The Experience of 50 Years in Dentistry From Dr. Hirsch





By Mike Wong May 4, 2020

Rolando Mia, from Zyris, hosts a video series focused on the latest news, topics, and conversations happening in dentistry featuring dentists across the nation. Dr. Tom Hirsch, Founder and Board Member of Zyris, joined our series to discuss his close to 50 years of dental experience and how history is repeating itself in relation to the Coronavirus.

Watch this video to learn the following:

  • How history is repeating itself in dentistry
  • A new wave of PPE/protocol relating to Coronavirus
  • The experience that comes with 50 years in dentistry – a look back
  • Ways to stay in touch with patients and employees during this time
  • Business management related to dentistry

Transcript

Rolando Mia

All right. Good afternoon or good morning or good day everybody. This is Rolando Mia with Zyris. I have a very special guest here and really excited to spend some time with Dr. Thomas Hirsch. Dr Hirsch is the inventor of our system.

He’s also a principal and founder of the company and he’s, he’s here today. But the reason we have him on right now specifically is we wanted to bring him into kind of the dialogue that we’re having around this and, and get his perspective because in addition to being one of our owners, he also has a full time practice and practices full time in Malibu.

So the purpose of this is to talk about and get his advice and his insight into how we’re dealing with this crisis  as a dentist, as a practitioner. So thank you for joining us, Dr. Tom. It’s a pleasure. Really look forward to talking.

Dr. Tom Hirsch

Good morning Rolando. How are you today?

Rolando Mia

Ah, I’m doing, doing well.

Dr. Tom Hirsch

I’m honored that you’ve allowed me to sit down there and voice my opinions to the live audience of dentists and anybody else’s online today.

Rolando Mia

It’s going to be fun. So, we’re in a crisis right now and so many things are impacting dentists specifically and the industry. What are you doing to get through this and what advice would you give people starting out relating to your experience?

A Look Back on Tom’s Experience

Dr. Tom Hirsch

Rolando, that’s a great question. What do we do in these uncharted waters? Nothing like this has ever happened.

I’ve been practicing dentistry for almost 50 years now. Still a full time practice in Malibu. I get up, I go to work every single day. I used to be a wet finger dentist. I’m a wet gloves dentist.

But I’m here in the office every day four days a week. You know, Monday, Tuesday, Wednesday, Thursday. We start at 7:30 in the morning. We finished up about 4:30 or five o’clock. Emergencies dependent. But what am I doing today in these uncharted waters?

We’re trying to be as safe as we possibly can in the office. Our office has always had a really high level of sterilization protocol.

Rolando Mia

So could you share with us … yes, sterilization, PPE, all that type of stuff has been in dentistry for awhile. But from your experience, what have you done to not only make sure it’s in place, but enhance that? How do you treat your emergency patients when they come in and out?

Dr. Tom Hirsch

So what we’re doing right now, we are only seeing emergency patients in the office, a true dental emergency, somebody in a massive amount of pain or they’ve got an infection or they’ve got some facial swelling that can go down to a cellulitis, angina anything that’s that serious that we don’t feel that it can be handled just by antibiotics alone.

We’re going to get them in the office and we’re going to take care of their immediate problem. That’s the first thing that we do. Routine dentistry for us to stop. We don’t have any hygiene patients. I’m not seeing any other patients on any procedure.

So that’s just kind of common sense mandated, dictated as far as what we need to do to keep ourselves safe. So that’s the protocol in the office is emergency patients only.

Now to answer directly your question, what are we doing well, besides our regular sterilization protocol, which really began back in the 80s when HIV and AIDS hit the scene before that, before 1980 we came into the operatory and we’d wash our hands.

Most of the time I was working in a polo shirt and a pair of slacks, and that was my protocol in the office, I didn’t have scrubs, I wasn’t doing surgery, so I didn’t feel that was necessary.

But the moment that HIV hit the scenes, things changed. It was a paradigm shift in dentistry. It was a paradigm shift in sterilization protocol.

For instance, before 1987 we did not only have our hand pieces and everything that was being sucked up and into the turbines. Yeah, it was wiped down, but we didn’t worry about it.

