Podcasts about Dent

Kiera is joined by the tooth-healer himself, Jason Dent! Jason has an extensive background in pharmacy, and shares with Kiera where his pharmaceutical experience has bled over into dentistry. This includes the difference between anti-quag and anti-platelet and which medications are probably safe, what to do to shorten the drag time in the pharmacy, how to write prescriptions most efficiently, and more. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: The Dental A Team (00:00) Hello, Dental A Team listeners. This is Kiera and today is a really awesome and unique day. It is, think the second time I've had somebody in the podcast studio with me live for a podcast and it's the one and only Jason Dent. Jason, how are you? I'm doing well. Good morning. Thanks for having me. It is crazy. I I watch Instagram real like this all the time where people are like in the podcast and they're hanging out on two chairs and couches and now look at us. We're doing it. Cheers. Cheers.   That was a mic cheer for those of you who are only listening, but yeah, Jace, how does this feel to be on the podcast? It's weird. Like I was not nervous at all talking about it. I got really nervous as soon as you hit play. So if I stumble over my words, please forgive me ahead of time. Well, Jason, I appreciate you being on the podcast because marketing had asked me to do a topic about teledentistry and I was like, oh shoot, that's like not my forte at all. so   You and I were actually chatting in the hot tub. call it Think Tank session and you and I, we have a lot of good ideas that come from that Think Tank. A lot of business. no phones. That's why. We do leave our phones out. But I was talking to Jason and this is actually a podcast we had talked about quite a while ago. Jason has a lot of information on pharmacy. And if you don't know, Jason isn't really, we were going through all of it last night. It's kind of a mock in the tub. And I think it's going to be great because I feel like this is an area, I'm working at Midwestern and   knowing about how dentists, pharmacology was surely not your favorite one. Jason actually helps a lot of dentists with their clearances. And so we were talking about it and I like it will just be a really awesome podcast for you guys to brush up on pharmacology, different things from a pharmacist's side. So Jason, welcome. Thank you. Yeah, no, we were talking about it and here's like, what should I talk about on the podcast next? I have all these different topics and she's like, what do you know? And the only real interaction I have with dentists is doing clearances for procedures. We get them all the time, which makes sense.   Lots of people are on blood thinner, I've always told Kiera, like, hey, I could talk about that. Like, that's kind of a passion of mine. I'm not a dentist. Or my name is Jason Dent. So in Hebrew, Jason means tooth. No, no, no, sorry. Nerves are getting to me. Jason means healer and Dent means tooth. So my name means tooth healer. So, here's a little set. Hold on, on, hold Can we just talk about? I brought that up before you could talk about it more. So.   My name means tooth healer but I did not become a dentist. I know you wanted me to become a dentist. did. I don't know why. I enjoy medicine. I know what you're going to get to already. The things you're going to ask me. There's been years of this. But nevertheless, that's my name. We'll get that out of the way. But you did give me a great last name. So I mean, it's OK. You're All is fair and love here. SEO's up for that. But yeah, Jason, I'm going to get you right into the show. And I'm going to be the host. And we're going to welcome to the podcast show. Jace, how are you?   Good, good, good. Good, good, good. So by getting into clearances, right? This is what you're kinda talking about with you know, before we get to clearances, I actually wanted Jason, for the listeners who don't know you, who haven't talked to you, who don't know, let's kinda just give them like, how did you go from, Kiera wanted you to be a dentist, to now Jason, you are on the podcast talking as our expert on pharmacy. fantastic. I've always really loved medicine, a ton. As a kid getting headaches and taking Excedrin, like you just feel like a miserable pile of crap.   and then you take two pills and all of a sudden you feel better. Like that's amazing, like how does that happen? Also getting ear aches as a kid, just being in so much pain and then taking some medicine and you start feeling a lot better. I always had a lot of appreciation for that. I've always been mechanically inclined. I went to, started doing my undergrad and took biology and learned about ATP synthase, which is a spinning enzyme that's inside the mitochondria, like a turbine engine. I used to work on small engines on my dirt bike and thought that is so cool. So I really got wrapped up into chemistry.   All the mechanics of chemistry really pulled me in. I'm not getting goosebumps. checking. I usually get goosebumps when I think about chemistry. But it's so cool. You think an engine's awesome, like pistons and camshafts and pressures, the cell is the same thing. It's not as loud, so it's not as cool. But it's fascinating. that's why we're like. ⁓   chemistry and really got into coagulation. So I did my residency after pharmacy school. we went to Arizona for three years. ⁓ You did and your main focus, you were never wanting to be the guy behind the counter. No, I haven't done that. Yeah. No, I love them though. I've always really want to go clinical. ⁓ But I love my retail ⁓ pharmacists. They're amazing resources. And ⁓ I use the retail pharmacist every day still to this day, but I went more the clinical route, really love the chemistry aspect of it.   did my doctorate degree and then I did my residency in Reno. Reno's kind That's how we got here everybody. Welcome to Reno. Strategically placed because I was really interested in critical medicine and where we're located we cover a huge area. So we pull in to almost clear, we go clear to Utah, clear to California, all of Northern Nevada. We get cases from all over. So we actually are kind like the first hub of care for lot of areas. So we really get an eclectic mixture of patients that come in that need-   all kinds of different cases that are coming to them. So it's what I really wanted. So I did my residency in critical care there. And then for the next 10 years, I worked in vascular medicine with my final five years being the supervisor of the clinic. Ran all the ins and outs of that. So my providers, two doctors were on our view. So when we talk about dentistry, talk about production, those kinds of things, totally get it. My doctors were the exact same way, my vascular providers. ⁓   There's some pains there, right? You wanna be seeing patients as much as possible, being able to help as many people, keeping the billing up. And had other nurse practitioners, four practitioners, a fleet of MAs, eight pharmacists. We also had that one location we had, going off the top of my head, I think we had eight locations running as well. And we took care of all the different kinds of vascular cases that came to us. Most common was blood clots, ⁓ which is just a...   which is an easier way of saying VTE. There's so many different ways to say a blood clot. Like you might hear patients say, I've had a PE or a DVT or a venous thromboembolism or a clot in my leg, right? They're all clots, but in different locations. Same with an MI, and MI can be a clot as well. ⁓ there's a lot of, everybody's kind of saying the same thing, but sometimes the nomenclature can make it sound hard, but it really is actually pretty simple.   No. And Jason, I love that you went through, you've been in like, and even in your, ⁓ when you were getting your doctorate, you were in the ER. You also worked in retail pharmacy. remember you having a little sticker on your hand. And retail pharmacy, I have a lot of respect for those guys. They have a lot of pressure on them. and then you also, ⁓ what was that test that you had to take that? I don't know. You were like studying forever for it. ⁓ board certification for, ⁓ NABP. Yeah. So I did that board certification as well.   And now you've moved out of the hospital side onto another section in your career. Now in the insurance, right? So it's really, really interesting. So now I'm on the other side reading notes and evaluating clinical appropriateness and trying to help patients with getting coverage and making those kinds of determinations. So yeah, I've really jumped all over. Really love my clinical days. I know. don't I don't I do miss them. But yeah, kind of had a good exposure to a lot of.   pharmacy a lot a lot of dentists actually with all the places that come through which Jason I really appreciate that and honestly I know you are my spouse and so it's fun to have you on but when I go into conversations like this I don't know any of this information and so finding experts and Jason I think here's me talk more about dentistry and my business than I do hear about him on pharmacy so as we were chatting about this I really realized you are a wealth of knowledge because you've been on the clinical side so you've done a lot of patient care and you've seen how   medications interact and I know you've had a few scares in your career and ⁓ you've known some physicians that have had a few scares and ⁓ you've seen plenty of patients pass away working in the ER and gosh in Arizona drownings were such a big deal. I remember when you were in the ER on your rotations I'd be like who died today? Like tell me the stories and you've really seen and now going on to the insurance side I felt like you could just be such a good wealth of knowledge because I know dentists are sometimes so   I would say like maybe just a little more anxious when it comes to medications. I know that dental students from Midwestern were like here was like four months and we had to like pass it, learn it. And Jason, you've done four years plus clinical residency, plus you've been in it. And something I really love about Nevada Medicine is they've been so collaborative with you.   like your heart, your cardiologist, they diagnose and then they send to you to treat with medicine and... Yeah, I've been really lucky being here in Reno too. The cardiology team has been amazing to work with. We started a CHF program, sorry, congestive heart failure program for patients. So we would collaborate with cardiologists. They'd see the cardiologists and then they send them to the pharmacist to really manage all the medications. So there's pillars of therapy ⁓ called guideline directed medical therapy and the pharmacist would take care of all that. So that's gonna be your...   your beta blockers, your ACEs, your ARBs, your Entresto, which would be a little bit better, spironolactone. So just making sure that all these things are dosed appropriately, really monitoring the heart, and make sure that patients are getting better. we've had real positive outcomes when the, sorry, this is totally off topic. do, talk about that study. When we looked at when patients were coming to see our pharmacists in our clinic that we started up, the patients were half as likely to be readmitted. And this was in 2018, and our pharmacists,   We're thinking about all the medications. We're usually adjusting diabetes medications too at the same time. Just kind of naturally just taking care of all the medications because we kind of got a go ahead from the providers, a collaborative practice agreement that we could make adjustments to certain medications within certain parameters. So we weren't going rogue or maverick, but we were definitely trying to optimize our medications as much as possible. And then years later, some studies came out with, I'm sure you've seen Jardins and Farseegh. not trying to, I'm not.   I don't get any kickback from them. I have no conflicts to share. But because our pharmacists were really optimizing that medication, those medications were later shown to reduce hospitalizations and heart failure, even though they're diabetes medications. Fascinating. So it wasn't really the pharmacists. It was just the pharmacists doing as much as they can with all the tools that were in front of them. And then we found out that the patients were going back to the hospital.   half as much as regular patients. So, yeah, being here, it's been so amazing to work with providers here. the providers here want help, want to help patients, don't have an ego. I mean, I just, it's awesome. I love it. I do love how much I think Jason sees me geek out about dentistry and I watching Jay's geek about his pharmacy and how much he loves helping patients. And ⁓ really that was the whole idea of, all right.   Dentistry has pharmacy as a part of it. And I know a lot of dentists are sending in clearances and I know working in a chair side, it would be like, oh no, if they're on warfarin or on their own blood clot, you guys, honestly don't even know half of what I'm talking about because this is not my jam, which is why Jason's here. But I do know that there was always like, well, we got to talk with their provider. And so having Jason come in and just kind of explain being the pharmacist that is approving or denying or saying yes or no to take them off the blood thinners in different parts, because you have seen several dental   I don't know what they're called. What is it? Clarence's? that what comes to you? don't even know. All day my mind, it's like, here is the piece of paper that gets mailed to you to the pharmacist and then you mail it back. So whatever that is. But Chase, let's talk about it because I think you can give the dentist a lot of confidence coming from a pharmacist. What you guys see on that side. When do you actually need to approve or disapprove? Let's kind of dig into that. Yeah. Well, first of all, I think I'm not a replacement for any kind of clinical judgment whatsoever. Every patient's different. But the American Diabetes Association, you   I work with diabetes a lot. American Dental Association has some really great guidelines on blood thinners and I would always reference them. I actually looked at their website today. Make sure I'm up to speed before I get back on this again. They have resources all around making decisions for blood thinners. And I think the one real important thing in putting myself in the shoes of a dentist or any kind of staff that's around a patient that's in a chair, if they say I'm on a blood thinner, right, a flag goes up. At least in my mind, that's what goes up.   Like, okay, how do we get across this bridge? And I think the important thing to really distinct right then when they say they're on a blood thinner is that is kind of a slang word for a lot of different medications, right? Like it's the overarching word that everybody pulls up saying, I'm on a blood thinner. It's like, okay, but I don't know what say. It's like, I have a car. You're like, okay, do you have a Mazda? Do you have?   Toyota, Honda, what do you have? or even worse it'd be like saying I have a vehicle, right? So when somebody says they're on a blood thinner, it opens up a whole box of possibilities of what they're Blood thinners are also, doesn't, when they're taking these types of medications that are quote unquote a blood thinner, it doesn't actually thin the blood, like adding water to the blood, if that makes sense, or like thinning paint, or like thinning out a gravy, right? It doesn't do the same thing. Blood thinners, really what they're doing is they're working on the blood, which.   