articulated and stuff, and I could see exactly where that is. Okay. And I was one of the first dentists in Colorado to bring digital X-rays to my practice, and I paid a lot of money for it. But the look at the savings in and efficiency and efficacy, increase in efficacy. Okay. I instead of a seven-minute meditation, I got instantaneous, uh, development that the patient now can see because I had the, the screen right in front of the patient, and now they were engaged. Wow, what is that? And they would ask questions and, and, and I could see it better. So, it's improved efficacy. So technology was expensive, but over time, as it's introduced, it comes down, and, and we're going to see a major shift in the delivery of dentistry over the next 25 years, as well as, uh, as what we saw in the 25 years we've been in practice. And so one of the things we're doing at the ADA is, uh, under Dr. Rich Rosado, uh, is, is Oral Health 2050. What is dentistry, the delivery of dental care going to look like 25 years from now? And if we are to be thought leaders.

We must provide thoughts. Okay? And it's time for us to drive the profession towards the preferred future. And we can only do that if we create a vision along that way. Technology is going to be a big part as I said to increase the efficiency and the efficacy of the delivery of care and and AI is going to be a big driver of that.

Dr. Kesler, uh, you talk about obviously this concept of delivery, access to care, increasing in pre-increasing prevention, trying to give, um, dental services and true, I think, comprehensive care to a patient. Is this intersection point between medical care, dental care, and you talk a lot about that oral systemic connection? I wonder the impact, and you can go a few different directions with this, but I wonder what you make of the effect or the impact that DSOs have on our delivery care system.

I think from my perspective, it, it's an interesting thing because the cost of care seems to have come down through the advent of DSOs and the prevalence of DSOs. So more people seem to have, uh, more access to care. At the same time, there's this battle because maybe dentistry and the specialties, us in the endodontic field, maybe dentistry has become commoditized. So from the ADA's perspective and your personal perspective, how has the DSO model played a role in giving people access to care and and maintaining the beauty and the art and science of dentistry as an independent thing?

I would say that, you know, DSOs are in place, their management, you know, they, they help with the management of our businesses. They shouldn't interfere with the, the, the, the personal choices as we have as dentists to drive care to our patients. The doctor-patient relationship is the sacred cow that cannot change. What DSOs have done is shown, uh, business efficiencies and therefore, yes, they can probably provide things at a cheaper rate because they've got more efficient systems than the private practice world does.

DSOs grew because the, you know, it's just a natural progression of things. Medicine, we see it, uh, we s, we saw it happen 20 years ago, and dentistry is, you know, following probably seven, eight years behind where medicine was. Um, but we in the private practice world, I think we failed our, our future colleagues. Okay. If I were to hire an associate in my practice and they commanded $100,000 in salary, I would have to have $400,000 of dentistry lying around. And and, you know, because the dental students are the, the young dentists that are coming out, and they, they come out at a level of, you know, competency. They're not great dentists yet. None of us were when we first came out. And we grow that. And but but we didn't, uh, we didn't afford them the opportunities of a guaranteed salary, of benefits, and and recognize their values of what they are looking for out of their careers, and we just assigned our values on them. And we had this inflated self-worth of our practices that we expect, well, I had to go through this, now you have to go through this too. And this, and, you know, the young dentist said, well, no, I don't want to do that. And they want, they went for areas where there are guaranteed salaries and benefits and, you know, and a, uh, and and freedom, um, to to practice a schedule that they can, they can, you know, dictate and stuff like that. And so DSOs grew, you know, and they're not going away. But I think where the ADA stands with that, like I said before, is a doctor-patient relationship is the sacred cow, and we must keep that in the forefront, no matter practice model anyone chooses to practice in.

