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

Dr. Scott Sayre, Founder of Advance Dentistry, Vesper Alliance and Vesper Institute discusses:

Dental IV sedation & anesthesia driven dentistry
The Vesper Institute
The Vesper Alliance
Shared goals for the profession of dentistry
and much more!

Education – To find out about the Vesper Institute visit – https://vesperinstitute.com/

DSO – To discover how to partner with the Vesper Alliance visit – https://vesperalliance.com/

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

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Full Transcript:

Bill Neumann:

Welcome everybody to the Group Dentistry Now Show. Appreciate everybody being here. Whether you’re watching us on YouTube or whether you’re listening to us on Spotify, iTunes, or Google, we appreciate it. Without great audience coming back every single week, we wouldn’t get great guests like Dr. Sayre, who’s up next. And first off, thanks for being here, Scott. I appreciate it.

Dr. Scott Sayre:

Thank you, Bill. I really appreciate you having me on.

Bill Neumann:

Yeah, this is going to be fun and it’s actually timely, and I’ll tell you why in a second, but I was actually out at a small group practice conference last week in Nashville, and there were probably about 30 groups there in attendance. And so there were a couple of clinicians working for small groups and large groups, and one was asked a question on stage regarding IV sedation, which is going to be one of our topics today. And so it was just interesting. And I would say most of the audience there, two to five locations, there was a lot of interest and a lot of follow-up questions to how he specifically was using IV sedation in his practice. So let’s talk about it from your perspective. Where does IV sedation and anesthesia-driven dentistry fit into the larger industry, the landscape?

Dr. Scott Sayre:

Well, Bill, that’s a great question and we in dentistry have missed the boat now for a while. Horace Wells was the dentist in the 1840s I believe that introduced nitrous oxide to dentistry. And we’ve been involved in anesthesia ever since. Many dentists don’t realize that you can go straight from dental school into a medical anesthesia residency program. It’s the only residency that we have left from a medical standpoint. 36%. This is by literature, and I can’t quote it right now, but just go look it up. 35 to 36% of people in the US don’t want to go to the dentist. They don’t want to go. Well, okay, that’s fine, 36%. Well, what about the number of people who have special needs? That’s like 10% of the population. What about the percentage who are older, that have dementia, that have Alzheimer’s? What about those that have other medical needs?

What about just the complicated procedures in dentistry that general dentists can do except they don’t do sedation? Complicated endodontics, multiple extractions. Some of the implant procedures that dentists want to do: sinus lift, multiple implants, all on fours, patients in the office for hours and hours and hours. Where well over 50% of the population that need sedation in dentistry.

Explained it to some of the people like this, would you go and have a carpal tunnel done without sedation? Everybody goes, they’re aghast. They’re like, no, why would I do that? Why would I want to have this medical procedure that I don’t know anything about and not have sedation or anesthesia? And I say, wait a minute, wait a minute. Look. I said, this is your arm. It’s going to be way over here. They’ll drape it. You won’t be able to see it. You won’t know about it. You won’t smell it, you won’t feel it. They’ll give you a brachial plexus anesthesia, which we do in the mouth all day, every day. It’ll be totally numb. It’s a six minute procedure if you have a good surgeon and you’ll know nothing about it. Couple of sutures, it’s soft tissue. Why wouldn’t you have that without sedation?

Now I’m going to come into your mouth. You can smell it. You can hear it. It’s near your tongue. Everything, all of your senses are right here. This is the most formidable place in your body. And I’m going to drill, even just an occlusal filling. Multiple crowns, root canals, those people want to be sedated. We in dentistry have missed the boat. We have given in. God bless all of our patients that say, I’m happy. I’ll get a little Novocaine. I’m going to get a cleaning. I love my dentist. They’re fabulous. They don’t need it. I understand. That’s great. But those that need gag reflex, can’t get numb. 10% of the patients supposedly can’t get numb. The list is so long. We have missed the boat, and this is all I do all day every day.

Bill Neumann:

So you’re the President of Advance Dentistry. So can you talk a little bit about how you’re using IV sedation.