which is really cool, try not to tangent on that. ⁓ When they're working on the blood, it's not thinning it per se, but it's making it so that the proteins or platelets that are in it can't stick together and make a cloth quite as easy. So whenever somebody's on a blood thinner, I usually ask, what's the name of the blood thinner that you're on? It's not bad that they use that slang, that's okay, on the same page, but it's really broken into two different classes. There's anticoagulant and antiplatelet.   And a way to kind of remember which is which, when residents would come through our clinics, the way that I teach them is a clot is like a brick wall. You know, it's not always a brick wall. Usually the blood is a liquid going through. But once they receive some kind of chemical message, it starts making a brick wall with the mortar, which is the concrete between the and the bricks, the two parts. When it's an anti-quagent, it's working on that mortar part. When it's an anti-platelet, it's working on the bricks part, right? You need both to make a strong clot or strong brick wall.   But if you can make one of them not work, obviously like if your mortar is just water, it's not working, right? You're not gonna make a strong brick wall. So that's kind of the two deviants right there. So that's what I do in my mind real quickly to find out because antiplatelets are usually, so that's gonna be like your Plavix, Ticagrelor, Brilinta. And hold on, antiplatelets are bricks? Good job, bricks. They're the bricks. And so the reason I was thinking you could remember this because I'm, antiplatelets, it's a plate and a plate is more like a brick.   And anti coagulant, I don't know why quag feels like mortar to me, like quag, like, know, it's like slushy in the blood, like it's coagulating. It's a little bit of that, like, honestly, I'm just thinking like coagulated blood is a little bit more mortar-ish. And so platelet is your plate, like a brick, and anti-quag is like.   the gilly between the bricks. Okay, okay, I got it. Yeah, so there's an exception to every rule, but when they're on that Don't worry, this is Kiera, just like very basic. You guys are way smarter listening to this, and that's why Jason's here. No, no, you helped me pass pharmacy school. When we were doing all the top 200, you helped me memorize all know what flexorill is, all right? That's a muscle relaxant. Cyclo? I don't know that part. It's a cyclo, because you guys are cycling and flexing. I don't actually know. just know it's a muscle relaxant, so that's about as far as I got. When we're looking at antitick platelets, so that's the brick part, so that's going to be your, you know,   Hecagrelor, Breitlingta, Clopidogrel is the most common one. It's the cheapest one, so probably see that one the most. Those, I mean, there's an exception to every rule, but that's generally being used after like a stent's placed in the heart. It can be used for VTE, there's some out there, but that's pretty rare. But also for some valves that are placed in the hearts, it can be used for that as well. So antiplatelet, really thinking more like a cardiac event, right? Like I said, there's always an exception to every rule, but that's kind of where my mind goes real quickly, because we're gathering information from the patient.   They're on anticoagulant. Those are like going to be the new ones that you see commercials for all the time. So Xeralto, Alequis, those are the two big ones right now. They're replacing the older one. And also we were supposed to do a disclaimer of this is current as of today because the ADA guidelines do change. this will be current as of today. And Jason, as a pharmacist, is always looking up on that. I had no clue that you are that up to speed on dental knowledge. so just throwing it out there that if you happen to catch his podcast,   a few years back that obviously check those guidelines for sure. But the new ones are the Xarelto and Eloquist. They're replacing the older ones of warfarin. Warfarin's been around for a really long time. We've seen that one. Those are anti-coagulants. So when you're looking, when a patient says that, generally they're on that medication because they've possibly had a clot in the past or they have a heart condition called atrial fibrillation. Those are kind of the two big ones. Like I said, there's always caveats to it, but that's kind of where my mind goes real quickly. And then,   as far as getting patients cleared, the American Dental Association has really good resources on their website. You can look at those and they're always refreshing that up. They even say in their own words that there's limited data around studying patients in the dental chair and with anticoagulants or anti-platelets. It's pretty limited. There's a few studies, some from 2015, some from 2018. There's one as recent as 2021, which is nice. But really, all of those studies come together and it's really more of an expert consensus.   And with that expert consensus, they have kind of simplified things for dentistry, which is really nice. ⁓ comparing that to, we have more data for like total hip replacement, total knee replacement. We have a lot of data and we know really what we should be doing around then. But going back to dentistry, we don't have as much information, so they always say use clinical judgment, but they do give some really great expert guidance on that. So if a patient's on an anticoagulant, ⁓   they generally recommend that it doesn't need to be stopped unless there's a high bleeding risk for a patient. as a provider or as a clinician in the practice, you can be looking at high bleeding risk. Some things that make an oral procedure a little bit lower risk is one, it's in the compressible site, right? Like we can actually put pressure on that site. That's the number one way to stop bleeding is adding pressure. It's not like it's in the abdominal cavity where we can't get in and can't apply pressure. So number one, that kind of reduces the bleeding risk.   is number one. Two, we can add topical hemostatic agents. Dentists would know that better than me. There's a lot of topical ways to do that. So not only pressure, but there's those things as well. And also, but there are some procedures that are a little bit more likely to bleed. And that's where you and dentists would come in hand in What's the word in APO? Oh, the APOectomy. I got it right. Good job. like, didn't you tell me last night that the ADA guideline was like what?   three or four or more teeth? great question. So you can extract one to three teeth is what their expert consensus One to three teeth without. Without really managing or stopping anticoagulation or doing anything like that. I think that's some good guidance from them. I'm gonna add a Jasonism on that though. So with warfarin, I do see why dentists would be a little bit more conservative or worried about stopping the warfarin because warfarin isn't as stable as these newer agents. Warfarin, the levels.   quote unquote levels can go really high, they can go really low. And if the warfarin levels are high, they're more likely to bleed. So I do think it makes sense to have a really recent INR. That's how we measure what the warfarin's doing. I think that makes a lot of sense, but the ADA guidelines really go into the simplification version of all these blood thinners. Generally, it's recommended to not stop them because the risk of stopping them outweighs the benefit of stopping them in almost every case. Almost every case.   ⁓ So when you're with that patient, right, they say I'm on a blood thinner, finding out which kind of blood thinner that they're on, you find out that they're on Xeralto, right? How long have you been on Xeralto for? I've been on it for years. You don't know exactly why, but if they haven't had any recent bleeding, you're only gonna remove one tooth. ⁓ You can do what's called a HasBlood score. That kind of looks at the bleeding risk that they'd have. That'd be kind of going a notch above, but in my mind, removing one tooth isn't a real serious bleeding risk. I'd love to hear from my dentist friends if they...   disagree, right, but ADA says one to three tooth removals, extractions, that's the fancy word. Extractions, yeah, for extracting teeth out. Is not really that invasive. Sure. It's not that high risk, so it's usually perfectly fine. So if a patient was on Xarelto, ⁓ no other, this is in a vacuum, right? I'm not looking at any other factors, which you should be looking at other factors. I would be perfectly fine to just remove one to two.   And when those clearances come in, because dentists do send them, talk about what happens. You guys were working in the hospital and you guys would get these clearances all the time. do. We get them so often. I mean, we get like four or five a day. We'd love to give it to our students, student pharmacists, and ask them what to do. And they would usually look up the American Dental Association guidelines and come up with something. We're like, yep, that's what we say too. In fact, we say it so many times a day that we have a smart phrase.   which just blows in the information real quickly and faxes it right back to the So it's like a copy paste real quick. So what I wanted to point out when Jason told me this is dentists like hearing this and learning this, this can actually save you guys a ton of time to be able to be more confident, to not need to send those clearances on. And we were actually talking last night about how I think this might be a CYA for dentists. like, as we were talking, I think Jason, you seeing so many other aspects of medicine, like you've literally seen patients die, you've seen other areas.   And so coming from that clinical vantage point, we were realizing that dentists, we are so blessed to live in an injury. I enjoy dentistry because possibly there's someone dying, not super high, luckily in dentistry. The only time that I have actually had a doctor have a patient pass away, and it was only when they were completely sedated and doing ⁓ some other things, but that was under the care of an anesthesiologist. And so that's really our high, high risk. And so hearing this, Jason,   That was one of the reasons I wanted him to come on is to give you doctors more confidence of do we have to always send to a pharmacist? I mean, hearing that on the pharmacy side, they're just sending these back and not to say to not see why a to not cover this because you might be questioning like, well, do I really need to? But you also were talking about some other ways of so number one, you guys are just going to copy back the 88 guidelines. So so 88 guidelines. Yeah. And I think that that gives a lot of confidence to a provider or a dentist is that you can go to the 88 guidelines and read them, right? Like you're listening to some   nasally monotone pharmacist on a podcast. Rumor has it, people love him at the hospital. were like, you're the voice, he's been told he has a good radio So for the clinic, I was the voice. Like, yeah, you've reached the vascular clinic, right? And they're like, oh my gosh, you're the voice. But sorry, you me distracted. That'll be your next career, Jace. You're going to be a radio host. OK. I would love that. I love music. But you're hearing from a nasally guy, but you can actually read the ADA guidelines. You just go right to the ADA, click on Resources, and under Resources, it has the   around anticoagulants, I think that's the best way to get a lot of confidence about it because they have dentists who are the experts making calls on these. I'm just reiterating what they say, but I think it makes a lot of sense to help providers. And the reason why my heart goes out to you as well is having the providers that used to work underneath me, they're always looking for our views, which is a fancy way of making sure that they're drilling and filling. Can I say that? Yeah, can say drilling and filling. They're being productive, right? They're being productive, right?   They're always looking to make sure if a patient's canceling, like get somebody in here. Like I need to be helping people all day long. That's how I, we keep the lights on. That's how I help as many people. And so if you have a patient coming in the chair and it has an issue, they say I'm on Xeralto. Well, you can ask real quickly, why are you on Xeralto? I had a clot 10 years ago. my gosh. Well, yeah, we're pretty good to go. Then I'm not worried. We're only removing one tooth or we're just doing a cavity or a cleaning. Something like that. Shouldn't be an issue whatsoever because there's experts in the dental. ⁓   in the dental society, the ADA guidelines that recommend three teeth or less, minimally invasive. They really recommend if it's gonna be really high bleeding risk. And clinically, that's where you would come in, ⁓ or yourself. know, apioectomy is one that's like on the fence line. I don't know where implants set. though, and like we were talking, implants aren't usually like a date of procedure. Most people aren't popping in, having tooth pain, and we're like, let's do an implant. Now sometimes that can be the case, but typically that one's gonna have   a few other pieces involved. And so that is where you can get a clearance if you want to. ⁓ But we were really looking at this of like so many dentists that I know that you've seen will just send in these clearances because they are. And I think maybe a way to help dentists have more confidence is because you know, I love routines. I love to not have to remember things. So why don't we throw it in, have the team member set it up where every quarter we just double check the ADA guidelines. Are there any updates? Are there any other things that we need to do on that? That way you can just see like   getting into the language of this, of what do I need to do? Because honestly, you guys, know pharmacy was not a big portion for it, so, recommending different parts, but I think this is such a space where you can have confidence, and there's a few other things I wanna get to, and I you- I some pearls too. Okay, go. I'm so when she get me into talking about drugs, I'm not gonna stop. So, some other things around that too is these newer blood thinners like Xarelto Eloquist, they now have reversal agents, so a lot of providers in the past were really worried about bleeding because we can't turn it off. We can turn those off. Warfarin has reversal as well, right?   