There are some amazing dentists who practice in the DSO world, and it's happening in the specialty world too. Even endo, I hope you know that. Okay. But there's some lousy dentists who practice in DSOs, too. And there's some amazing dentists that practice in the private practice world. And there's some lousy dentists that practice in the private practice world, too. Okay. And we can't vilify for being part of a DSO that makes them bad. Okay. I think the personal dental, uh, you know, ethical set of ethics that they have are going to dictate that. I know there's a lot of different pressures on them by different DSO companies, and, uh, and I recognize that and I respect that. And we have to make sure that each practitioner has the opportunity to at least offer the finest care to their patients in an ethical manner.

That brings us to dental education. Is that perfect segment? Okay, there you go. And and, you know, we had Rick Valakovic on, what was that, guys, about three weeks, a month ago, we had Rick on. And I've known Rick for, I don't know, 40 years or something, right? None in a long time. And we were talking about education. It's not just about the tuition that schools are being forced to charge. And I'm going to use endodontics as an example. I think every postdoctoral program is terrific. But among all the different dental schools, and there's a lot now, the undergraduate experience varies widely, especially in terms of clinical experience. You know, I, I still continue to do, you know, 40, probably a year, you know, intensive hands-on courses with general dentists. And I'll have, and especially with the younger dentists, I always ask them how many cases did you do in dental school? And the average now, believe it or not, is about two canals. And some schools even splitting teeth, like, Brett, you do the buccal, I'll do the palatal. Yeah.

So the question is twofold. One is, do you have any formulation or any suggestions how these schools can somehow make and maintain their tuition at a reasonable level? I know it's almost impossible for the schools. And number two, how can these schools increase the patient flow, those in terms of clinical experience, not just implants, but endo, perio? There's enough patients to fill the students' needs.

So I'll, I'll answer the first, the second question first. You know, I, I've been to about 25 dental schools this year. I'm on, I'm on a dental school tour. And, uh, you know, and it's, it's great being with the dental students. You know, they have a, you know, I hope I'm inspiring them to, you know, to be their best and live their best lives and things like that. But I get to see, you know, the clinics and I get to see the activities, and some are, you know, more busy than others. And and, you know, and and, you know, we, uh, have CODA as a, as as an affiliate of of the ADA, but we can't direct CODA. That was that was kind of actually what my real question. Yeah. So, you answered that right there. Okay. Um, we can't direct them, but we, we have to hold them to their feet to the fire that they better be, uh, you know, um, you know, standing up for accreditation. But accreditation is really difficult for a dental school to have to go through. So that needs to evolve. And we have Frank Lair, who's the chair of CODA, and we think we've got a great opportunity under his leadership. He's a forward-thinking, visionary guy to really drive CODA into today's day and age. Okay. Um, as far as tuition, uh, for dental schools, year after year after year, we're getting a record number of applicants, okay? Supply and demand, you know, uh, you know, and so it's, it's just following an economic model. Unfortunately, um, back when I, I used to teach at the University of Colorado when I first started teaching there, 20-some years ago, you know, the state funded, it's a state-funded school, probably 30% of its budget was funded by, uh, uh, by the state, and where it was, you know, very dedicated into investing in higher education as a state. Okay. Right now, I think it's less than 2%. Right. Right. Okay. And so, where can we advocate, you know, for state schools? We, in state dental associations, can advocate for, you know, please, state legislature, put it in your budget to invest in higher education. Um, again, politically, right now, everything's volatile. We don't know where are the opportunities there because because funding is is being cut for for universities and, you know, all these restraints on on freedom of speech and DEI, and it's crazy. So, I don't, I don't know where the opportunities are there yet, but we're seeking them and we're working with ADIA to try and figure that out.

I want to throw one other idea because the gentleman whose idea this was is sitting up in the upper left of the screen. That's Dr. Nasi Ali. When we were, when we had Rick on, Ali had a, had a question, and I hadn't really heard this. It was certainly not on my screen. And Ali was talking about, in terms of tuition, making it degree-based, not the number of years. So, in other words, if, if you happen to be really a gunner and by December of your fourth year, you completed all your requirements, you're done. You get the degree, you paid the money. Also, you could take it to the other side. If all of a sudden May comes and, you know, it's like it's like a minor league baseball player, you need a little bit more seasoning. Yeah. We'd like to have you stay over until September. But again, that fee is paid for the degree, not per year. Has a great concept. I think it's an incredible concept. Why don't you speak to Brett about it? Because I never heard of it before, and I thought it was brilliant.