And sure, there was the need forward at that time. But we as a general dental population, not just myself, but as a general dental population, weren’t doing everything that we needed to do.

AIDS came along. We wore gloves, handpieces were autoclave from the sterilization protocol. Just went up to the next level.

A New Wave of PPE for Dentistry

Well, it’s happened again. This is some, what, 35 years later, 33, 34, 35 years later. Once again, we have to up our game. The common everyday sterilization protocol isn’t good enough anymore.

So here’s what we do. If an emergency, if a patient calls up when they have an emergency, my receptionist will instruct them as far as what they’re going to do to be allowed to come into the office.

First of all, she’ll do a history over the phone to get medical history. She will then when they come in there, tell the patients they’re not allowed in her office until the other patient is gone.

If we happen to have another patient, we see one patient at a time, they are to wait in their car or in their transportation mode or outside of the building or wherever they happen to be until we call them to come up.

When they come down, my assistant will go down, take them the health histories and stuff to fill out. You’ll also hand them a pair of gloves. You also handle the mask. So when they come into our office, when we’re ready for them and everything is ready to go, their gloved, they’re masked, they’re not seated in the reception and they’re taken immediately into the operatory.

They’ve been instructed not to touch anything in the office, not a counter surface or anything. So that’s the first thing that we do when somebody comes in. The second thing that we do besides our normal everyday protocol at wiping everything down surfaces, infections, that’s really kinda gone over the top. We wipe it down. Once we wipe it down twice, we wipe it down three times. My assistants are just over the top on that.

A patient leaves the operatory, it’s wiped down. It’s wiped down a second time after the patient leaves the operatory and then immediately before the other patient comes in, the new patient comes in, is wiped down a third time. So that’s the second thing that we do.

A Changing Landscape in Dentistry

Anything that I’m going to touch has a barrier on it. We used to go ahead, if we were going to go in and open up a drawer, pick up a gauze square where we’d get the handle the drawer and open it up that way. But now what we’ll do is barriers on everything and the patients really appreciate that barriers are on all of our hand pieces, sleeves on our three-way syringes.

Surgical barriers on the light handles, anything that we can touch is covered and above and beyond in the elevator when our assistant goes down to get patients. I just thought about this, when our assistant goes down to the elevator to escort the patient up or have the patient come up, the buttons on the elevator are covered with a sticky barrier too.

So is it over the top? No, it’s not. It’s safe and that’s what it is. And it’s safety for myself, safety for my staff and safety for the patients. And the patients really appreciate the extra steps that we’re taking. They feel comfortable to come into the office and sit down knowing that they’re the only ones that are going to be seen.

Rolando Mia

You know, that’s incredible when you think about it, just the scrutiny that you are putting in place to ensure that people, patients, staff are separate from that is huge. Also, I appreciate you clarifying that even though you are open, you only see emergency patients. What are some of the things that you’ve been seeing lately, what’s the…

Dr. Tom Hirsch

Kind of, what’s the protocol on the treatment? Oh, let me think about what happened last week. That’s kinda kind of a cute story.

Last week I had a fellow that came in on Thursday. He called up and he was just in a massive amount of pain and he was starting to swell and so we got him in the office and we took a look at it and it turned out that the situation was isolated to the tooth number 18. 

He had called up because he said he was swollen. He had a lot of pain there when he came in there. He walks in with this thing in his hand. I couldn’t quite tell what it was. I couldn’t tell if it was gold or it was silver, it turned out it was an amalgam build up on a root canal tooth on number 18 that he’d done in the service.

And I looked at and it was falling out. And it was all massively decaying and the tooth was beyond salvage. There was a lot of drainage around that tooth. So we decided we’re going to take that tooth out that day. And I was questioning him about his history and this and that he said he’d have a lot of work done in the service.

Paying It Forward in Dentistry

So we, we talked a little bit about that and you got to pay this thing forward from time to time. So what we ended up doing is he was real concerned about the cost. I said, “Well, you know what?” This one’s on me. You served you, you took care of our government. I’m going to take care of you. He’s a Pepperdine student. He’s 30 X amount of years old. He’s a Pepperdine student on the GI bill of health going to a school up there and his tuition is being paid for by the government so he doesn’t have the extra money.