Dr. Scott Sayre:

So yes, I have four practices. We’re growing. It takes time to grow a sedation practice because the dentists have to be super generalists. If you’ll ask me about that later, I’ll explain it. All of my docs are sedation certified. All of my clinical staff as they come on board within the first year are certified in ACLS, Advanced Cardiac Life Support. It’s required by all the docs in Ohio. And that’s where we are at this point. This is something that we believe in and we do. So the four practices, everybody does sedation. We are filling the practices. We have never looked back. We’ve grown every single year. During COVID, we grew. So it’s a phenomenal thing. We did a PSA during COVID that said, please don’t go to the emergency room, go to these oral surgeons and practices, and this is where you can get an extraction or be treated for pain or have a root canal. Because even during COVID, this is what we needed.

Bill Neumann:

So you built your practices really around sedation and you’ve got four locations in Ohio right now. You’re based in Cincinnati, so they’re pretty much the greater Cincinnati area.

Dr. Scott Sayre:

We have three in Cincinnati and we have one in Columbus.

Bill Neumann:

Okay. All right. Very good. So I normally start these off with your professional background, but I wanted to get into that, the IV sedation because it was incredibly timely that that question came up when there was so much interest around that from groups very similar to your size, two to five locations. And I think some of that can also be tied into maybe economic times where practices are maybe aren’t growing like they used to. They want to accommodate maybe a broader group of patients like you talked about, which you’re not touching. A giant percentage of the population when you look at, you talked about it, dementia patients, special needs, people that are scared to go to the dentist. So it makes a lot of sense.

Talk a little bit about your professional background. How long have you been practicing? I’d love to find that out. And did you start out initially with IV sedation?

Dr. Scott Sayre:

Yes. So this is a really interesting story. So I pulled a Doogie Howser and went through undergrad in dental school in five years. And I thought, I’m a little too young to practice dentistry. And so I went into a residency and it was fabulous, in Miami Valley Hospital in Dayton, Ohio. And I studied under Dan Becker. Anybody who does sedation and knows pharmacology and dentistry, was one of the premier people that taught that. [inaudible 00:08:45] , who was the secretary of the American Academy of Implant Dentistry was in charge of the residency program. So implant dentistry in 1978, are you kidding me? We did all kinds of cases, everything. I did six months of general anesthesia in the hospital. I did all kinds of surgery. I call it the cowboy days. I mean, we just did it all.

At that time, implants were not being taught in perio and oral surgery. They just weren’t being done because it was just too early. 1978, the year I got out was the first consensus conference on implants, and they said it’s still experimental. 10 years later, 1988, they said, go for it. And that’s about when everybody got involved. So I’d been doing implants already for 10 years.

So it was an amazing time for me. I continued on, went to the Misch Institute, did 1500 hours of continued education. I have a master’s in aeronautical science, I have an MBA. I just have this really interesting background of education. I’ve been an instructor at the Advanced Cardiac Life support for 20 years. I’m not currently, but that’s because of politics. It’s hard to do all that stuff. So I’ve been doing sedation for 45 plus years. Implants for 45 plus years. There are not many people out there, but I love technology.

So we have taken sedation plus technology. We use Gentle Wave from Sonendo, we use X-Nav for our implants from Nobel. We use lasers, we use all kinds of things. And so we treat our patients with the absolute best of care and it’s really phenomenal. And that’s what I think that the DSOs that want to get involved in sedation have to understand, that you have to take care of the patient when they’re sedated, which means you’re going to do endodontics, you’re going to do implants, you’re going to do surgical extractions, you’re going to do dentures, you’re going to do wisdom teeth, you’re going to do everything that falls under general dentistry. We don’t think that way, but we need to start thinking that way. So sedation’s a wonderful, wonderful way to increase your practice profits and give your patients what they need. And that’s number one.

Bill Neumann:

And you didn’t mention your military background. You did mention your background in aeronautics, but you’re also a pilot as well.

Dr. Scott Sayre:

You’re trying to dig into all of it, aren’t you?