No, I just think that it helps, uh, even out the the playing level the playing field, uh, for those people that might be coming in as international students versus, uh, others and so on. And it just creates a different set of, uh, kind of models for the amount of loans that different students from different backgrounds end up having. This kind of sets it up. It levels the whole thing based on a degree. But to be honest with you, Dr. So, the idea of the, you know, of of using the tuition as a kind of a form of a capitalist kind of a supply and demand model, it, it may be true that it could certainly be treated that way, but it has unintended consequences in the sense that if, because of the application numbers, the tuition keeps going up because the supply or because the demand is high, then the unintended consequence on the profession as a whole is that people leaving with greater loans will be especially under pressure with now with the insurance companies, with the other factors that are involved, then they're going to ri, you know, raise prices. And so the public ends up suffering as a result of that, too. So, there is that other consequence that I feel our organizations essentially have had the foresight. That's the whole point of organization is that so that in microeconomics, you know, individually optimized people will make decisions based on their own self-interest. But the whole point of like a bigger entity so that they can organize the thought and the idea so that the net benefit of, you know, the greater harm could be reduced. And I feel like that's why if we just let tuitions roll higher and higher, that creates a structural problem in the system in which the cost of education will just have trickle-down effects on care as a whole. Don't you think so?

Well, Ali, absolutely 100%. And we're starting to see it in the behaviors. First of all, in '27, we're expecting to see an academic cliff where there's going to be the fewest number of of kids going to college, undergrad. Okay? It's, it's, it's the, the question right now is, is a, is a bachelor's degree worth the investment? And exactly, you know, and maybe, maybe not. Okay. So, if there's fewer number of people going into college, there'll be much less people going into, you know, uh, into the health and the healing fields post-college, okay? Advanced degrees, we're already starting to see a decrease in in specialty applications. So, the tip of the spear right now, so there's four-year oral and maxillofacial surgeon programs, there's six-year programs. Okay? For the first time in history, there were open seats in the six-year program modality because why go six years when you could do it in four? Interest accrues for two more years. We're starting to see that people are going to start choosing not to go into specialties. We've got a ton of dentists coming out, but they may choose not to do, to do specialties, and that's going to affect endo, uh, absolutely. Okay. And so, so, but we're working with ADIA, and ADIA has a, a re, reimagining dental education task force going on right now. We got to hear the first part of that, you know, of, you know, kind of giving an environmental scan at the ADIA conference a few, a few weeks ago. Um, so, but this is my idea and my, my thinking is, you know, the first year of dental school, we've got all those, you know, those basic science courses for medicine. You know, can, can we take histology, histology, and put that in undergrad? Can we take, you know, biochem and put it in undergrad? Why did I have to learn how many ATP molecules are are generated in a cycle? Hydroxyl ion, no, in in dental school, okay? How did I use that? Why can't that be as a demonstrated competency as part of the DAT, uh, you know, to be qualified to go to dental school and get that first year in undergrad? Okay. And, and, and the dental, they, they go right into clinical and applications of all that basic science and health science and and integrating into dentistry and make, you know, those first three years instead of four years, um, you know, clinical-based with with applications of the science. Still not changing the, the, the requirements for for knowledge and our ability to integrate that knowledge into, you know, and formulate treatment. And then make that fourth year, like in medicine, a residency. Okay. And, and therefore, that fourth year would be paid with GME dollars and not tuition dollars. And, and, you know, and, and, and they get extra in the field, hospital-based or AEGD or an internship, an endo internship, or oral surgery internship, or perio, you know, the implant internship. So that would cut it by 1/4 and boost their efficacy on on how they can deliver care, right? Okay. So, reimagining that. And but, but the only way for us to do that is for us to be entering into the medical field. Okay? Because GME dollars in medicine are 10 times that of what they are in dentistry. And this was before the potential cuts in HERSA. So we don't know whether that's going. So, but, but we need to reimagine it. And because, are we doing the best for our future? I don't think so right now. And I think ADIA recognizes that too.