So I looked at it and we decided to take that tooth out – we went the extra mile. You know, anybody can take tooth out and leave a massive hole there. Someday he may want to put an implant in there. So, you know what, I grafted it. I put a membrane on it, I sutured it closed. And we set the foundation for what’s going to happen in the future.

You know, pay this thing forward a little bit. What did it cost me? A few bucks in supplies, some grafting material on a membrane, some sutures – pay it forward. That’s one thing that you can do in my experience. So we got the tooth taken out and that’s what we did last Thursday. He came in for a postoperative follow up yesterday, a Monday.

We looked at it just to see how the swelling was, how the infection control was going and everything looked really fine and great. I had taken this set of extra on him when he came in and he’s missing a lot of teeth. I see number seven right up there in the front, and I looked at this thing and I thought, “You know what? This guy’s in the office. He’s missing number seven. Well, that part of the procedures and the emergency procedure, but he’s here anyway on a followup visit that had to take care of.”

So I said, “You know what? I’m really going to help you out here again. I said once again, and you served me. You served my country, you helped me. You made me safe, so I’m going to help you a little bit.” While he was there, I said, “You know what? We’re going to make you a bridge.” And so what I did is I have a CAD cam situation.

We scan this thing, made him a note, no prep bridge – oh, also, he had a massive crossbite. So a class three occlusion. So it didn’t have to do any preparation work at all. We just imaged this thing. I spent an hour, hour and 15 minutes designing it, milling it, baking it, and custom saying this map. And this guy walked out so happy he couldn’t even believe it. And I said, “You know, I’m not even going to charge for this thing. You know, it’s my time. God, I got plenty of time right now.” So I said, “I’m not even going to charge you for this.” But then I just got to thinking was walking out of the offset.

I said, “Wait a minute. You know what? I take that back. I am charge you because really people don’t appreciate what they get for nothing in my experience. So you’re going to give me $10 I’m going to be and if you can’t pay that today. We’ll let you come back.” So it made me feel good. It made him feel good. I’m sure it’s going to boost his confidence way up over the top when he goes out and he starts interacting with people cause he was kinda shy but you know but walked away with a smile on his face.

Rolando Mia:

That is cool. Well thank you for sharing. I mean, you’re right. It’s funny – everyone is talking about doom and gloom, how things are going to be closed forever and all that. And, and it’s nice to hear a cool story like that. I’m sure he was thrilled about that. So thanks for sharing that. 

What Is an Emergency In Dentistry?

Dr. Tom Hirsch:

Let me give you another story. Being in the office, what are we doing to help survive? Being in the office, being available is so huge for your practice in an emergency situation. I had another patient that called up with an endodontic problem, a lot of swelling. No, I take that back. It was his son. His son that had a lot of pain. He’d been up for three nights and it woke him up every night, the kid was 12 years old.

And I said, “Well, how about your dentist?” He said, “Well, I called my dentist and he says he’s not going to see me because it’s not an emergency. It’s not unquote a real emergency.” And I said, “Well, you know what, if your child’s a pain to me in my evaluation, that’s an emergency.”

No, he’s not bleeding. No, he’s not swollen, but he’s in pain. So pain to me is an emergency. So I said,”Bring him in. Let’s see what we can do about this.” So he brought him in and we looked at the tooth – hey, it was 18 again. Two 18’s in the same day. So a student number 18, again, so we took an x-ray of if, but he’s a gagger. This was after hours on a Friday, which I’m not usually in the office on a Friday, but I saw him anyway.

My staff wasn’t even here.  I said “Eh, come on in.” I took an x-ray – I couldn’t even get an x-ray very well. My assistant, I’m sure would’ve done a much better job than I, but I looked at this thing and it’s right there next to the right next to the pulp so I could go ahead, I could send to the endodontist or clean it out, not knowing what we’re going to do.

So I started cleaning the tooth, got him numb, cleaned it out and went right down right next to the pulp. Not an exposure, but I’m sure if we would have left this for another month, this would have turned into an endodontic problem. The kid would’ve had a root canal and the root canal would have led to a crown and sooner or later, 30 years down the road, something’s going to fail and you’d probably lose that tooth.