So I'm looking at these patients. It's really low risk. It's in the mouth, generally speaking. Very rarely are they a high bleeding risk. Now if you're doing maxillofacial surgery, this does not apply, right? This does not apply whatsoever. you're like general dentist, you're pediatric dentist. Yeah, yeah, and it's kind of on the fly. So just trying to really help you to be able to take care of those patients on the moment, have that confidence, look at the ADA guidelines, have that in front of you. I don't think it's a bad thing to ever...   check with their provider if you need to. If you're thinking, I feel like I should just check with the provider, I would never take that away from you. But I just want to kind of steer towards those guidelines that I have to help. But what did you want to share? No, yeah, I love that. And I think there were just a few other nuggets that we were chatting about last night that can help dentists just kind of get things passed a little bit easier. So you were mentioning that if they were named to their cardiologist, what was it? was like, who is the last? Great question. Yeah, when a patient's on a blood thinner,   It could be prescribed by the cardiologist. It could be prescribed by the family provider or could have been punted to like a vascular clinic like where I was working. It can go to any of those. And when you send that fax, right, if it goes to the cardiologist and it's supposed to go to the family care provider, like it just kind of goes, goes nowhere, right, from there. So I think it's a really good idea to find out who prescribed it last. If the patient doesn't know who prescribed their blood thinner last, you can call their pharmacy. I call pharmacies all day long.   I have noticed in the last year, they are way easier to get a hold of, which has made my job a lot easier, working on the insurance portion. So reaching out to the pharmacy, finding out who that provider is and sending it to them, because they should be able to help with that. I thought that was a good shift in verbiage that you had of asking instead of like the cardiologist, because that's who you would assume was the one. But you said like so many times you guys would take care of them, and then they go back to family practitioner, and you guys would get the clearances, but you couldn't clear because you weren't overseeing. So just asking the patient.   who prescribed their medication for them last time. That way you can send the clearance to the correct provider. then- And they might not know. You know patients, right? They're like, I don't know, my mom's or else, I don't know who gave it to me. Somebody told me I need to be on this. But at least that could be another quick thing. And then also we were talking last night about-   ⁓ What are some other things that dentists can do when like writing scripts to help them get what I think like overarching theme of everything we discussed is one how to help dentists have less I think drag through pharmacy. ⁓ Because pharmacy can take a little while and so perfect we now know the difference between anti-quag and anti-platelet. We know which medications are probably safe. We know we can check the ADA guidelines so that we were not having to do as many clearances. We also know if they're on a medication to find out and we do need a clearance.   who we can go to for the fastest, easiest result. And now, in talking about prescriptions, you had some really interesting tips that you could share with them. Yeah, so with writing prescriptions, right, pharmacies are pharmacies. So I'm not gonna say good thing or bad thing. There are challenges working with pharmacies. I'm not gonna play that down at all. ⁓ If you're writing prescriptions and having issues and kickbacks from pharmacies, there's some interesting laws around ⁓ writing prescriptions. Say that you're trying to ⁓ prescribe   augmentin, you know, 875 BID, and you tell the patient, hey, I want you to take this twice a day for seven days, and then you put quantity of seven, because you're moving fast, right? You want it for seven days, quantity of seven. Quantity would actually be 14, right? It's not that big of a deal. Anybody with common sense would say if you're taking a pill for twice a day for seven days, you need 14 tablets. But LAHA doesn't allow pharmacists to make that kind of a change, unfortunately. They have to follow what you're saying there. So you're going to get a...   An annoying callback that says, you wrote for seven tablets. I know you need 14. Is that OK? Just delays things, right? So ⁓ I really like the two letters QS. That's Q isn't queen. S isn't Sam. Yeah. It stands for quantity sufficient. So you don't have to calculate the amount of any medication that you're doing. So for me, as a pharmacist, when I was taking care of patients, I hated calculating the amount of insulin they would need for an entire month. So I would say.   Mrs. Jones needs 15, I'd say 15 units ⁓ QD daily. ⁓ And then I say QS, quantity sufficient, ⁓ 90 day supply through refills. So the pharmacy can then go calculate how much insulin that they need. I don't have to even do that. So anytime you're prescribing anything, I like that QS personally. So that lets the pharmacy use ⁓ common sense, as I like to call it, instead of giving you a call. I think that's super helpful. I also thought of one thing too.   going back to blood thinners is when it's kind of like a real quick, like they're not gonna have you stop the blood thinner at all. like you're seeing if you can stop the blood thinner for a patient, there's some instances it's just not gonna happen. And that's whenever they've been, they've had a clot or a stroke or a heart attack within the last three months. Three months. Yeah, that's kind of like the.   Because so many people are like, they had a heart thing like six years ago. And so I think a lot of my dentists that I worked with were like, we got to stop the blood thinners. But it sounds like it's within three months. Yeah, well, I'm just the time. Like this is general broad strokes. What I'm just trying to say is when you want to expect a no real quick. Got it. Right. So because benefits of stopping a blood thinner within those first three months of an event is very, very risky versus the, you know, the benefit of reducing a little bit of blood coming out of the mouth. Right. Like that's not that bad.   when somebody's had a stroke or a heart attack or pulmonary embolism, a clot in the lung, like we can't replace the lung, heart or brain very easily. We can replace blood a lot better. We've got buckets of it at most hospitals have buckets of it, right? So I'm always kind of leaning towards I'd rather replace blood than tissue at all times. So that's kind of a quick no. If they've had one those events in the last three months, we are really, really gonna watch their brain instead of getting.   root canal, right? Like really worried about them. So you'll just say no. And they could the dentist still proceed with the procedure or would you recommend like a three month wait? Or is it provider specific way the pros and cons because sometimes you need to get that tooth out. Great question. think then it's going to come into clinical. That's that's when you send in the clearance, right? Like, and it's great to reach out to the provider who's managing it for you. But I think it's kind of good to know exactly when you get a quick no quick no is going to be less than three months.   ⁓ Or when it's going to be like a kind of a typical, yeah, no problem. If it's been no greater than six months, they're on the typical anticoagulants or alto eloquence. Nothing crazy is going on for them. You're only removing two teeth. This is very, very low risk. But again, I'd urge everybody to read the ADA guidelines. That way you feel more comfortable with it. I'm not as eloquent as they do. They do a real good job. So I don't want to take any of their credit. I think they do a real good job of simplifying that and making you feel confident with providing.   more timely care for patients. Which is amazing. And Jayce, one last thing. I don't remember what it was. You were talking about the DEA and like six month rule. yeah. Let's just quickly talk about that and then we'll wrap this because this is such a fascinating thing for me last night. Yeah. So when comes to prescribing controlled substances, most providers have to have a DEA license. OK. First of all, though, what's your take on dentist prescribing controlled substances? ⁓ I don't think, you know, I worked on the insurance side of things. Right. And I look at the requirements for the   as the authorizations, what a patient, the criteria a patient needs to hit in order to qualify for certain medications. A lot of times for those controlled substances, they have pretty significant issues going on, like fibromyalgia or cancer-related pain or end-of-life care versus we don't, in all my scanning thread, I don't have a ⁓ perfect picture memory. Sure. But I don't usually see oral.   pain in there. There is some post-operative pain that can be covered for those kind of medications but I really recommend to keep those lower and in fact in a lot of our criteria it recommends you know have they tried Tylenol first, they tried, have they filled NSAIDs or are they contraindicated with the patient. So really they should be last line for patients in my two cents but there's always going to be a caveat to the rule right? Of course. comes through that has oral cancer and you're taking   like that would make sense to me. Got it, so then back to the DEA. Yeah, okay. Okay, ready. So as a provider, you should be checking the, if you're doing controlled substances, you should be checking the prescription drug monitoring program, or sometimes called the PDMP, looking to see if patients are getting ⁓ controlled substances from another provider. So it's really just a check and balance to make sure that they're not going from provider to provider to getting too many narcotics and causing self harm or harm to others.   And so with checking that PDMP before prescribing, I think a lot of providers do that. A lot of softwares that I'm aware of, EMRs, electronic medical records, sometimes have links so that you can do that more quickly. However, I don't think it's as intuitive that they need to be checking that every six months in some states. And like here in Nevada, you're supposed to be checking it every six months, not for a patient, but for your actual DEA registration to see if anybody else is prescribing underneath you. Because if you don't check that every six months, you could get in some serious trouble with...   not only DEA, but even more the Board of Pharmacy and your state. Now, I don't know all 50 states, so I check with your state to see if you need to be checking that every six months, but set an alarm just to check that real quickly, keep your nose clean. ⁓ I've had providers, I've had to remind to do that. And if somebody was using your account, prescribing narcotics, you'd never know unless you went and checked that PDMP.   Yeah, I remember last night you were like, and if that was you, I would not want to be you. The Board of Pharmacy is going to be real excited to find you. So that was something where I was like, got it. So, and we all know I'm big on let's make it easy. And Jason, I love that you love this so much and you just brought so much value today. And like also for me, it's just fun to podcast. fun. Yeah. But I got a nerd out on my world a little bit. Bring it into yours. I work with dentists or at least you know, when I was working in Vascular Clinic all day long. Great questions that would come through. Yeah.   So I think for all of us, as a recap on this is number one, I think setting yourself ⁓ some cadences. So maybe every quarter we check our ADA guidelines and we check our, what is it, PDMP. PDMP. so each state, so they call it Prescription Drug Monitoring Program. We need that. Yeah, but there are different acronyms in different states, though. That's just what it's called in Nevada. I forget what it is in California, but you can check your state's prescription monitoring program, make sure that opioids aren't being prescribed under your name. Got it. So we just set that as a cadence.   We know one to three teeth most likely if they're on a blood thinner is According to the 88 as of today is good to go You know things that are going to get a quick know are going to be within the last three months of the stroke the heart attack or the Clot I'm thinking like the pulmonary embolus. Yeah, that's what we're trying to prevent   Those are gonna be quick knows and then if we're prescribing, let's do QS. We've got quantity is sufficient so that we're not getting phone calls back on those medications that we are. And then on narcotics, just being a bit more cautious. Of course, this is provider specific and in no way, or form did Jason come on here to tell you you are the clinical expert.   Jason's the clinical expert on medications. And if you guys ever have questions, I know Jason, you geek out and you want to talk to people so that anyone wants to chat shop. Be sure to reach out and we'll be able to connect you in. we've even talked about possibly, so let me know listeners. You can email in Hello@TheDentalATeam.com of ask a pharmacist anything. I talked to Jason. I was like,   We'll just have them like send in questions and maybe get you back on the podcast or we do a webinar. But any last thoughts, Jace, you've got of pharmacy and dentistry as we as we wrap up today? No, I think that's pretty much it. So check the ADA guidelines. I think it's really good to have cross communication between professions. Right. If you're working with the pharmacy, CVS, Walgreens or something like that or Walmart, I know that it can be challenging. Right. They're under different pressures. You're under different pressure. So I think ⁓ just coming in with an understanding, not being angry at each other.   you know what mean, is super beneficial and working together. When it comes to it, every dentist that I've talked to is actually worried about their patient. Every pharmacist that I've worked with is really worried about the patient as well. So we're trying to accomplish the same thing, but we have different rules and our hands are bound in different ways that annoy each other, right? Like I know Dr. Jones, want 14 tablets, but you said seven. And I know Common Sense says I should give them 14, but I've got to make that change.   knowing that their hands are tied by the law. They can't use as much common sense, which is aggravating. I mean, that's why I love what I gotta do here. I gotta just kind of help a lot more and use common sense and improve patient care. But those kinds of things I think are really beneficial as you work together and then not being so afraid of blood thinners, right? So I think those guidelines do a great job of giving you confidence and not worrying about the side effects. And there's a lot of things that you can do locally for bleeding.   You have a lot of control over that. I think that's pretty cool, the tools they have. Yeah. And at the end of the day, yes, you are the clinician. You are the one who is responsible for this. so obviously, chat, but I think collaborating, talking to other pharmacists, talking to them in your state, finding out what are the state laws, things like that I think can be really beneficial just to give you peace of mind and confidence. And again, dentistry, are maybe a bit more risk adverse because luckily we don't have patients dying That's great thing. Yeah, that's fantastic. I want my dentists to be risk adverse. I think so too. But Jason, I appreciate you being on the podcast today.   And for all of you listening, ⁓ more confidence, more clarity, more streamline to be able to serve and help our patients better. if we can help you in any way or you've got more questions, reach out Hello@TheDentalATeam.com. And as always, thanks for listening. I'll catch you next time on the Dental A Team podcast.  