No, you're absolutely right. I think this, just the whole concept of education in the modern world, in which you have access to information on demand so much more efficiently, and plus when you add AI to that, it has to change. And there has to be different set of priorities in terms of what are important. It's funny because my teachers on my in the school as they go, there's plenty of trigonometry and plenty of like, you know, all of these other big-time courses, but not enough like, you know, just basically like personal finance, you know, home. Some of these things that we used to have. Sometimes you wonder it's like the education is moving away into this hyper-specialization and then just kind of creating a whole group of overeducated, hyper-elite. And that we've seen that that kind of kind of caused a little bit of a blowback as a result of that. And people end up getting hyper-specialized. Maybe it is better to kind of become a little more efficient in our education as well. There's no reason for this stuff to be this long. I mean, for us in the endo thing, for us at our school, it's like 11 years to be an endodontist, right? Does it take? Who's going to dedicate that nowadays, right? Um, even though the payoff is there, you know, you know, Dr. Ker, the interesting thing is that you talk, you made a really good point, and Dr. talks about this a lot too. Um, you know, I, I think there, there's a bigger question of like, how do we attract the biggest and brightest to come into dentistry, right? So, usually the question is, I, I'm interested in the medical field. Should I go to medical school, dental school? They're both four years. What do I want to do? And so, a lot of people choose to go to dentistry because they love the head and neck and the and the teeth, or they prefer a better lifestyle. This is no shade on the on the physician colleagues, but I think dentistry is a little bit better of a profession.

No, someone shameless. I think it's the best. Absolutely. It's the best. So, but, but I think like the point of how, how does it work, right? So, four years of of college, very competitive performance needs to be accomplished so that you can get into dental school, which is a whole other ball game. DAT applications and four years of dental school, and then a lot of people will go to either a GPR, a GDE, or if not a specialty program, several years. So you, when you look around during those years, you have, and we talked about this, but you have people, let's say, who go into the finance field or the consulting field or the technology sector, and they're in and out of college, and they, they're off, and they're making multi-six-digit incomes, which is very competitive. They're probably have more time on their hands to enjoy their life or travel and do different activities. And so, there is a little bit of this discussion, I think, for the, for the new generation of whether this time investment, this cost investment is likely worth it in the end. So maybe we can have you share your insights and your advice to the, the new generation of people who are aspiring to be in dentistry or the specialties. How can they look at this this internal conflict they're having whether to go into dentistry or not, based on your wisdom?