Bill Neumann:

Well, like you said, it’s a pretty interesting background, diverse, and you don’t see too many people out there with such a varied background. So pretty interesting. Yeah, I checked out your LinkedIn profile before this.

Dr. Scott Sayre:

I started flying when I was 14 or 15. Soloed it at 16, got my license at 17. I spent all the money that I was making cutting grass and bailing hay and digging graves. Yes, those were my first jobs, picking corn, and started to fly. And then I’ve flown my whole life. I’ve had 10 different airframes and airplanes. I flew on the Lima Lima flight team, which is a six ship formation aerobatic team.

I wanted to go into the services. All my family was military. And I wanted to do that out of dental school. This was right after Vietnam, I had a draft number, believe it or not, I’m that old, and so I took the exclusion and was in college, but I really did want to serve. And they said, no, this is not time to do that because everybody’s getting out. This is post-Vietnam. They’re gone. So I didn’t do it, but after 911, when I was actually quite old, I said, that’s it. I’m going to go in. And so I got in and served for about 12 years. I got the rank of colonel and was the commander at the four445th Aeronautical Medical Squadron at Wright Patterson for several years. So it was a really great experience for leadership and for training, and I would never trade it for anything.

Bill Neumann:

Glad I asked the question. That is really interesting. So can I ask how old you were when you went into the military?

Dr. Scott Sayre:

Now, you’re pulling on my memory. It was either 48 or close to, yes, I think it was 48.

Bill Neumann:

So not many people do that.

Dr. Scott Sayre:

No, I had to get a waiver to get in. I had to pass all the physical fitness and everything, and at the same time, there were probably two or three people in my ROTC class who were close to my age. So it was really interesting. We had a lot of physicians, nurses, engineers, other professionals that were looking to help the country.

Bill Neumann:

Yeah, really interesting. Okay, so you weren’t alone. Yeah, that makes sense. It was an interesting time for sure. Let’s talk a little bit more about dentistry. Talk a little bit about your goals, what you’re passionate about. And then I’d love to, I want to get into the Vesper Institute.

Dr. Scott Sayre:

Okay, so what I’m passionate about. I want to bring comfortable dentistry to everyone. That is my mission. And I think we need to really, really think about anesthesia, sedation, whatever form of, again, if the patient’s totally happy with local anesthesia, that’s fabulous, but if they’re not, we need to look at wow, we can help these patients. So that’s really what my mission is. Now, how do we do that? There’s so few dentists trained in sedation that it’s not even funny. If you look at Malamud’s book, which is considered the text of Sedation dentistry, he says 87% of those dentists who go out and get trained in sedation don’t use it. 87%. It’s really probably 90%. 3% nobody’s going to quibble about, right? So there are so few people that go out and get trained in sedation dentistry because they don’t understand the whole concept.

This is a life-changing event. It’s scary. You’re taking a person to the edge of their life in essence and bringing them back. You have to understand airway, medications, medicine. You have to understand heart monitors, breathing. It’s just an endless new technique that you have to know. So my premise is we’re going to end this. I’m kind of old to do this, and at the same time, this is my mission. This is what we’re going to get done. So we want to teach docs how to do this. We have a three-pronged program. Advance Dentistry is my group of practices that I will continue to enlarge that are specifically doing sedation dentistry. Maybe we’ll get to Indiana, maybe we’ll get to Kentucky, maybe we’ll have a few more practices. One, two, three per year, whatever we can do. This takes training.

The next thing is what’s called Vesper Institute. Vesper Institute is the education arm of what we’re doing. That’s how we’re going to train multiple dentists to do sedation. We’re going to train them correctly. We’re going to teach them how to intubate. We’re going to do everything that they need and we’re going to hold their hands. So we’re going to have a 1-800 number, whatever they need. If they have that emergency, a problem, they got a concept, they need somebody trained, they need somebody in their office to talk to about supplies, we’re going to be there. So we have a concept to try and help them get through this. We also know that unless they get their staffs trained, they’re not going to make it.

