Looking Beyond COVID-19





By Lexi Marino January 11, 2021

In this episode, we met with Dr. David Fantarella and owner of Fantarella Dental Group to discuss his philosophy of “tomorrow’s technology today” and how COVID-19 has accelerated the adoption of certain tools.

Watch this video to learn the following:

  • Increasing use of infection control tools you already have in your office
  • Why the future of dentistry relies on technology
  • Patients awareness to office cleanliness and protocols related to COVID-19
  • COVID-19 isn’t the end. Prepare for the future now

Rolando Mia, from Zyris, is the host of our series, Dental Voice. In this show, we focus on the latest news, topics, and conversations happening in dentistry and assess differing views across the nation. In Season 2, we’re focused on, “What’s Working and What’s Not”, where we’re debunking myths by assessing trial and error since the start of Covid-19.

Transcription:

Rolando Mia: Good day, everybody. Welcome to Dental Voice, Season Two. My name is Rolando Mia, and this is Zyris. When you look at the purpose of Dental Voice, our intent is to hear directly from clinicians to understand their perspective, understand their experiences.

Then get some advice with regard to the things that they’re doing to overcome some of the issues that we’re facing, especially today with COVID, the pandemic, and especially opening up and starting to practice again. Right now there’s so much information out there. How do you separate reality from speculation?

Then, how can you continue to thrive in this environment? Our guest today is Dr. David Fantarella with the Fantarella Dental Group. Talk about a progressive, talk about a practice that is … I mean, you’re not going to find a lot of practices that have done what Dr. David and his team have done. With that, Dr. Dave, how the heck are you?

Dr. David Fantarella: Oh, good morning. Very well.

How are you doing?

Rolando Mia: Very well. Thank you for joining us and I’ll get right into it right now. As I said, there are so many things that are going on right now. When you consider and when you think about COVID, it’s this wrench that got thrown into our profession, our industry. How has COVID affected your dental practice and the things that you’ve been doing, and how are you navigating through that right now?

You Get Paid When Things Go Wrong, Not Right

Dr. David Fantarella: Yeah. I mean, especially one thing I have always loved about dentistry, I’m getting close to my 25th year, is that it really is autonomous. We’ve been able to have a small business and thrive and progress and watch it grow. All of a sudden, we were told what to do. That was very uncomfortable for me. I’ve never really been an employee, so I’m not a very good employee. It was an uncomfortable suit. You have to be careful not to try and correct things 180 degrees when you get into those uncomfortable situations.

Really the answer is maybe 25/30-degree correction. What have I done? It’s really just more of the same. All right? COVID has been very trying. It is. It’s been trying as a global level. It’s a pandemic. I’ve never lived through a pandemic. The world has before, but in my lifetime I haven’t. It’s unchartered territory. However, let’s think about it. Do we deal with infectious communicable diseases every day? Yes. Do we deal with business challenges every day? Yes. Do we deal with anxiety and patients and sickly patients and unhappy patients and happy patients? Yes.

Do we see a trend in dentistry towards moving from the single practitioner to group practices? Yes. Do we see those practices that have reinvested in themselves and run themselves more like a traditional business and invested in technology and their staff? Have we seen that trend before COVID? Yes. What’s really new when we think about it? The thing that’s new to me is the gas pedal. When COVID hit, somebody hit the gas. The turbo boosters went on.

Those that had been doing those sorts of things to prepare themselves for an event, those are the practices that are thriving. The ones that were not prepared for that, those are the ones that aren’t. Then you’re seeing a massive consolidation that was happening already, but is just happening faster. Where’s the needle? It’s just 25/30 degrees. Do we lose some sleep about it? Absolutely.

To me in the dental world and probably all the dentists in the country, we live on six-month increments. Are we concerned about that? Sure. What are we doing? Well, we’re cash positive. We’re going to make sure that we continue to be in a strong position to reinforce that we’re here to stay to our staff and support them and make sure that they have the PPE that they need. We’re here for patients. We’re going to do more of the same, because we believe in our mission.