Yeah, I, I think the golden age of dentistry is right in front of us. I really do. I think that the opportunities, I talk about is with the, the benefit reform and our ability to participate in the primary care delivery model, right? You know, we can do A1C screenings. There's a, uh, a benefit company in Arizona that just announced they're going to start paying for A1C screenings in the dental chair. Imagine that. Okay? I can't tell you how many patients in my practice, I live in Colorado, the fittest state in the country, and I've got a bunch of athletes in my, in my practice who, you know, they didn't get better after scaling and root planing. They came back four to six weeks later, and they were still really inflamed. And my hygienist is like, "Well, it's not an oral hygiene problem. They're clean. It's a host problem. They're inflamed." And so she would start asking questions about, "Tell me about your diet. Tell me about your stress level. Are you using any, uh, tobacco, any illicit drugs? Tell me about your drinking. Uh, when was the last time you were at your physician?" We can do, you know, uh, you know, A1C testing. We can do, uh, you know, genetic testing, uh, inflammation, uh, testing. Um, microbiome testing, all these things that can, you know, be, be a play in and improving our patients' overall health of a lifetime because we can be the ones that catch it early on, you know. And so these patients that didn't get better, we'd send them to their physician, and they come back undiagnosed diabetic from the fittest state in the country. They didn't look like they would be diabetic. They were undiagnosed diabetic. And so we can play a part in, in, you know, in expanding our, our repertoire and, and in the delivery of, of primary care. And in addition to all the procedures we do, in addition to, um, you know, the improvement of lives of smiles and bites and, you know, and oral health, it's, it's going to be amazing. Technology is going to be a big driver of that, and how we can utilize technology to, to drive trust with the patients, you know, using AI as a personal assistant to tell us what's going on with that patient, reminding us of what we wrote in the chart six months ago. Um, you know, and, and so I, I feel, and then like you said, lifestyle. If someone wants to go into the healing field, you know, being in the medical field, you're going to be dealing with, you know, some pretty big tragic, uh, you know, conversations you're going to have to have. And, uh, the lifestyle is not so good in the, in the medical, the medical world. In the dental world, I mean, we still have this amazing life. And the worst news we usually have to give a patient, and with regards to, uh, to, you know, obviously oral cancer is a thing, but most of us will tell us, yeah, that tooth isn't going to work. That's the worst news we usually have to give our patients. Um, and so lifestyle-wise, it's, it's much better. The best and the brightest are going into dentistry. And I think as long as we can keep it that way, we're going to continue that. The way we're going though, it's going to be those that can afford it will go into dentistry because of the high cost. We are the highest cost of education to train in all the healing fields, and that's got to, that's got to change, right? We need help.

And there's never been a moment of doubt in your 30 years plus, and I've really never asked this to you guys either, Dr. Nasa, Dr. CJ, has there ever been a moment of regret for me? Absolutely not. Never. Not once. I love, I love being a dentist. I love it. I love it. Absolutely love it. I, I'm so, so proud of the work that I've done. I'm so grateful for the relationships I have with my patients. So grateful for the opportunity to be a leader, uh, within organized dentistry, pushing this amazing profession forward. I'm so, so grateful for this. No regrets whatsoever. It's an amazing profession for women. And I think, I think the DSO model also works very well for many women where, unlike most men, women will have a life, you know, they'll have kids and stuff. So having a situation where they can work two and a half, three days a week and feel sated with their education, do well financially, and then have a life that's really important. Full disclosure, my wife is a dentist as well. She's an orthodontist, and we met in dental school, got married our fourth year. So, yeah.

I agree with you completely. That's awesome. That's awesome. Yeah. For me, I come from a dental family. So, I was destined to be a dentist. And, you know, you can't say never a moment of regret because there's always opportunity cost. Well, you know, if you have multiple loves and things, then you, you know, you always kind of say, well, maybe I could have done a little bit more of this or more of that. But the question really is, are you happy having done what you've done? And for me, it's a, it's a resounding yes, for sure. You know, there's, you always feel like you wish you had multiple lives so you could do multiple different things, but you, you can't. So, so you all sing, you can do anything, but you can't do everything. So, you're going to have to make some choices in life. And, uh, cuz I know, cuz you know, Para is an extremely bright, uh, young guy, and you obviously could have done many things. And, you know, I'm sure is questioning.

No, I just, no, no, no. Just, you're in the right field. You, you'll do things. No worries. Let me share. When I turned 50, I asked myself some midlife questions. Not midlife crisis, but midlife questions. What do I want to do with the second half of my career? What do I want to do with the second half of my life? And, you know, and I felt I made a pretty big impact in the first half of my career and life. But, uh, you know, I was getting burned out in practice. And, and so that was 2018. That was the year I decided to sell the practice. That was the year, uh, I, I, uh, decided to run for the board of trustees of the ADA for that second half. How can I make a bigger impact is really what I was looking for. And so, so that's when I decided to run for the board. That was the year I did my first Iron Man race at 50 years old. And, and so it's like, you know, you can redefine yourself based and, and, and use your experience from the first part of your career to, to accelerate the impact on your second half. And so we have choices. And, and I want to, can't stress that enough. Um, that you can do whatever you want and reinvent yourself in, in many ways, many times. 1,000%. Yeah.