And the last thing is Vesper Alliance. We got Vesper, Advance Dentistry, Vesper Alliance and Vesper Institute, and I talked to you about Vesper Institute. Vesper Alliance is in essence our DSO. So we have a practice out there and says, Hey, this is great. We want to learn about sedation, how you do this, how you create the new patient exams, how you treat specifically sedation patients, and then we’re going to be there. We’re going to help them with anything: billing, HR, staff needs, how to do supplies, and that’s how we’re going to do our DSO basically.

Bill Neumann:

So that Vesper Institute, is that in Cincinnati? Is that where you bring docs in to train them? Can you talk a little bit more about that? I’d love to find out more about what the curriculum looks like and how that works.

Dr. Scott Sayre:

So yes, Vespa Institute is in Cincinnati. We have about a 20,000 square foot building that we’re creating a really nice working space for education, including a vendor room and areas to eat and take care of the people that are there. That’s going to be completed here in the next oh three to six months. The building’s been there for a long time. I bought it a while back. We’re renovating much of that. So yes, Vesper Institute is located in Cincinnati.

Bill Neumann:

And how long does it take to become, is it a certification process or how does it work?

Dr. Scott Sayre:

So most states require that you do 40 hours of didactic work in sedation dentistry, and then 20 cases that you see or you actually do and provide the care for. So we’ll do 10 cases a day in our office, maybe more. So our commitment to this is going to be easy and simple, and we’re going to get the docs through this in as normal time as we can. But really our concept is that’s minimal training. That’s just what you need to ask your state board to give me a little license. Once that happens, your responsibility is to continue to train. So with us, we want to give you 40 to 60 hours of education. We want you to intubate patients. We want you to start IVs that are different than others. We want you to see special needs patients. We don’t want you to just have these 20 cases that are easy, easy, easy, that somebody’s helping you through this.

We want you to see what’s available, what’s possible, and what can be done in sedation dentistry. We want to take this to the next level. So Vesper Institute is going to do these sedation courses. That’s one arm. The other arm is if you’re doing sedation dentistry and you don’t understand the concept, the business part, how to charge for it, what the patient’s needs are, then you’re going to be lost again. Are you doing molar root canals? Because if a patient comes in and you’re not doing a molar root canal, what good are you? The [inaudible 00:21:13] docs around you don’t do sedation.

So if the patient comes in, they need two crowns, four fillings and three extractions, and you’re not doing extractions or surgical extractions or difficult extractions, what good are you? So all of our other training courses are to teach basically a super generalist. We want you to understand how to do wisdom teeth, how to do implants, how to do surgical extractions, difficult molar root canals. Anything that you need to do to be able to do this under sedation dentistry. This is where the need is. It’s really pretty simple. It’s fabulous for the patients and the bottom line for the doctors is incredible.

Bill Neumann:

Yeah, there were some questions last week around the compensation portion of sedation dentistry as well. They were trying to figure that out. So pretty appropriate. So super generalist. So you’re not just teaching sedation dentistry, you’re teaching the docs how to be super generalists as well,

Dr. Scott Sayre:

Correct, yes. All facets of that because that’s what they’re going to need to do.

Bill Neumann:

And so you talked a little bit about Vesper Institute, the building actually being complete in early 2023. So talk a little bit about that because that’s when 2023, you’ve got some big plans.

Dr. Scott Sayre:

Yes, we do. I think we’ve got about 20 courses already lined up, and that’s not including our sedation course and or some of our other courses. So we teach Gentle Wave by Sonendo. We specifically do our implants with X-Nav. We have not plugged in some of these really specific high-tech courses. So again, we’ve got 20 or so courses lined up from perio-hygiene business models, OSHA. We’ve got courses on bone grafting, just a lot of different things and that’s not plugging in so much more.

Bill Neumann:

Well, that’s pretty interesting as well. You talked about the business models. How do you make this work if you’ve got four or five or seven practices? So that will be really appropriate for our audience. So what’s the website if people want to find out more about Vesper Institute.

Dr. Scott Sayre:

I think it’s www.vesperinstitute.com. You hopefully can post the right one.