Listen, I’ve also heard the sayings and maybe just because it gets me through the day, but my saying for this is, “you get paid for when it goes wrong not when it goes right.” When it goes right, everybody can do it. When it goes wrong and you can pull it off, that’s when you get paid. To be the calm in the storm and make your patients and your staff feel comfortable during a pandemic so that they can continue to get the care that they need, that will prevent more morbidity health-wise, then you know you’re doing your job. We never shut down. We just kept on going, and then we’re speeding up now.

Rolando Mia: The message that you got across, which hit me really hard, and I resonate with so strongly is what you outlined. You’ve been doing … or in dentistry, when you’re looking at the context of it, you’ve been doing all of those things. Effectively, the only difference is … Actually it’s not. COVID is an infectious disease and in dentistry you’ve been dealing with infectious diseases. It’s just something to make you more conscious of it. I really appreciate the calmness, the confidence around it, and the recognition that, “Hey guys, we either deal with this, or we don’t.”

It’s the preparation. Have you experienced … This is one of the biggest topics that we’ve been hearing with dental practices right now, fear, apprehension from the teams. Fear, apprehension from other members of the group because of what you mentioned, the unknown. Have you experienced that with your group? If you have or haven’t, how have you been working through that with them?

Making Your Staff Feel Comfortable

Dr. David Fantarella: The answer is yes, we have experienced fear. The majority of the fear was during the shutdown when we were out of the game. The staff was not here. My partner and I, and about 10% of the staff, saw a lot of the emergencies for other dentists who had not had their practices open to emergencies. One very trying day I’ll tell you was when we had treated a patient with a large dental abscess around a previous root canal. We had no choice but to have some aerosol produced, do the procedures three different days within a week because the infection was so strong.

We were trying to keep her out of the hospital. Then on Saturday, she was nice enough to call us that she had contracted COVID from her work in a health care facility. She just wanted to let us know. My partner and I went home and basically looked at our wives and said, “Okay. This is it. I’m going to have a fever in the morning and we’re going to have to work through this. Is the will ready?”

Rolando Mia: Oh, no.

Dr. David Fantarella: We were scared to death, but that didn’t happen. The PPE works. You could argue that maybe it works a little too well, and it’s not progressing through society fast enough for herd immunity. Nobody really knows. That’s the trouble. Now, we’re 10 to 15,000 patients into this. We have our own empirical evidence as to how this virus reacts. We’ve done all sorts of things. We had been doing all sorts of things and we’ve been able to keep an environment in the practice that has not propagated the disease.

What do I mean by that? None of our staff has gotten it and we haven’t propagated it through patients. We’re very protective of that. What do we do? We check temperatures twice a day of the staff. No one in the office that is febrile or has a change in smell and taste gets in the office. Those have really been the big factors that exponentially reduce the risk of propagation, is-

Rolando Mia: Exposure.

Dentists Are Critical Front-Line Workers

Dr. David Fantarella: Right. Do I have all the answers? No. I would never assume that I do that. Humility is an elusive thing. When you think you have it, you’ve lost it. This is big and beyond one individual. Do I have more empirical evidence than a lot because I’ve been on the front lines? Sure. I’ve been on the front lines. We had another patient come in that had a huge abscess. She had done telemedicine, gotten some antibiotics, came to us for tooth pain. We sent her directly to Yale. She was the sickest person at Yale New Haven hospital.

She had basically necrotizing fasciitis down through her … gangrene down to her heart and she survived nine surgeries from a dental infection. How could we not stay open? I mean, we had to stay open to deal with those issues to try and reduce the load on the healthcare system and it was terrifying. Where we are right now is we stick to the protocols, we do what we’re supposed to do. We use the technology that reduces the aerosols and we move on.

Rolando Mia: Wow. Wow. Just when you said your patient called you and said, “Hey, I’ve been tested positive.” Coming home, I couldn’t imagine telling your wife, family and thinking to yourself, “Holy cow.” Grateful that nothing happened. Now, you mentioned aerosols. What have you done in your practice or how are you managing those? What have you been doing to minimize or mitigate that type of stuff?