Did the same. I did the same thing with Real World Endo. Got to the point, you get tired of, you know, the, the whole thing with the rigor with clinical practice. And I found out with Real World Endo, it gave me a lot of opportunities to do different things, I think, different aspects of my personality. And it's, it's stimulating. It's not just a physical thing, but it's mentally stimulating. It's the same thing what you're doing. So I think that's is a great option in dentistry, no question. You know, I felt we can make an impact one patient at a time, chairside. But now I'm making an impact for the entire profession. Or you're making an impact in all those that are learning from you that are then spreading it to the community. It's just accelerating your impact. It's amazing. Thousand percent. It's wonderful. We're happy you chose to actually, uh, sell the practice. You know, not only your life and your inspiring, but it's today. I think today's example shows so wonderfully that, you know, the organization's in good hands, and that, uh, you are really leading and thinking about the right thing. So, it is, it's so great and refreshing to hear.

Right. And in the spirit of the Boston Marathon happening this weekend here in Boston, um, it's fitting that we talked to you as, uh, this, um, marathon, unbelievable athlete, Iron Man marathon runner, and ultra marathon. That's true. Is that true that you actually can run ultramarathons? I can't even drive that long, to be honest with you. Oh my god, that's great. Yeah, I'm not all that right in the head, you know. Well, the interview through here. That's what they said about Brady, too. So, it's not a horrible thing. Right. Right. But, but through those races, you know, yes, they're physical feats, but honestly, and it's mental. It's, it's, you know, I learned so much about myself and what I'm capable of by doing these crazy races. And, you know, and, and if you follow me on social media, I always have the, the tagline, "Anything is possible." And, you know, and I, I truly believe that. And I get clarity of mind when I do these long runs and, you know, and do these races. And it's just, it just, you know, keeps me healthy, keeps me young, keeps me sharp, and keeps me focused. We love it.

Your, your personal journey itself has been extremely inspiring, and you've been really open about it. The challenges you've gone through and how you've overcome it. I think it does take this kind of mentality to realize that, you know, nothing is, is can't be overcome. So, to the extent where you want to kind of enlighten us with the challenges and so on, that would be terrific. Yeah. For, for those that don't know me, I'm a recovering alcoholic and drug addict. I got sober in my third year of practice. And I, I made a call to the Michigan Dental Association well-being program to ask for help. And I attribute that phone call to the beginning of my recovery and what ultimately saved my life. And, uh, you know, over the years, I became more and more inspired to live my best life. And that's why I'm here right now. I view every day as a, as a gift. Um, because I should be dead. Absolutely should be dead. And so this is bonus time, and it gives me perspective. But a lot of the tools that I use for my recovery, and it's a daily deal for me, you know, and I haven't had a drink or or drug in, in 26 and a half years. Um, but, but the, it's a lot of mindfulness, uh, work that I, that I have done and continue to do. And that's helped me become, you know, find clarity in my life. And it's helped me become the leader I strive to be. And, and, and it, it helped me find my why. And, and, you know, and then live in my purpose. And, and to make the world a better place because I've got this, this sense of gratitude that, you know, like I said, there's a reason why I'm still here. I want to maximize that every single day. So, thank you for asking about that.

It's truly inspiring to know that we can turn everything around and then achieve such great heights to become the president of the American Dental Association, to run ultramarathons. I'm still, I don't know which one I'm more impressed with. It is a terrific feat of achievement, and to share that message because today's world, I think students, young people, everybody, and even older people. I mean, to, I feel like people in my generation and Annie's generation have had the benefit of living in a world in which we were not, you know, overly bombarded with, uh, information that was not necessarily not only not useful, but also harmful. But I feel like this younger generation is living a very special time in which it's very challenging to manage, you know, the mental health model. And so, you know, do you have any advice for the young dentists, uh, in Par's group and so on, and in this age group, that, you know, how can they overcome some of these, uh, challenges that they face?