Bill Neumann:

It is, yep. That looks right to me. And we’ll, what we’ll do is we’ll drop the link, we’ll put the link in the show notes, and then for people that are watching this, we’ll have a URL that they can just click through. So yep. vesperinstitute. V E S P E R Institute.com. Yeah. And then another question for you as far as …

Dr. Scott Sayre:

There’s also, let me just jump in. Yeah, there’s also Vesperalliance.com I believe, same spelling, and then there’s also our offices are nofeardentist.com.

Bill Neumann:

So tell me the difference between the Alliance and the Institute.

Dr. Scott Sayre:

So the alliance is specifically going to be more of a business structure. That’s there if you want to join our group, if you want to just say, hey, I’m tired of it. I want to be Advance Dentistry, then they would onboard you, create that system, all of that. If you say, hey, I’m struggling with HR, I can’t hire anybody, I don’t understand. We have our HR staff. If you are struggling with marketing, we have our marketing staff. If you’re struggling with billing we have our billing staff. So you could probably choose and pick what to do out of Vesper Alliance as part of, in essence, a DSO, dental service organization. Doesn’t mean that I have to come in and own your practice. It means service. So what service can we provide? What service do you want?

Bill Neumann:

Gotcha. So yeah, that means either way though, you’re going to have to learn IV sedation, whether it’s going to the Institute or joining the Alliance, right?

Dr. Scott Sayre:

Yeah. Our marketing specialty is in sedation. So why would you have a market you for doing cosmetic dentistry?

Bill Neumann:

Absolutely.

Dr. Scott Sayre:

Sure. Yeah, I’m sure we could help, but maybe not as good as some others.

Bill Neumann:

Dr. Sayre, do you have an idea of how many dentists are actually practicing IV sedation now? I mean, you talked a little bit about some percentages, but I mean would you say when the day-to-day, what clinicians out there are really spending a lot of time on it,

Dr. Scott Sayre:

So few that it’s almost something that you can’t talk about. I have a lot of friends that do sedation and they do it one day a week or one day a month, or they did it and they’ve stopped. That’s the most prominent is that they just stopped doing it. They lose their assistant who was doing a pretty good job in helping them with sedation who they never trained in ACLS. They never got really comfortable with it. And then that person’s gone. Now they got to train somebody else and it’s like, this is too dangerous. And they just stop. Whereas again, I’ve got a staff of, I’ve got 17 operatories in one office and like 26 assistants and almost all of them have had ACLS. This is true with all of my offices. All of our offices are 10 to 17 operatories and we’ve got multiple docs in each one, and that’s how we do it.

Bill Neumann:

Talk about a little bit about ACLS. What type of training is that? How long does it take?

Dr. Scott Sayre:

ACLS, the basic course, I believe is 16 hours. It may be less than that. You have a full day of didactics or day and a half, and then you have what’s called a mega code where you are supposed to specifically discuss how you would go through various emergencies. They’re almost all cardiac. That’s why it’s called Advanced Cardiac Life Support. I don’t really think that ACLS by itself should be mandatory. I think that we in sedation and anesthesia need to broaden this and create a really good course. One of the most common problems in dentistry that most dentists have no idea how to handle, is fainting syncope. And most of them don’t understand, put the chair back, do this, do this, maybe some oxygen. It’s a pretty simple process, but everybody gets befuddled. Even when you’re starting an IV, the most common problem you’re going to have is somebody not liking the IV and they faint. It’s probably the biggest problem you have right there. Understanding everything else is critical, but the simple things, if you really keep an eye on those, it’s very important.

Bill Neumann:

So as we start to wrap things up here, first off, I want to make sure I didn’t miss anything, but like I mentioned, we have three websites, three URLs, so we have vesperinstitute.com, that’s the training, the education. We have vesperalliance.com. That is the support and the service. You want to either work with Dr. Sayre or you just want some assistance on the business side, you can go there. And then if you just want to find out about his practices, nofeardentist.com. Did I get all this right? I think I did,

Dr. Scott Sayre:

Yes. That’s great.