It Pays off to Be an Early Technology Adopter

Dr. David Fantarella: Well, it turns out we’ve been using Isolite for many, many years and that stacked the cards in our favor because it drastically, if not entirely, reduces the aerosol, number one. I’ve always been a big proponent with Solea laser as you know and I’ve helped bring it to market. We have been using that since the day it came out. They’ve proven that Isolite reduces the aerosols while the infectious part of the aerosol kills the virus. We’ve been doing that. We were prepared for that because we knew the plume coming off the laser so we’ve used level three masks for a decade.

Again, already in place. We instituted common things, open doors, took away magazines because we really thought it lived on surfaces in the beginning. It turns out it doesn’t. We’ve instituted UVC disinfection within the operatories once a day to get the nooks and crannies. Then the landlord did it in the duct work of the building so we make sure we don’t propagate disease throughout the building. We tried to find a chemical that we could spray or fog the rooms with, or at least just spray with. We used to use Virex sprays.

We’ve tried to cut back on a lot of that because of the occupational hazard. Then we use Cavicide wipes, but then what do you do about those little nooks and crannies? We started spraying down the rooms with hypochlorous acid, which is basically what’s found in salt pools. They sprayed fruit with it and it’s potable. We instituted all these protocols. The reality is that this virus is some combination of other viruses that we treat. We know that hepatitis, for instance, lives a long time on surfaces so it’s not like that.

We know that it’s very communicable, so it’s like the flu. We know it exists in aerosols and we deal with that with say HVE. We don’t want to aerosol and breathe it into our oropharynx. It’s a matter of the knowledge, the understanding, moving the needle just a little bit to protect ourselves. It’s what we signed up for. I had friends of mine calling me that were able to work at home and so worried about us. I said, “Listen, I’m happy for you. Do it, but that’s not what I signed up for. I signed up to be a healthcare professional to help my patients and a small business owner.”

The business side of it is a whole different issue. That’s just what we’ve done. We’ve just been really steadfast with it. To be honest with you, I don’t know, I kind of like it because it’s brought us closer together. My staff is unbelievable. I admire them.

Rolando Mia: That’s cool. That’s so cool. It’s amazing. One of the things that I’ve experienced … And I’ve known you for many years. I’ve seen you and I think we met six, seven years ago, is one thing that I’ve personally observed and seen with Fantarella Dental Group is you and your team are incredibly technology-focused, technology-savvy. You’ve mentioned some of the different systems, Solea is phenomenal, and the different … even UVC and all that. From your perspective, how do you see technology?

Do you see it as something that can help or aid other practices in battling, not just COVID, but other infectious diseases, other things that are going to come up in the future? Because we’ve heard COVID is not the one and only. Like you said, hepatitis, HIV, if you look at history continuously. How do you see technology affecting your ability and dentists’ ability to overcome and thrive beyond and succeed beyond that?

Looking Beyond COVID-19

Dr. David Fantarella: Well, I’m glad you said it and not me. I mean, I’m looking beyond COVID. COVID, to me, could have been a lot worse in a lot of ways. There will be something else that comes along. It’s just the nature of viruses and bacteria. You have to be progressive with that. To answer your question directly, I don’t think you’d do that without technology. Let me put that plainly. First of all, I don’t think you can exist in the dental space in the next 10 years and be competitive without technology. I mean, it’s just as simple as that.

I mean, I’m not going to tell you I was so smart and I figured it out. It was more of a life lesson, I guess. I got to give my … I hope my cousin … He’s probably not watching this, but maybe he is. Who knows? I’ll give him a shout-out in Hawaii. I was at a very difficult time in my life, and I just didn’t know what I wanted to do, personally really. He said to me, “Dave, don’t worry about what you want to do. Just don’t do what you don’t want to do.” At about 38, I stopped doing anything I didn’t want to do. I found out that I love technology.

I was just lucky. It just is what I like to do. I pretty much have bought any piece of technology I thought was worthwhile in dentistry, regardless of the cost. I never even worried about the cost and I’ve never lost. I’m very careful with my ‘nevers’ and ‘wonts’ and things. I’ve never lost on technology. It’s always enhanced the patient and my experience in treating my patients. It’s led to less treatment, better outcomes, and a better financial benefit for the doctor and the patient.