Absolutely. Great, great question. Um, you know, like I said, I, I go, I'm going around the country and visiting a bunch of dental schools. And, you know, and I, I talk about the wellness journey that I, I am on. And I talk about the highs and the lows. And, uh, you know, and, and so I, I hopefully inspire people to recognize that you are your most valuable asset. Take care of yourself as such. Okay? And, you know, I'm, I'm 57 years old, and I've got an asset, you know, of money over here, you know, that I've collected over the years. Um, and I try and manage that. But, but I am my most valuable asset. And so I have to really, you know, invest in myself in all ways. And if I, you know, physical, mental, emotional, spiritual, social, all those buckets for me, I, I review them on a regular basis to make sure that I'm, I'm, I'm putting effort into their, into those areas and making right choices in those areas. And when I find I'm not doing well, I ask for help. And, you know, even as president, I still ask for help, um, because, uh, I'm human. And, uh, you know, we've, we have way too many of our colleagues who have decided not to continue living. And I just found out about another one, uh, this week. And, and we have to be there for our colleagues. We have to be there in support of those that may be suffering. And we have to reach out to, you know, you as a specialist, you get to see a lot of work from your general dentists. And, you know, and you can see changes in, in, in the quality. And, and you hopefully meet with them on a regular basis. And, you know, if you are concerned, please say something. You know, and come from an area of concern. And, you know, and I, you know, I'm concerned, and I, and I'll stand with you and support you to get you right. Because, you know, if you're recognizing there may not be right, that, that that could be the catalyst that could turn them around, right? Um, and so, uh, you know, take care of yourself as your most valuable asset, especially in the younger demographics. You know, if, if you're unable to practice, the loans are still going to be due, right? They don't care. And, and so, you must be able to produce. You, you know, you cannot produce and, and provide the impact you set out to do if you're not well. Get yourself well, first and foremost.

That's great. That's terrific advice. That's interesting because I mean, you know, as dentists, we are kind of like athletes. You need your body to do what you need to do properly. There's a certain mind element with technique, but at the end of the day, your career is only as long as your body is capable of producing what it does as a surgeon. And so that's like tremendously good advice to, you know, think of your body as a shrine. Seriously. Right. It is. And, you know, when I was in practice, I'm not practicing now because of my, my job as president, but I had, you know, had weekly chiropractic appointments and, you know, massage, uh, appointments because, you know, neck problems, back problems, shoulder problems, hand problems, sciatica, back, all of those are prevalent. And will, you know, 66% of us will miss work due to work-related chronic, uh, injuries. That's staggering. You know that is. And so, get your ergonomics right now. You know, that patient that can't, can't lay back, I'm sorry, I can't treat you. That's what I say. That, that is critical advice. I mean, what says about the ergonomics and the reality of, of, of what we were just talking about. So, uh, spending time taking care of your body is super important. It's an investment. Yes. LeBron James, so basketball playoffs are about to start. LeBron James spends $3 million a year on his body. I know. Amazing. You know, his body is his, is his, is his money maker. Okay. Our body is our money maker. We need to be at our best physically. I have to try to go for a run with you when you're in town, Dr. Kessle. Try to try to get to the ultramarathon level. Uh, it's really inspiring though. It really is. It is amazing.

What about just one last thing? I'd like to also, um, because you said that you have practiced more mindfulness, and I'd like to have you share your experiences with the concept of mindfulness for those people who don't know as well as how you feel that has helped you open up and understand yourself better.