Lin Zexu believed moral clarity and the largest drug bust in history could end the opium crisis and avert war. Yet, as his solution drained into Humen Bay, so too did the last hope of peace between China and Britain.Time Period Covered:1836–June 1839 Major Historical Figures: The Qing Empire:The Daoguang Emperor (Aisin-Gioro Minning) [r. 1820–1850]Lin Zexu, Imperial Commissioner and Governor-General of Huguang [1785–1850]Deng Tingzhen, Governor-General of Liangguang [1776–1846]Huang Juezi, Minister and court official (opium policy advocate) The British Empire:King William IV [r. 1830–1837]Queen Victoria [r. 1837–1901]Henry John Temple, 3rd Viscount Palmerston, Foreign Secretary [1784–1865]Charles Elliot, Chief Superintendent of British Trade in China [1801–1875]Lancelot Dent, Opium trader and head of Dent & Co. [1799–1875]James Matheson, Merchant and political advocate for war [1796–1878] Major Sources Cited:Fairbank, John K. Trade and Diplomacy on the China CoastPlatt, Stephen R. Imperial Twilight: The Opium War and the End of China's Last Golden AgeWakeman, Frederic, Jr. “The Canton Trade and the Opium War,” in The Cambridge History of China, Vol. 10Wakeman, Frederic, Jr. The Fall of Imperial ChinaLovell, Julia. The Opium War: Drugs, Dreams and the Making of China Learn more about your ad choices. Visit megaphone.fm/adchoices