That’s really been our mission at Fantarella Dental Group and our tagline, “tomorrow’s technology today”. I speak a lot about it. I tell other doctors to do it and not everybody listens to me, but the ones that do, usually win.

Rolando Mia: When you say the ones that do usually win, the sentiment or the message about you see technology, you invest in it. You’ve clearly done … When I first met you, I believe it was you and several team members. You had a single practice. Over the past, what six, seven plus years, you’ve grown. The Fantarella Dental Group now has how many? Three or so, four offices. You’ve got all sorts of members. One of the things that this pandemic and COVID has done is it’s put a lot of stress into the dental system. There are still practices that aren’t opening are.

How do you see the effect of that to the other practices? You continue to thrive. You continue to grow. If I understand correctly, you’re seeing a lot of patients and they’re safe and they’re happy to be there and they’re feeling comfortable because of what you’ve done. How do you see this affecting not only dentistry, but the growth of the Fantarella Dental Group?

Consolidation in Dentistry Isn’t Bad

Dr. David Fantarella: Right. I don’t necessarily see it as a negative thing. There’s a consolidation. It doesn’t mean that necessarily doctors need to go out of business. I just think we have to work together and unite and leverage the economies of scale to provide the best care we can with the latest technology.

Our mission was never to grow. Our mission was to do the right thing. That’s what it is. Do the right thing, give the patient the best care, the best outcomes, the best patient experience at the cheapest price, with the least amount of treatment.

That’s our goal. We just do that. I tell my team all the time, you do that, you’ll never be wrong. That’s what we do. We don’t really have multiple practices. We just have the Fantarella Dental Group at different locations with multiple … We have, I don’t know, 40 chairs going every day, something like that. It’s just a matter of making sure that everybody is working towards the same goal. There’s not a better day than when a staff member comes to me and says, “We’re doing this, and it just doesn’t make sense to me.

We’re using a box to transport instruments or something that was used for this or that. We should have something designated for that.” Or whatever it is. When they tell me we can do something better and it makes sense, and they come to me with the solution, I know I’ve done my job because I can’t be all the eyes and ears. I have patients come to me that say, “I knew that this place would be safe during COVID.” They do that because I’m fanatical about it. You got one shot at your first impression, and then your continued reputation.

I take that very, very, very seriously. For my staff to continue to come to work with that type of an attitude, that means everything to me. The goal is not just to grow and grow and grow. No. The goal is to stick to the mission and then as we get an opportunity to move and grow the practice, we take it. We say no more than we say yes. When we say yes you know you have 110% of our back, if that make sense.

Rolando Mia: I love the clarification because there’s discussion out there about how take advantage of the situation. What I’m hearing is you’re not. What you’re doing is you’re trying to reach out, help and this context of consolidation, helping each other.

It’s not about acquiring. It’s not about growing. It’s about doing the right thing and then doing it in a manner that helps the patient first, helps the people next and in the end, it comes back to you. That message is incredible. I love the sentiment behind that. I think that’s incredible and makes total, total, total sense.

Dr. David Fantarella: I’ll give you just one more example, if you don’t mind me interrupting.

Rolando Mia: No, no. Please, please.

Benefits of Merging Practices

Dr. David Fantarella: Maybe when we get into a situation where we merge with a practice, because of the economies of scale we can give those employees sometimes medic … We have medical insurance, 401k profit sharing plans. Different benefits that we’ve invested in that they might not have had the opportunity as a smaller business, because we do operate it as even larger than we are.

That’s a positive thing. These are individuals that are trying to make a living and have a good life and pay for their kids and their family. They come to work and they work hard and they put themselves at risk and they deserve it.

Rolando Mia: See, the investment, the thing that I was going to get to is, even with all the investment, even with all the technology, you’re still focusing on providing the best care the most efficiently for your patients. Not just you get this mindset, “Well, if I’m investing in all this, then I have to raise my prices. I have to. Hey, that’s the …” No. I’m not hearing that.