So, we have to use our common sense here in my experience. I use my common sense and help them out. What’s that going to do for me? You know what? I got a new family as patients. I’ve got four of them. They’re going to be coming to me because I’m here, I’m available, I’m closer than their other dentist is. So being available is one of the ways that you’re going to combat the coronavirus crisis.

Rolando Mia:

That’s so cool. Thanks for sharing that. How are you dealing with the fact that you’ve gone from treating so many patients to very few? What about the financial impact to your practice? What advice would you give people who are uncertain and you know, this overwhelming, “Holy cow, I owe a lot of money.” What advice would you give regarding to that?

Cash Is King

Dr. Tom Hirsch: 

No, its tough out there. It really is. So companies that we’re working with that we buy our supplies from, they’re there to help you. For instance, Patterson, that’s who I get all my supplies from. They just sent a notification out saying, “Hey, if you’ve got any loans that you want, you can put them on hold for three months.” So right now, conserving cash is King. I’ve told my assistants, any orders that go out, I want to see them. I wanna make sure they’re absolutely mandatory.

I don’t want to be stocking up on things and I’m not worried about hoarding stuff. So I want to see every order before it goes out. So that’s one of the things that they do is they’ll come to me and say, “We need this order. We need these.”, and I say, “Well, what’s our stock?” What’s our supply? Where are we on this?” We’ll postpone it or we’ll let it go forward. So we try and conserve our cash that way.

Another thing that I did. my staff may not like it all that much, is I said overtime is gone. There is no overtime anymore cause my girls are usually be here. You know, if I’m seeing a patient and I have to stay a little bit longer they would stay or both of them would stay – two or three of us stayed to check on the patient. So the overtime aspect of the practice is gone because I have to conserve cash.

Back to Patterson once again, we’re able to put on hold or apply to put on hold some of our dentistry equipment financing. I’ve got a lot of high tech equipment in my office with cone beams and pretty, fancy Serona chairs, and the new prime scan and the milling machine. So, I’ve got a lot of stuff with equipment loans. Patterson said, “Hey, you can put this thing on hold for three months.” I just got a response back from them and they said, “Yeah, you’re good until July.” So April, may and June, I don’t have to make any payments, so that’s going to give me a little cushion, a little bit extra that I can deal with. A lot of your other suppliers do the same thing.

Rolando Mia:

So it’s about reaching out and working with them, it sounds like reach out to people. Thank you for that. How are you communicating and what is the message that you’re giving to patients – what is it that you want your patients to know beyond the fact that you’re available? What are some of the other things that you’re currently working through for that?

Communicating With Patients in New Ways

Dr. Tom Hirsch:

Boy, that’s a great question, Ro. So, one of the things that we’re doing is with our office software, we’re able to text patients. When we elected to elected or mandated to stop hygiene and stop all dental appointments, we push those appointments out about three or four weeks and now we’ve had to push them out again another the three or four weeks so we’re staying in constant contact with our patients. That’s really important to do.

We have to let them know what’s going on here; how they’re going to be safe. We let them know what our protocols are in the office to maintain that degree of sterility that we have to maintain how we’re above and beyond what might be required just for their own safety and their own benefit for us.

Rolando Mia:

So it’s constant communication. I like the fact that you, even though it sounds like you’re uncertain when you can do this, you’re just kind of putting a stake in the ground for when they can come back and then if you need to, it sounds like it’s just a matter of letting them know or rescheduling further down so that you maintain that connection.

Dr. Tom Hirsch:

Exactly. What you can’t do is you can’t wait for this thing to come over or when you can’t wait for the government to tell you, “Okay, you can go back to work now.” You can’t wait for that day and then open up your door and expect the patients to flood into the office. You have to be proactive on this whole thing. You have to be reaching out to your patients. Saying, “Look, you know, we have this on hold right now. Are you ready to begin?” For instance, just this morning I had a fortunately, you know, there’s a full mouth reconstruction waiting to start but I can’t in all good faith start right now, even though she’s got broken teeth and missing teeth and she looks pretty bad – she’s ready to go.