Pat Brady, SVP of Mercury Public Affairs, former chairman for the Illinois Republican Party, and former federal and state prosecutor, joins Wendy Snyder, filling in for Lisa Dent, to discuss the fatal shootings in Minnesota and the political fallout as a result. [audio https://serve.castfire.com/audio/7941486/Pat_Brady_01_28_2026_2026-01-28-211726.64kmono.mp3

Clinical psychologist and parenting expert Dr. John Duffy joins Wendy Snyder, filling in for Lisa Dent, to discuss how a period of ‘national trauma’ is affecting the mental health of the country.

Tanner Mitchell, known as Tanner the Planter on social media, joins Wendy Snyder, filling in for Lisa Dent, to discuss how to take care of house plants during the winter.

Wendy Snyder, filling in for Lisa Dent, checks in with the newsroom to hear their stories including a nationwide class‑action lawsuit accusing Costco of falsely advertising that its rotisserie chicken contains “no preservatives.”

Tom Appel, Publisher, Consumer Guide Automotive and host of the Consumer Guide Car Stuff podcast, joins Wendy Snyder, filling in for Lisa Dent, to discuss car care during a deep freeze.

WGN-TV weather producer Bill Snyder joins Jon Hansen, filling in for Lisa Dent, to talk about the ongoing cold spell. He shares that the cold “isn’t going away anytime soon.” It’s not just Illinois that is facing freezing temperatures. Cities as far south as Miami, Florida are seeing freezing temperatures.

Terry Savage, nationally syndicated money columnist, joins Jon Hansen, in for Lisa Dent, to discuss the latest money news. She reviews the latest movements on the stock market; comparing the Dow and the S&P 500; the Federal Reserve, the strength of the dollar, and more.

Dr. Jim Adams, Chief Medical Officer of Northwestern Medicine, joins Jon Hansen, filling in for Lisa Dent, to discuss several health topics. He discusses the growing measles cases in South Carolina, herd immunity, the latest on Alzheimer’s testing, and the flu.

Restaurateur Grant DePorter joins Jon Hansen, filling in for Lisa Dent, to share that the Harry Caray's Tavern Navy Pier Location is hosting the 3rd Annual Harold Ramis Day on February 2nd for Groundhog Day. For more information, click here.

Jon Hansen, filling in for Lisa Dent, checks in with the newsroom to hear their stories, including the death of Virginia Oliver at age 105, who spent nearly 100 years working as a lobster harvester in Maine.

Pat Hynes, Lyons Township assessor and candidate for Cook County assessor, joins Jon Hansen, filling in for Lisa Dent, to discuss the role that assessor have in local government and his campaign for Cook County's assessor position.

President and founder of Innovation DuPage Joe Cassidy, MBA EdD, joins Jon Hansen, filling in for Lisa Dent, to talk about what Innovation DuPage is and how they help small businesses thrive. Cassidy shares their efforts in helping companies that are focused on clean energy.

Jon Hansen, filling in for Lisa Dent, checks in with the newsroom to hear their stories.

WGN-TV weather producer Bill Snyder joins Jon Hansen, filling in for Lisa Dent, to talk about the dangerously cold temperatures coming this weekend. Snyder shares that Friday will feature the coldest temperatures in seven years.

WGN-TV Chief Meteorologist Demetrius Ivory joins Wendy Snyder, filling in for Lisa Dent, to discuss the weather. Listen in while Demetrius breaks down this upcoming cold weather, whether or not we should expect snow, and how he’s also counting down the days until we have warmer weather.

Dan Hampton, NFL Hall of Famer and host of the Hamp and O'B show, joins Wendy Snyder, filling in for Lisa Dent, to reflect on the 2025 Chicago Bears season as a whole and what he’s looking forward to most for the team next season.

Terry Savage, nationally syndicated money columnist, joins Wendy Snyder, in for Lisa Dent, to discuss how the stock market is looking on this day, January 20th, 2026. Then, as always, Terry answers questions from listeners.

Pat Brady, SVP of Mercury Public Affairs, former chairman for the Illinois Republican Party, and former federal and state prosecutor, joins Jon Hansen, filling in for Lisa Dent, to discuss what the future is looking like pertaining to the potential of a new NFL stadium for the Chicago Bears and what Illinois legislators need to […]

Patrick Dolan, Employment Lawyer at Conti & Dolan, joins Jon Hansen, in for Lisa Dent, to discuss all things employment law. Listen in while Patrick stresses the importance of knowing what your rights are as an employee. To learn more about how Patrick can help you, call him at 1-312-332-7800 or visit contidolanlaw.com.

Lou Manfredini joins Jon Hansen, filling in for Lisa Dent, for Lou's To Do List, sponsored by Perma-Seal. Lou answers any questions you have about projects on your to-do lists.

Ron Brown, news anchor for WGN Radio, usually joins the show to share his weekly movie review. However, this week, as Jon Hansen fills in for Lisa Dent, Ron joins the show to break down the 2026 Oscar nominations list and to also share some of his predicitons for the 98th Academy Awards.

Executive Director of The Banchet Awards Michael Muser joins Wendy Snyder, in for Lisa Dent, this Foodie Friday to talk about all the culinary excellence that Chicago offers year in and year out. Listen in while and who Jean Banchet is to the culinary world. The Banchet Awards for Culinary Excellence will take place on […]

Dan Hampton, NFL Hall of Famer and host of the Hamp and O'B show, joins Wendy Snyder, filling in for Lisa Dent, to reflect the ’85 Chicago Bears Super Bowl XX win on January 26, 1986 hitting its 40th anniversary. Then, Dan shares his Super Bowl LX prediction.

Wendy Snyder, filling in for Lisa Dent, checks in with the newsroom to hear their stories.

Peter Greenberg, travel expert and host of Eye on Travel on WGN Radio, joins Wendy Snyder, in for Lisa Dent, to discuss how safe water and coffee actually are on board and the necessity for buffer time between connecting flights.

Alexander Zalben, Editor of Comic Book Club, joins Wendy Snyder, in for Lisa Dent, to discuss the latest in television, entertainment, and streaming. Listen in while Wendy and Alexander break down two must-see documenataries: ‘I’m Chevy Chase and You’re Not’ and ‘Mel Brooks: The 99 Year Old Man!’ Then, Alexander talks about shows to be on […]

Purdue had been playing with fire for a few games and finally got burnt in Pauley Pavilion. Poor three point shooting and in ability to make stops ends Purdue's 9-game winning streak. Hosted by Simplecast, an AdsWizz company. See https://pcm.adswizz.com for information about our collection and use of personal data for advertising.

Jon Hansen, filling in for Lisa Dent, checks in with the newsroom to hear their stories.

Jon Hansen, filling in for Lisa Dent, checks in with the newsroom to hear their stories.

Jon Hansen, filling in for Lisa Dent, checks in with the newsroom to hear their stories including the 25th anniversary of the “Super Fans” sketches on Saturday Night Live.

Tarik Shahzad, birding hobbyist, joins Jon Hansen, filling in for Lisa Dent, to share his record-breaking 2025. Shahzad captured 296 bird species for Cook County's Big Year competition, more than any other birder in Cook County history. He broke the previous record, his own, set in 2024 by two birds. The 27-year-old shares how birding […]

James Gardiner, Aussie Bears fan, joins Jon Hansen, filling in Lisa Dent, to talk about his Bears fandom. He shares how he was introduced to American Football, his introduction to the Chicago Bears in 1985, and his continued support for the team ever since. Gardiner has been to Chicago to see the Bears play seven […]

Ron Brown, news anchor for WGN Radio, joins Jon Hansen, filling in for Lisa Dent, to share his weekly movie reviews. Brown shares his thoughts on Primate, I'm Chevy Chase and You're Not, Die My Love, dishes out some Brownie Points, and more.

Lou Manfredini joins Jon Hansen, filling in for Lisa Dent, for Lou's To Do List, sponsored by Perma-Seal. Lou answers any questions you have about projects on your to-do lists.

Jon Hansen, filling in for Lisa Dent, checks in with the newsroom to hear their stories including the trend of carrying around books, puzzles, embroidery kits, and other non-digital entertainment in something being called an “analog bag.”

Jon Hansen, filling in for Lisa Dent, is joined by Deanna Goodwin, VP of marketing, communications and development for Visit Lake Geneva, to talk about Lake Geneva's Winterfest. See how fun Winterfest in Lake Geneva can be with the photo gallery below!, with photos provided by Visit Lake Geneva.

Ben Szalinksi, Illinois Statehouse reporter for Capitol News, joins Jon Hansen, filling in for Lisa Dent, to discuss the finer details of what the Chicago Bears are asking of the state of Illinois in order to start the construction of their potential new stadium in Arlington Heights.

Bill Snyder, WGN-TV weather producer, joins Jon Hansen, filling in for Lisa Dent, to talk about the sudden burst of snow that the Chicagoland area experienced, what they call it, and why meteorologists missed it in their forecasts.

Pat Brady, SVP of Mercury Public Affairs, former chairman for the Illinois Republican Party, and former federal and state prosecutor, joins Jon Hansen, filling in for Lisa Dent, to discuss the Republican primary race for Illinois governor. Brady shares his thoughts on who leads the race in the early months of campaigning.

Jon Hansen, filling in for Lisa Dent, checks in with the newsroom to hear their stories including John Mellencamp announcing a concert tour with a trailer that stars Sean Penn.