I’m hearing patients first, let’s figure out what makes the most sense, and then let’s move with it, which is huge because you don’t hear a lot of that because there’s so much focus on the business first, as opposed to the patients sometimes.

It’s pretty cool. I guess, moving forward as we get past into this, from your perspective, what do you see are things that you feel are going to be happening in the future? You’ve been prepared to this point, what are you preparing for now as we see getting through this pandemic, getting through that, and then moving forward? Any thoughts on that?

Dr. David Fantarella: Again, not to be a broken record, I think it’s going to be a lot of the same, right?
We’re investing in a huge software change and that’s just to make everything more streamlined, make it easier, make it more accessible to the patients, be leaner on our end and provide the best care that we can. I mean, we did it well yesterday, we want to do it better tomorrow. I just see that as the future. It doesn’t matter really what comes at us.

People need healthcare and their dental care, so we just have to figure out how to give it to them in a safe environment and the best way we can. To be honest with you, to drive down the cost.

Listen, it goes back to don’t do what you don’t want to do. If I said, “Ro, listen, forget about the money of anything. We’re going to give you everything you need or want. You want XXX, you got it. Doesn’t matter. Anything. Now, just come to work and just do what you want to do.”

Rolando Mia: Focus.

Dr. David Fantarella: That’s it. Would you have a problem with that?

Rolando Mia: Absolutely not.

Stop Doing What You Don’t Want to Do

Dr. David Fantarella: No? That’s my life. That’s what I do every day. I am entirely grateful to my patients for allowing me to do that, and I give them everything I can to make it happen.

Rolando Mia: Thank you for that. You’re right. When you love what you’re doing, it’s not work. It’s something that you enjoy doing. Keep doing more of what you love doing and stop what you don’t. That message is coming across incredibly clear and I very much appreciate that.

Dr. David Fantarella: Yeah. I mean, dentists, let’s relate that to them. Say you’re in a PPO that you don’t want to be in or you’re in an area that you don’t want to be in or you’re doing some type of dentistry you don’t want to do. Don’t do it. This is not a dress rehearsal. Do what you want to do so you can do it well and enjoy it because it comes out in how you work. That’s different for different people. I mean, I’m not telling them what to do. I’m just saying do that, everything else will work its way out.

Rolando Mia: If you were to provide advice in summing up what we’ve been talking and advice to other clinicians, viewers who are going to see this video later on, your patients, the team, your team in looking at this. What advice would you want to give them with regard to how to move forward here?

Dr. David Fantarella: I think I’ve given them some of the advice, which is just do what you want to do. From a broad spectrum, single practitioner or larger practices, I think the best thing to do is really a strategic plan first. Is to really come up with a plan for your practice, have a mission, communicate the mission, and get a staff that buys into the mission. Then as a staff member, find a place that you want to work that has that mission. It’s not always about money. Most of the time it isn’t. It’s more about environment.

There’s a range of what everybody makes, no matter what, whatever industry it is. Very few times is it all based on money. It’s more based on environment and the cause and the mission. Do the strategic plan, get the mission, invest in the mission, find the staff that has the mission, and as a staff member, you do that for yourself as well and execute. That would be my advice.

Rolando Mia: Where’d you get all of this wisdom?

Dr. David Fantarella: I don’t know if it’s wisdom. We learn every day. Listen, if you had a hundred years, the first 20 of them … My grandfather used to say youth is wasted on the young. The first 20 years for me, I didn’t know anything, the last 20, that might be the back of the runway unfortunately. You got 60 in between.

Took me a good 30 to really get my engines running. If I can do this for another 30 years, the way I’m doing it and just have these people around me and do what I want to do, so some tough times will make you think about things like that.

Just make sure your health is good. Health is wealth, and enjoy your environment. It’s really, really very simple when you think about it.

Rolando Mia: That is cool. I’ve known you quite a few years now, and you’ve always been the kind of person that you feel very comfortable with, and I very much appreciate that. I appreciate you taking the time. I know you’re really busy and yes, you are actively working. You’ve got an organization to work with to spend with us. Thank you so much for that.

Dr. David Fantarella: Thank you very much.