So what we’ve done is we’ve reached out to her and have said “Look, when we’re open, and I don’t know what date that’s going to be, but let’s suppose it’s going to be “X”. Let’s get you in right away so we can get started.” So I haven’t even begun that thing yet other than take some diagnostics and put together a treatment plan. I’ve got some models, I’ve got a diagnostic wax of the case – she’s ready to go and she’s committed.

Once we’re able to start seeing patients again in dentistry, I’m ready to go. All this stuff that we have that we’ve been working on, put it on the books, get it there and tell them we’re going to get you here and get you organized. If we have to move it we will and maybe allow yourselves a little longer time with your patients. Actually you’re going to need to allow yourself a longer time with your patients because your sterilization protocol is going to take longer one patient in the office at a time.

You’re going to have to distance your patients in the reception room. Reception room stuff’s gone out of the reception room. Yeah, that coffee maker in the reception room, we had magazines in the reception room. Right? We don’t have that anymore. We had a charging station in the reception room. Don’t have that anymore. Things that are in common. It’s a paradigm shift in dentistry. It’s just that paradigm shift as far as what we’re going to have to do.

Staffing Your Business Relating to Coronavirus

Rolando Mia:

Yeah. I love the context that you built earlier in referencing HIV. It sounds like these crises are these things cycle and it forces us as a community and industry to have to revisit things that we kind of took for granted. It’s amazing. To see how you’re adjusting that, I think that’s really powerful for a team member. From a staff perspective, how are you handling that? Is your entire staff still fully employed? Are they on furlough? How are you managing that right now?

Dr. Tom Hirsch:

That’s a really good question that I don’t have all the answers for, but let me tell you what we’re doing and what I’m doing may not even be right at this point in time. The staff has been reduced down to half of what it was. My hygienists are at this point furloughed you know, they actually voluntarily said, “You know, we’re going to voluntary not come into the office.” I have a I have a staff of five. I’ve got two hygienists, two assistants and one front desk person. I had two other front desk people that just over the course of time just kind of faded out. So we’ve been able to manage our office with the five people that we have now with a little bit of crossover from front to back and back to front.

So everybody’s cross trained to take care of things. So what we’re doing is my two assistants are on half 50% reduction in hours. They each work alternating weeks right now. My front desk person is there full time.  We’re thinking about having her work on Fridays, you know, since I’m not even available on Fridays, she’s taking enrolling or the phone communication. Everything goes to her so she’s in contact with patients. Any emergencies that come up over the weekend, she can get ahold of me, she can screen them and then get ahold of me and decide whether it’s a true emergency or not. So we’ve cut down by about 50% on staff.

The other thing, there is a new package for a new stimulus package that we’re just waiting to deal with right now. And that’s what the government program, I’m not familiar with it enough to tell you exactly what’s in it, but with the $4 trillion of aid that we’re going to be getting, I hear that we’re going to be able to apply for loans that can be forgiven so that we can keep our staff fully employed. That’s something that you need to look into or yourself go online. There’s tons of information on the web right now. Talk to your accountants. They’ll be able to fill you in on that and stay proactive and stay informed.

Dentistry Advice For Recently Graduated Students

Rolando Mia:

That’s great. Great advice. So, you know, we work with a lot of the dental schools and we had Dr. Jean on yesterday. What advice would you give the students who are looking for jobs or the young dentists who are sitting there going, “Holy cow, I just started…”. What would you want to tell them directly? 

Dr. Tom Hirsch:

Are you speaking about the dental students or the people that are just graduating from school?

Rolando Mia:

Yes. I mean from the voice of wisdom, having been practicing 50 years, what would you want to let them know?

Dr. Tom Hirsch:

Here’s probably the number one lesson that I can give any new student graduating from school. My dad is 99 years old and still alive. My mom is 95 and still alive and they’re both in great health. My dad was a coach, so any of you guys that had a coach, you know what coaches are like, you know, boy, they sat down and if you broke the rules, it was a tennis shoe on your backside. I got it a few times. So only a few.