Wow, it's been everything. Um, I wish you could see my, my setup here. You know, I've got a vision board right here to my right. I've got inspiring notes over here. I've got Kobe Bryant inspiring notes over here. I love it. Surround myself with positivity. Okay. Um, but, but every morning, you know, I wake up and, and I do, um, some meditation work. I do some journaling, um, just to get, you know, clarity on things. And so I do guided meditations through the Calm app right now. That's what I've been using. And, you know, and then there's a topic that they'll, you know, focus on for 10 minutes. And, you know, and, and just being able to, to, to focus and notice how my brain works. It's, some days it's very focused, some days it's just spinning so fast, and I'm trying to count my breaths, and before I know it, I'm talking in my mind. I'm like, "Oh, I got to pick up my kids here. I got to go do this and pay this bill." I'm like, "Oh, wait. Come back. Breathe. Breathe. Breathe." They call it the monkey brain. But, um, but I get clarity from that. And, um, and, and, you know, and I used to have an, and my thumb. I used to put a little check mark, uh, in a black Sharpie on my thumb when I was practicing. And when I take my gloves off, I'd see my check mark, and it would be a reminder that the next patient that I'm about to see couldn't give a crap about what happened in this operatory. I have to just, just reset my mind and be fully present with this patient in front of me. And, and being present, uh, has allowed me to be that amazing practitioner because that, that doctor-patient relationship, as a sacred cow, um, happens when I'm present. It doesn't happen when I'm not present. Um, and then it's also afforded me the opportunity to live with intention. As I said before, you know, when I turned 50, I, I made some, some, you know, myself look at some questions. And, you know, I chose my practice modality. I chose to go into leadership. I chose to live in this house. I chose to buy this car. You know, it's very, you know, the wind is blowing us, we can set the rudder and trim the sail to sit, you know. And so, um, I've done it five times. Uh, I've on five-year visions, five times since I've been sober. Um, and I could tell you, every time I've done that, pretty much everything has come true. Not definitely not in the way I had planned it. You know, I never, I never wrote in my vision I was going to be president of the American Dental Association. I wrote things like, I'm going to maximally contribute to my profession. And, you know, and then that gave me, you know, when the opportunities, you know, were in front of me, it gave me, uh, you know, that choice to choose to go that route. And, you know, with the, that preferred vision of, of what I had, it wouldn't have happened intentionally. It would have, it may have happened, you know, accidentally, the Forrest Gump way. But, but, you know, I set out on an intention to really, you know, live my best life, and that's what I do. Mindfulness is everything.

Sweet. That's terrific. Absolutely. You know, I'm a big believer that leadership starts from inside out. And I think your example, your path from inside and now leading us, it's really reassuring. And I'm really happy. And we could probably speak to you for another two hours. That's right. You understand that you have to go, and it's really been a pleasure. So, Annie, you want to have our final award and then pause at a couple.

First thing I want to say, absent six, go Brock Nelson. Okay. Yeah. And I think what's, what's really wonderful, one of the things that you've, you've kept going back to it during the conversation over the last 90 minutes is the patient-doctor relationship. And as I see the younger generations come along and and have everything. Google this, Google that, technology is going to do this, AI is going to do everything. It's still a very personal relationship. And I think that's something that we can never forget about. It's what makes dentistry the profession it is. But there is a personal component that we all have to be aware of. So thank you so much for eloquently bringing that forward. Thank you. Thank you for illustrating that. And I would just say this, this conversation has been such a gift to me too. So thank you for creating this environment where we can have these open, candid, um, talks about really important things that are affecting our profession. Yeah, it means a lot, Dr. Kesser. And, and I, I remember hearing you talk at Foresight Dentech, and you, you made a huge impact on me personally. And then when you spoke to our, our cohort at, at, at the Harvard School of Dental Medicine, it's interesting because I, it felt like you were really telling us how you feel and your true opinion. And given the stature of your position as president, you, you really gave us, uh, a lot of hope because you told us exactly how you feel, and it's very clear that you mean what you say. So, uh, from fluoride to insurance, education to inspiration to mental health, we covered a lot. But, uh, as Dr. Nas has said, we thank you for for joining us on the Paul podcast. Absolutely. Absolutely. Thank you so much. Have a great. Thank you all. Happy holidays, everybody. We'll see you in the studio at some point in the future. We look forward to it. Have a great weekend.

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