Bill Neumann:

Okay, good. All right, we can wrap it on up with a goal that you might have for the profession of dentistry. If you had one that you could assist with, what would that be?

Dr. Scott Sayre:

I don’t know that you want me to say this because I think that we have … You talk about the alchemists back in the Renaissance time, you talk about the barbers back in the 16 to 1800s and the people that would put leeches on you and bleed you. And then the barbers that would do extractions and hopefully give you a little drink of whiskey. We’ve come full circle. I think that it’s in Germany where you become a physician first and then your residency is in dentistry. You get to choose that. And I think that we need a lot more education in dentistry. I think that we’re doing a disservice to our dentist to make them go out and they do one or two root canals in school and then they don’t know what to do. They send it to a specialist. There’s 4,000 give or take, endodontists in the US. 4,000.

We do 17 million root canals per year. There is no way the endodontics can do all this. There’s just no way. Same with oral surgeons, same with orthodontics. Most of the orthodontics in the US is done by general dentists. Most of the oral surgeries done by general dentists, most of the endodontics is done by general dentists. So we need to find a path to allow the general dentist to do excellent work here to the standard of care. And we’re just not doing that.

So I’m sure that I am up against a world of hurt when people hear this, but I think that we need to do more training, not less. A great idea might be to have dentists become physicians and then go through a residency, a year of anesthesia, a year of general dentistry and endodontics and basics and a year of oral surgery, something along that line so that we can get out there and really, really help the public in our practices. And at the same time, we probably need dental nurses. So RNs that are well trained in dentistry that can place sutures, that can help us, that can maybe do simple fillings and things like that. We need to open dentistry’s eyes and change it.

So I’m actually a very, very conservative person. Don’t even ask me about my politics. But when it comes to dentistry, I think that we need to start expanding our eyes, expanding our horizons, and create a rainbow that will take us into the next century. I don’t know that we’re doing that.

Bill Neumann:

Well, I think that makes a lot of sense. And I think probably if you can keep the education costs down, which is probably the big challenge to adding more education, that that’s probably the one challenge you have that even if it’s limited education that they’re getting now, it’s so expensive. But to your point, that’s why you’re offering services like Vesper Institute and there are other organizations out there that out of necessity really are providing the education after the fact.

Dr. Scott Sayre:

And you know that most of the residencies in these situations, keeping costs down, you’re generally talking about the person who’s taking this. And so most residencies are paid in a general dentistry, even as a general practitioner, back in the seventies, I was paid. I’m looking at starting a residency in my office because I don’t know how to do this. It would be paid at some kind of a stipend level and the person goes out saying, geez, I know implants and wisdom teeth and sedation. That’s how we’re going to train these people. We need to create a system to do this. It’s going to be tough. That’s my vision.

Bill Neumann:

This is great. This was an incredible conversation. That’s why I love my job. I get to learn so much from people like you and what a great background. I think the audience is going to love this. So if they want to get in touch with you, is there a way that they can email you or is it best to go through the website? Is there like a contact us form?

Dr. Scott Sayre:

No, I’m happy to give you my email. It’s Dr Sayre, DRSAYRE@nofeardentist.com.

Bill Neumann:

And we’ll put that link in the show notes. But thanks Dr. Sayre for spending time with us. We appreciate it and we know it’s after hours now and you’re kind of winding down, so I appreciate you spending the evening with the Group Dentistry Now Audience.

Dr. Scott Sayre:

Oh, thank you very much. It was a pleasure and I hope somebody sees like-minded to what I’m doing and please contact.

Bill Neumann:

Yep, I’m, I’m sure we’ll get a lot of great feedback on this. So thanks everybody for listening in or watching us on YouTube today. Again, this is the Group Dentistry Now Show. I’m Bill Neuman and a big thank you to Dr. Scott Sayre. He is the President of Vesper Institute, Vesper Alliance and Advance Dentistry. And if you want to reach out to him, we’ve got all his contact information in the show notes blow. Until next time, thank you.