Yeah, what my dad told me was this, he said, “Tom, this is really important. Going to be probably the most important thing that I ever going to tell you. You need to take 10% of your income and you need to save it.” And that’s all he told me. But what he, what he didn’t tell me was the power of compound interest of compounding your investment.

I didn’t know that. And it took me a long time to understand that. So I tell my kids this, “You got to save. You’ve got to plan for your future, you’ve got to have an emergency fund. You’ve got it, you need an emergency fund.” Right now we’re in an emergency. And if you don’t have an emergency fund or you didn’t have an emergency fund, you’re scrambling right now.

Luckily, I had a little bit of an emergency fund that I have been going through, paying my rent and do all stuff cause I’m basically down to zero income in the office right now. So I do need that emergency fund. But above and beyond that, you need to plan for your retirement. So whatever you’re making, whether it’s $100 a week or $1,000 a week, or $10 a week, put a little bit of side find a good investment plan or a good, a good fiduciary person that can give you investment advice – that’s not going to be me.

I’m not going to give you the investment advice, cause I just don’t know. I’m not that smart but there’s a lot of great opportunities. So that’s number one. Plan for your future plan for your retirement. Even at this young age, even when you’re only 20 or 25 or 30, whatever that happens to be.

Then number two, watch your overhead when you go into a business. If you possibly can, buy a business  – try to be your own boss. Try to own your own building. Even in this time crisis, especially this time crisis, the last thing that you want to do, even though I’m doing it, I have to pay rent here cause I don’t own the building that I’m in right now. I pay rent, but boy, I sure wish I would’ve bought it when I was available so many years ago because then this wouldn’t be such a crisis for me.

Let’s continue down this road a little bit. When you’re practicing dentistry, practice a quality dentistry, do the very best that you can do. Give your patients the very best care with a top quality that you possibly can. Don’t say, “Oh, this is good enough.” Because when you go back and say this is good enough, it’s going to fail someday, sooner rather than later. So do your very best. Use good materials, get good equipment. You know, always strive for the best that you can be.

The Future of Dentistry

Rolando Mia:

So it sounds like even in crisis, there’s the other side and what’s really important, especially to younger dentists, is, you know, talk to your vendors, talk to the people that you owe money to and all that. Also, don’t lose sight of what you need to do when we finally get to the other side of this.

Dr. Tom Hirsch:

We’ll get to the other side. I mean, it’s a matter of time. Things will be different once we get there, but, you know, we’ll adjust and we’ll accommodate and we’ll move forward. We’ve got to fight one battle at a time. We’ll move forward. This is a battle. We’re in a war right now. We are absolutely in a war with the Coronavirus. We’ll win. We’ll probably win in a shorter time rather than a longer time.

This doesn’t look like it’s going to take the great amount of time that HIV and AIDS took back in the 80s which we still haven’t – all we managed to do right now is slow it down. We haven’t conquered it, so I’m sure we’ll conquer this virus is like we have colds and flus and measles and mumps. They’re just viruses and you know, we’ll take this virus and we’ll beat it. 

Rolando Mia:

That is awesome. Dr. Hirsch, thank you so much for sharing what you’re doing in your practice, how you’re treating your patients, dealing with the emergencies, and the advice on how to get through this. It’s been a pleasure working with you. It’s a pleasure knowing you. I really appreciate the fact that you continue to do this and your love for dentistry is amazing. So any final last words?

Dr. Tom Hirsch:

Yeah, I do. I have a couple of final last words. Thanks for asking, Ro. So here’s my final last words. Eat right. Stay healthy. Workout. You don’t have to go to a gym to work out. You can work out right in your own home with pushups and jumping jacks. You can run around the block. You don’t have to spend money to workout. So workout, stay healthy, eat right.

Wash your hands and social distance. Keep a little bit of distance from people who are coughing and sneezing and this and that. Stay away from them. Stay safe, stay clean, eat well, a mind body, soul, religion, do all the right things and we’ll get through it.

Rolando Mia:

Thank you so much. Appreciate it. We’ll have you back again a little bit later and so you can share some more of your experience, but have a wonderful rest of your week. And thank you for taking the time to talk with us.

Dr. Tom Hirsch:

Thank you. 

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