Kiera joins Jill Simonds, founder of Savvy Strategic Partners, to talk about all things leadership mindset, including what to do when you feel trapped by your business (Kiera gets personal on this one!), the ebb and flow of motivation, psychology of ownership, and a ton, ton more. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript:   The Dental A Team (00:01) Hello, Dental A Team listeners, this is Kiera And today it's a special podcast. I was so lucky to be featured on a podcast with Savvy. They are actually a fractional company and we have hired them to get different team members on our team and their founder, Jill Simonds and I got on the podcast and talked about all things from founder mindset to guilt of being an owner to how we stay trapped in businesses. And I just felt that this is such a   poignant and pertinent podcast for all of you. So I hope you all enjoy this episode. I hope you learn a lot. And as always, thanks for listening and I'll catch you next time on the Dental A Team Podcast.   The Dental A Team (00:37) Welcome everyone to vision untethered conversations with inspirational leaders. My name is Jill Simonds, founder of Savvy Strategic Partners. We are a dedicated leadership team of fractional executives. I am so thrilled to introduce my special guest today, Kiera Dent, the dynamic founder of the Dental A Team, a consulting firm dedicated to helping dental practices simplify operations, strengthen leadership and elevate patient care.   With her unique background as both a dental clinician and business owner, brings a powerful blend of insight and business strategy to every practice she partners with. Her and her team have worked with hundreds of practices nationwide to build systems that reduce stress, increase efficiency, and foster long-term success. Kiera, I'm so excited to have you here. Thank you, Jill. Thank you. I'm so excited and honored to be here.   It's fun. love what you're doing out there. I love these kinds of conversations and wow, it's always fun to sit back and hear your own bio. So thanks. It feels, feels a good way to kick off the podcast. Let's hope I deliver up to that, but truly just honored to be here. Super excited and just love what you're doing for all the founders out there like myself. Just helping us get to that executive level that we need when we maybe aren't quite large enough to bring on all these amazing players full time into our company. So just super jazz and excited to be here with you today.   Yeah, me too. I'm excited to get into it. I don't actually think I know your full story and inspiration behind Dental A Team and your purpose and passion. So let's start there. What inspired your journey and how does your purpose align with the unique challenges that you face in scaling a business today? Yeah, well,   Dentistry was never meant to be in my blood. I just happened to be in high school and saw a really fast path to wearing scrubs. thought I can be a dental assistant or I can be a nurse. I don't want to learn the whole body. That's disgusting. Mouth, I could probably handle. So that's honestly what kicked this off. So was in high school. It was a random career. And then everybody kind of teases me because my last name is Dent. It's not a stage name. And I make the joke that's real life. I just had to get three fiancees to get that last name.   That was really what got me into it. I love dentistry. It turned out to be a perfect career for me. And so I did it in high school and then I went to college and college. I actually did an undergrad in marriage and family therapy. I was planning to be a therapist and I remember being, I was interviewing in Oklahoma for grad school and I remember sitting in the interview and I was thinking like, I wonder how that like filling's going. I wonder how that crown prep's going.   And I thought, gosh, this is going to be such a weird world. Like I am trying to like pitch myself to this future college. but I'm thinking about how much fun I had back in the office and how my patients were doing. And so I got a full ride scholarship and I decided to put it on pause. went to, pharmacy school with my husband. and we went out there and we decided we'll put this on pause. We'll see if we can both get into the same school.   But I just realized my heart, my soul, my passion is in dentistry. I'd been a dental assistant, a treatment coordinator, a scheduler, a biller, an office manager, all the pieces. And so when we went to pharmacy school, decided, you know what, I'm going to call around to all of his schools and I'm going to see if we can get a spouse discount if I work at the college. Because some schools, and man, pharmacy school was not for the faint of heart. So I called around and luckily Arizona, they did and Jason got accepted to it. So I was like, all right, sights are on.   I've always been a little hustler. I'm like, sites are on, I'm to get a job at this college. And I just felt truly, truly blessed. So many people tried to get jobs there. All my friends were trying to get jobs there. And I randomly was talking to this lady in the pool at our complex and she says she has nothing to do with me getting the job there. But I fully believe that Laura had a lot of, a lot of strings behind the scenes to get me the job at Midwestern in Arizona. So I a discount on the tuition, which was great.   Um, but I was able to then work at the dental college and that truly is what kicked off this Dental A Team consulting company because I worked at the college for three years, got the, got the discount. And then while my husband was doing his residency, one of the students actually asked me to come and start a practice with her in Colorado. And I thought, Oh my gosh, like good thing I said no to the marriage and family therapy. Like let's go from dental assistant to practice owner three years. Like, let's do this. So   actually helped start a practice in Colorado. ⁓ took our first office from 500,000 to 2.4 million in nine months, opened a second location and I was like hooked on this adrenaline junkie of business ownership. But at the same time, just like we were drinking from a fire hose. My marriage was almost in shambles. I was in shambles. Like I'm 5'8". I was 98 pounds. I was not sleeping. I was up at 2 a.m. staying like up till 10 p.m. Like just it was an exhausting road.   drain, everything was falling apart. And so when I split from that partnership, ⁓ I sat there and I remember just sitting, I didn't know what to do. Like I'd lost my marriage practically. I'd lost my identity. I was like on death row in lots of different facets. And I remember just thinking like, I don't even know who Kiera Dent is anymore. And so I sat there and I was like, well,   I'm going to start a consulting company. Like I love dentistry. If I could help her, I could probably help more people. And I think that this is the fuel of founders where when we're at rock bottom, we've got to have something that builds us into our next version. And that's what Dental A Team was for me. So Dental A Team, say, was built from like the ashes of my life. Like it feels like the Phoenix rising for me. And so I started a company. Like I just, I didn't even know what I was doing. Had no background in it.   And I went and consulted my friend and I was like, I just need to practice on you. I don't even know what I'm doing. And we took his practice and we grew it tremendously. He then introduced me to a consultant overnight. had 50 clients. I started like just making things up as I went. And it was really like an overnight success, but I went from like rookie don't know what I'm doing to this. I know that I can help practices and I want to serve. And I've got all these dentists that are just like these little babies that are going to get.   ripped apart in the industry, there's gotta be a way. And so it's always said, like I always said, I wanted to positively impact the wealth of dentistry in the greatest way possible. And that's what I've said since day one, that's how it is. And now I realize that life is my passion, dentistry is my platform, but changing people's lives, helping them live their best lives. And it's wild that we're even talking Jill, because what you do for me and my business is what I do for dentists. And so it's this weird annoyance to me that I'm like, I can be a miracle grow.   and I can grow dental practices and it can be so fun. But yeah, I have no idea how to do that in a corporate world. And so learning it and evolving, and that's actually how you and I even got together was I needed someone but not a consultant. I was like, listen, I know what consultants do. I am a consultant. Like I need, I need someone with me. So that's how we got here and that's how my passion's been. I don't get to wear scrubs. That's the only bummer. Like the whole story started with scrubs and now you like wear clothes.   ⁓ You can make some really stylish scrubs as part of the entire. I would love to, but I do joke. like, took my marriage and found my therapy background, tethered it with my passion of dentistry and created a company from like just true passion and love. man, it's just been a, I think it's good. We don't know the end from the beginning. So many people want to know that. I don't think knowing what I know now I would have ever started, but I think I needed that as a person.   to build, execute. And I think that that's how founders are. We're just meant to build, we're meant to create, we're to be these creators. And so to build something that's just been magical and changed so many lives, like, gosh, the joy it's brought me has been like a hundredfold beyond anything I could have imagined. ⁓ beautiful story. And yeah, quite funny too, the path ⁓ and steps that you took to get here, but wait a listen. mean, just listen to your intuition.   And it sounds like you have some of those key core memories along the way of like your thought process sitting in scenarios where you're like, wait, is this me? Is this even what I want? And acting on it and taking that initiative and to where it's got you. That's a beautiful story. Thank you. Yeah. Can you share a specific experience from this where you have felt trapped by your business? Every day,   What strategies have you implemented or are you to create space for true growth and scalability? Yes. This is such a good and I hope like listeners, they're probably like, I don't know. I just hope that what I share is making you not feel alone. I think is probably the biggest piece because I hear this from dentists. I'm like, I know I'm not alone and I joined a bunch of groups for it. But ⁓ I say that Dental A Team is a dragon that never sleeps. Like this thing just is a crying baby of   breathing dragon that just never ever stops. And I think that there have been times, so especially last year, last year was like my rock bottom. So technically we're eight years into the company, but like I was partnered with that other guy for five, for four years. So I feel like I'm like five years in on my own trying to do this, even though I know it's like just had a funny path. But last year I hit rock bottom.   Like I went cold turkey. I checked out of work. I remember just being like, I am sick. Like not physically sick, but mentally, emotionally, spiritually, like I'm apathetic to life. Like things just need to shut down. and I'm sure a lot of founders get to this level where you just, you're doing everything. Like the whole company is riding on you and you are so rad that you built this company, but it's outgrown you and you don't know how to shed that and to build and to create and to evolve. And so my, ⁓   And I think it was, I feel like I tell myself lies all the times, which I'm sure most people can relate to of, okay, care, just push through like three more months and we're going to be better. Like three more months, we got to hire three. So you're always in this like, okay, it's going to get better at three months. And then you're like, well, shoot, like this person didn't work out. So I got to keep doing sales or, this didn't work out. So I've got to keep doing this aspect of the business. that could be a me that could be not me, but last year my strategy was like completely checked out of life. I,   came back from a conference, I was so exhausted, so burnout that I just called my executive team and said, all right, you guys have it. Like, I don't want to hear from anybody. Like I put all the things like, here's a lawyer, here's the CPA here. Of course, I'm not just going to let this thing fail, but I needed a complete shut off reset and I slept for 17 hours a day for an entire month. Like it was every day just exhausted. felt numb. felt like I lost like,   The way to best describe it is I felt like I was watching a movie in color that went black and white and that was my life. Like there was no color, there was no emotion. There was no, I feel like I lost feeling to life. And I think that was just coping mechanism to get through. We did a lot of therapy, like lots of different pieces. And I realized like, okay, we got to take care of Kiera first and then we have to get to these spaces. So when you say like, do you ever feel trapped by your business? Yes. Cause it's like, what do you do?   This is a company that's a consulting company built on Kiera. That's Kiera Dent. That's her face. Like, how do you even sell this type of a B2B business to somebody? So I did meet with people. did find two potential buyers. I was like, I need a way out. I need to figure out how do I get rid of this crying baby? Like it's got to just stop, like make the crying stop. ⁓ And then that's where we actually pulled in a traction coach. So Rick, we hired Rick. I was like,   I need someone who's outside of this company who can see it that can also be the motivating voice for my team and help them see like, Kiera can't keep carrying all this. So I will say like Rick was a huge blessing. He came from a great network of people and then the leadership team. was like, we had to have a complete reset of everything's not on Kiera's plate, but I don't think it was all leadership team. think that there's a lot of pieces of Kiera perfection that my ego.   needed to feel important and to be able to let that go. Things aren't going to be perfect, Jill. I still stress like my, I have a little bracelet on that says trust and flow. And that's this year's theme of like, here, you got to trust people and you've got to go with the flow more than trying to curate and force because that's always going to be the hardest path. So, and then we obviously hired you. We hired Jenna who's been a phenomenal fractional. we brought on a CRO.   who's helping in the sales and marketing department. But I also think that businesses when they hit a certain level, they finally have the cash to be able to hire the expertise that you need to bring on. But before that, I was so cash flow scared that I think I maybe held on to profitability too hard rather than hiring help sooner that could have probably prevented it getting that low. So now it's like mandatory, I go to the gym.   three times a week, non-negotiable. have sets time, like we shut off from work every single day at five o'clock. My husband has alarm that goes off and like, we don't talk work. We hot tub every night. Like, I don't think I realized the mental bandwidth that being a founder, operator, doer requires to recharge. And now I'm just like really pro like, no, no, no guys, I don't care what goes on. Like if these things don't happen, I'll fall apart. And that's just, I don't show up the best for anybody on the team. So.   Yes, I still feel trapped. I still wish that some days I could quit my own job. But I think the fact that you can't quit is also a really beautiful blessing because it forces innovation and creation. ⁓ So well said. the help and the support and leaning on others in your circle, finding your people who you can trust.   That's the first step for sure. You're not alone. And the second we realized that, I mean, this it's lonely. It's lonely at the top. And even with a dynamic team, nobody else wears the pressure, the weight, the risk involved like you have to, you know, but knowing that you're not alone and you have a team that you can lean on, the more you can lean into that, grow that, expand that.   It's a give and take and an ebb and flow for sure. It's not linear, but. Yeah. You made me think about my brother-in-law has a very, very, very successful high end builds these beautiful custom homes in Utah. Like one of the top builders he's been on Netflix. Like he just has this very, very incredible company. And I remember when my husband, got married where ⁓ my husband's eight years younger than him. I was like, he's always so grumpy. Like this man is so angry all the time.   And then I realized he's a business owner and he's at the spot that I'm at right now. And I'm like, I am always just like in this space of anger and frustration. And he's actually been this really randomly. He was the one I didn't like. I like, had like clashes when we first got married. I feel like I understand him on an entirely different level now. And I'm like, I get it. Like, I see, I see why you were the way you were. Like it makes so much more sense to me, but he told me, he said, Kiera, the day you become free is the day that you stopped caring so much about.   Like in the day you realize that nobody can take anything from you. Like that is such a freeing moment. So if you do get sued or if you have a teammate that like writes, like last year it was like, we got reviews galore and it's crazy. You can't take those down because if you are a CEO executive, you are no longer a human and that doesn't matter. And I think just like the bullets, we had like a pending lawsuit. We had people writing awful things about me. Like it just felt like it was just this tumultuous tumbleweed.   But I think you go through that and you do build that. I don't want to say it's a calloused soul because for me, feel like becoming angry or bitter is never going to serve. think it's an internal knowing that you have the confidence and the certainty in yourself that no matter what bullets come your way, you are capable of solving anything and everything that comes. I think when you can... Yeah.   navigate enough storms to have that confidence. I think there is so much more freedom in there. And I just think about him, he's so much happier, but he's like, I'm not reliant on anybody for my happiness. No one can take anything away from me. And I'm not dependent on anybody for like this success. And I think that's a, it's a certainty. It's not an air of ego. And I think it could be possibly taken that way. It's an air of confidence and certainty within you that I think then the highs and lows are not as turbulent. And I think that that was   similar to what we were saying, it just becomes a, I think, an evolution of you as a person. And I think that that's ultimately why we all become business owners is for that evolution of soul that we are seeking, that maybe we don't want to go through the process to get there. But on the other side, it's a beautiful version of yourself that's far grander, far more beautiful, far stronger, far more confident than you ever could have imagined yourself being. Yeah. Well said.   That freedom point too is it's almost like a stance of serenity too, because, and if you know, you know, the serenity prayer, it's, is the, the acknowledgement of what we can or cannot control what is outside of us. And when we finally let go of people's perception, what they're going to, what they even think, right? We cannot.   even control as good as of work as we can put forward and as best as we can show up. We can't control others perceptions of us, what they're going to say, what they're going to do with that. And so that level of understanding and acceptance and wisdom to know this is mine, this isn't mine and let go of everything that we carry that, you know, we think we have some control over.   letting that go is ultimate freedom, I think, when we can see, be in that confidence and in a state of serenity. Yeah, the more you let go of that and just lean into what's within our realm and our controllables is the best you can do. And we show up better. Absolutely. That's the trust and flow mindset mantra for this year of   Yeah, there is no pain in change. There's pain in the like resistance to it. And so like you said, it's a surrendering. It's a surrendering of   I think just acknowledging that this is life, this is who you are, this is what you can control. And I never thought that you could really come back from being so low. But you hear it, like you see people, like you hear media talk about it. But I think business owners, someone said once, business is such a spiritual journey. And I was like, how? I don't get it, ⁓ but I do get it.   It's such a spiritual journey. It's such an evolution of soul. It's a surrendering. It's a give. It's a take. It's a beautiful blessing. It's a call. There's so much beauty in it. then I think like, turn it into a puzzle, turn it into a game, turn it into like, how can we make this into more fun? So I started just adding more fun too. was like, why do I need to always be the gladiator? Why don't we just have like a good time and like giggle about all these things?   But I think that that's truly an evolution of you as a person too. I don't think that that is not an overnight sensation. Anyone who tells you it is like, good luck. think that that is, that's a crafted, it's an evolution and it's a beautiful surrender like you said, and grace for yourself and for others. But I feel like the person you become through it is there's so much empathy, there's so much love, there's so much compassion for others that I don't think you get there any other way.   Yeah, that's so true. Having it for ourselves first is so much harder than having that for others. So the compassion and care and giving love of ourselves and acceptance, that's the only way to give it outside of ourselves. So good. What are what are some common psychological barriers either for you or that you see show up? You work with a ton of business owners in very specific industry, too. So   What are some of those barriers you see that prevent owners from stepping back and not being so tethered, you know, to their business? What contributes to that? What are some of the psychological factors, beliefs maybe that we carry that keep us stuck? Yes. And you're right. Like I've coached hundreds and thousands of offices. That's where it's so like.   so aggravating to me to be like, Jill, need help. Like I know how to do this for someone else, but I don't want to do it for my own. I think that there's beliefs of because you're a business owner, you have to know it all. I know that that's like a big one of there's humility, but at the same time you're like, well, I'm in this, I have to figure it out. I think one of my psychological ones that I know dentists have as well is in B2B when you are the service provider, it's,   It's a psychological belief of if you are the product and you step back, how does your business continue? And it's odd because as random as it is, I was able to give up consulting much faster and delegate that, which is shocking to me. think about it often, like you give that up, but you don't give up sales and marketing and reputation. Like it's fascinating to me that I'm like the biggest portion of it and like dentists, they'll hire an associate dentist. But to me, I think those are possibly easier skillsets because I   I have that skillset that I know I can look for it and I can train that and can evolve it versus like sales and marketing in different places. Like, I don't know if I'm trying to figure it out. How am I supposed to coach this up? So I think those keep us stuck. I think there's a, I think there's a, I don't know. I don't know what it is. I feel like it's societal. But I think I'm with this like asking for help or I don't know. Is this weird? Like for me,   I feel like I'm a very highly high capable human. Like we were talking the other day and it was, on client escalations, like it's either the CEO, the salesperson or the consultant, whoever knows them best. I was like, cool. I'm a trifecta. Like no wonder I'm good at this. Like I'm the CEO, I am the salesperson and I am a consultant that I think that there's sometimes this like this weird, because I'm so high functioning and so capable that I should be able to do this and I should be able to continue carrying all these pieces.   Why am I tired? Like get it together girl. And just like, keep moving on. I think that keeps you so bound in. And then truly when I even say that out loud, I'm like, it's just your ego screaming at you, wanting you to feel important. And if you step back at all, I know what I think about stepping back. A lot of my team is the same age as me too. And I sometimes feel very awkward about like, so I'm going to have a CEO lifestyle and not be eight to five with you guys because the business never stops crying.   But it's as weird. Like sometimes I also think I'm tethered and a lot of my doctors are because like same age, same demographic, same, like you feel so similar and so close that it's almost like, why are you better than them? It's so awkward. hate it. Like you can even see I'm like playing with my hair more than I should be like, that's the stress of like, I know what I need to be doing, but I feel like I need to be sitting at the table with them every day and in the trenches with them, but they're not sitting up on the, on the hill looking down the line.   but you feel like you've got to do both. it's this weird, like I said, I don't know if it's societal, I don't know if it's female, I don't know if it's ego. I think it's probably a combination of all, but those are psychological traps. And when I see it in a client, I'm like, all right, great, you need to delegate and we need to like take these things off your plate. But I think when you're a founder living through it or the business owner, I think sometimes it's very hard to even see that ego showing up around you or see where you should let go of things.   And then I think it's a lack of trust. Like I've delegated some of these things out. We've hired, like we have paid, last year was a $300,000 oops. And I hired really great people, but like it just didn't pan. So I think that there's also that like, well, how much do you want to throw at this problem to make it go away versus just continuing to carry the torch? So it's like this ball and chain you get out of it and you get back in it. It's like this weird, awkward relationship with yourself and your business that I think is slightly toxic.   but also very addicting, which is probably why it's so toxic on certain levels. So those are mine. I know that was like a very jumbled thought, but those I think are some of the psychological ones that I've seen personally and professionally that keep people very tethered. But I will say, I like boil it down, it's always ego. Always that keeps us tied in because who are we if we don't have all this busyness badge? think that that feels like a deep hollow dark hole for me anytime I think about it.   So I know that I haven't quite grown enough to see that there's a path out. But I think is also maturity and letting go of the ego. Absolutely. Well, and it's so common. It's really what would I kind of boil down oftentimes to founders guilt, owners guilt, right? You're the hero in a lot of situations or can come in and swoop in and help and   There's an identity crisis piece of it to that ego that's like, well, if I'm not doing all these, if I'm not still holding this, who am I for one? And maybe, maybe internally we have this perception of, and you know, we've, we've grown or we've healed in ways that we know, no, I like, I know I am worthy and valued and valuable outside of what I contribute here. But like, what about what everyone else thinks? Then it's this perception of.   Well, if I'm not doing all these things, what does my team think of me? And are they going to think I'm just off on an island somewhere slacking off when I don't deserve that? Or right, like all these, these guilt trips that founders often carry because we can do all these things. So there's, there's no excuse why we shouldn't or couldn't if we can, therefore we should do them. Right. So we just continue to hold and carry that.   but yeah, guilt, ego, those are definitely some, some key pointers that we see a lot. So, as you said, Jill, it just made me think about like, but why, like, where does this stem from? Because we all feel it like I do. And then I'm like, what, does it matter? So then you justify and you rationalize and you hang out in this other Island. And then it's like, I'm going on vacation because I worked like 50,000 hours. And it's like, there comes a line where I think that that   that serenity, that like, I remember there was a day I had to Google, what does a CEO do? Like, I didn't even know. I was like, what do you, like, what do you, if I'm not doing all the things, like, what am I even supposed to do? But I think when you can, when you realize that your company needs a captain, the company needs somebody looking down the line, you start to shift and change and realize that you've got to start shedding off a lot of these things.   and I think you, you feel the guilt and do it anyway, I think has been my mantra to, don't think it will ever be easy. I think you feel the guilt and do it anyway. For sure. Because that guilt is typically self-inflicted for the most part. If you have the right team around you and in the business that care about and are aligned with the division that you've crafted, that you've put forth, they need that from you.   just as much, right? You stepping away, you coming and showing up refreshed, aware, whole, right? Those fragmented pieces of us when we're scrambling to try to just uphold and keep all the plates up in the air is not the best version of ourselves. And so when we realize that too, and the more the team can even vocalize like, yes, like we need this of you and look at   look at all the places that a visionary needs to show up looking down the line, what's ahead, looking outward and not down and in is that pulls the rest of the energy and the rest of that, you know, that perspective for the rest of the team to see that more and more clearly if that's where your focus is. So you're doing them a favor, you're doing a service. ⁓   Cause every, yeah, every successful business needs someone charting that vision. And that is where your eyes are focused. That is where your pull is going toward that. That is what grows the I think that because it feels like it's just this like vision that's not tangible, I think for me at least, and for other people that often can keep us tethered into the company because it doesn't, there's no way to put on a KPI scorecard that I did my visioning.   for the day. It's like, do I even know that I'm showing up and having that as a checklist? But I think when you really are solid in it and you watch a team who has a vision versus a team who doesn't have a vision, you see the intangible, like it's a subconscious push. It's the wind behind the sails. You can see a sail, can't see the wind, but the wind is ultimately what makes it go. And I think when visionaries realize that you are an invisible, very tangible, intangible part,   I think it becomes much more clear of like, no, I need the white noise space. Like I need these things because ultimately it's my job. And I've got to be able to show up as that wind to push this boat in the direction it needs to truly go. I love that. I'm going to use that analogy. That's so well put. That's a good one. Well, to finalize the conversation today, what steps would you suggest to founders struggling to   let go, delegate, while also maintaining alignment with their vision.   That's a great question, Jill. I feel like such an Oreo. I've got a white side of me and it's a black and white in me. Because I'm like, what would I tell my clients? I would tell clients, the way you are able to step back is we set these pieces and we do all this. And then I'm like, well, let's speak from Kiera's perspective of, I've done this. This is where I'm at.   to step back and what I also watched. So I think they do actually go like, I'm like, okay, I'm not an Oreo. Like I've got both parts of the cookie on. Like I brought it together for everybody here. I think both sides, my side and client side would be, I think having a vision for yourself. When I got crystal clear of where I really wanted to go personally and professionally in the next one, three, 10 years, like I grabbed a big sticky pad. It was written out and I stick it in front of me every single day. So I'm looking at that.   that became a lot more clear. My decisions became much cleaner. So I think it would even tie to the book. Like 10 X is easier than two X when you have this big audacious vision, the path becomes so much cleaner and easier than when you're trying to just do a two X move. So I would say for visionaries who feel stuck, that is ultimately where you're at. If I get your 10 X vision, where is that going? Clean up the paths and stay laser focused on that. And then get your team rally behind it.   They get excited. They get the joy behind it. And I think like, even when I say that, I'm like, the 10X path is just so much easier. It's so much cleaner. It's so much more freeing. And then I think like, again, it's hard, but do it anyway. Right now it's a stripping down of letting go of clients for me. And I feel like such an awkward identity. I'm like, if I'm not a consultant, am I going to lose my edge? And it's like, but I'm so clear on the 10X, the 10 year vision.   that that part has to sheath off in order for me to progress and to grow. And I think when you are aligned, also be really careful not to lose that vision. I lost my leg last year. Like it was still there, but I buried it. think keeping that radiant, keeping that vibrant, keeping that like for me, it's a post-it note on the wall, like a giant one. Like this is where I'm headed. This is where the boat's going. This is where the wind needs to push me and the company. I think that that can help you stay true to you.   It can say true and it makes all the other decisions so much easier because then it's a yes or a no. And if you can get that black and white crystal clear and then truly trust and empower your team, that to me is like, I recognize it's a let go of control. It's a surrender like we discussed earlier and belief in your team that they're going to crush it. And if these aren't the right people, right seat, you're going to find them, you're going to grow, you're going to evolve. But the 10X vision is a non-negotiable.   But it's a 10X vision that makes you happy, fulfilled and not like exhausted, out at the end of the finish line. I think I used to feel it was a muscle through rather than a joyous journey. That 10X vision needs to be joyous journey. And who am I at the vibrant self at the end of it? I'm not going to muscle through anymore. I'm going to gracefully navigate. So I've got energy for me, energy for team, energy for family. because I think if we're not thriving in our businesses, we might as well just go get a job from someone else.   You don't want to have a worse job with you as the boss than you would somewhere else. So hopefully that, but I think it's just crystal clear on where you're enjoy that. ⁓ Kiera, thank you so much for your insights, your wisdom and sharing your heart. just truly and authentically it's beautiful. Thank you, Jill. Appreciate being here. Really, really appreciate what you're doing too. Well, thank you so much.   If anyone wants to learn more about you, Dental A Team and expertise of your team, where's the best place to find you and information or get connected? Yeah. We have a podcast, the Dental A Team podcast. So come on over. We'd love to have you there. Tips for teams and for owners. And then also Hello@TheDentalATeam.com or online, like social, we're on Instagram. Dental A Team would be great. But yeah, love to just share, inspire, help.   because I believe like all of us succeeding together is what this journey is about, but succeeding and being fulfilled. It's not, life should be fun. Owning a business should be fun. It does not need to be hard. So let's make it easy and fun together. ⁓ I love that. Well, thank you everyone for listening. Kiera, thank you again for being here and we'll see everyone next time.

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