Home Interviews “These young dentists… they’re not used to what I call edutainment…”

“These young dentists… they’re not used to what I call edutainment…”

Dr. David Hornbrook, San Diego, California

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A.         I’ve been in practice now it’s gonna be 32 years next month.  So I’ve been in the same practice, different location, but I bought a practice right after school.  Actually in school I still made the purchase so as soon as I got my license, I was in my own place.  So, 32 years which is hard to believe but it’s been an awesome experience.

Q.        Now you’ve been an educator in the dental industry for many years.  How’d you get started with that?

A.         Well, it’s kind of interesting.  I graduated in 1986 from UCLA and at that time people weren’t doing aesthetics, they weren’t doing very much metal free.  I first got hooked up with Yuri Uveski (?), a dentist out of Santa Monica that was doing concepts.  I just happened to go to a lecture and I was like this is so cool.  We’re saving tooth structure, these restorations have no metal, we can bond them to the tooth.  Patients are gonna like them better.  So I started doing those and then I went to a presentation by John Sorenson, of all people, who was actually an instructor of mine when I was in dental school, he was going through his Prosth program.  It was at UCLA and it was called porcelain inlays and onlays.  And I went with a buddy of mine from dental school and we sat there for a half day and John showed amazing stuff and amazing research.  I turned to my buddy Steve and I said, could you go back and do one of these.  He said there’s no way.  It just wasn’t set up like a recipe.  It’s like here’s the data, here’s the materials, but it wasn’t like you start with A as your treatment plan and you end with Z when you do your final polish and let your patient go.

So I went back to my office and I’m a simple thinker.  Mike, you’ve known me a long time but I’m a checklist and a list person, although I’m not a very good cook, I’m a recipe guy.  You start with A and you end with Z and Q does not go before K, it’s just not that way.  So I decided just to put basically a checklist of my own together.  So okay, this is where we start, these are the things you can’t do.  I was hearing people – they were trying to do these porcelain inlays or onlays and they were doing IRM bases and then putting Copalite and then putting resin which all three are incompatible with each other.  But there just wasn’t again this cookbook or recipe for these people to do it right.  So I started photographing, I wasn’t a very good photographer then and nothing was digital but I started photographing cases.  When I came up with my checklist of A through Z and sent it to some of my other friends, they thought this was awesome, you need to teach this stuff to other dentists.

So I actually had my very first program, and I set it up myself.  It happened to be Super Bowl Sunday and the Super Bowl started at 1:00.  So that’s why the hotel rooms were available because everyone is either at home or at a bar, they’re not gonna go to some ballroom in a hotel.  So at first I was a little worried but we had almost 100 dentists there.
Someone came to that program and they called me that night and said hey, I like what you had to show.  You did it in 3 hours, could you do like a half day and on different topics?  I said yeah, I would enjoy that, I could do a half day.  Of course I went home and I thought what the hell am I gonna talk about for 4 hours or 5 hours.  But I put some slides together and then I presented to a study club or an academy.  Then someone said could you do three-quarters of a day at the California Dental Association meeting and I thought yeah, absolutely, I’d love to do that.  Again, I fretted for several months to figure how I’m gonna be able to do that.  It just snowballed from that as I started photographing everything.  Having a practice and me stepping out on a limb in some of these things that I was doing, it just set up perfectly as the so-called aesthetic revolution as Ivoclar coined.  As that started to come into play in the late 80s or early 90s and I started talking about these subjects that were exciting and new and subjects that weren’t taught in dental school.  So it kind of just snowballed into that.  As you know, I started at LVI with Bill Dickerson, we started the first live patient aesthetic programs.  It’s just been this wild roller coaster since.

Q.        How has dental training changed over the years that you’ve been involved with it?

A.         Post grad has changed.  The primary change is these young dentists, these millennials and even a little bit older, they’re not used to what I call edutainment.  They would rather go to YouTube or get online training than actually go to seminars.  That’s changed a lot because obviously we didn’t have that way to educate in the past.  That’s a big change that I’ve seen.  The other thing is that things that were very exciting and new and on the forefront in the early 90s and 90s veneers and porcelain inlays and onlays and all ceramic restorations, there’s been so much education in the post graduate world whether they’re graduates from LVI or PAC Live or other programs.  We’ve kind of been saturated with these all ceramics because it hasn’t changed very much other than monolithic which we can get into as a separate subject.

Q.        What topics are you currently lecturing about?

A.         I’m still talking about all ceramics, kind of cutting edge.  Certainly addressing the monolithic, the new zirconium, the high translucents, zirconium dioxides is a very exciting field.  And I’ve really started speaking a lot about anterior implant aesthetics and implant restoratives and new abutments and restoration we’re putting on abutments.  But in my all day lecture, I still talk about adhesion.  There are still people that are confused as these adhesive agents and new cements are coming out by the manufacturers so that obviously is a topic.  My new presentation for my all day 2019 is ceramic and adhesive updates for 2019.  So that’s still a very hot topic.

Q.        How have advancements in materials changed dentistry over the years at this point?

A.         Let’s break it up to ceramics first and then we’ll go to adhesion and cementation.  Ceramics, the thing that’s changed is this whole monolithic deal.  In the past, it was either pretty and weak or strong and really ugly and we’re always trying to marry the two.  So dentists are looking for – and have been since the beginning – basically an unbreakable or very, very durable all ceramic restoration that they can cement with anything they want.  I’ve got probably 50 full mouth rehabs that are 28 units of Empress, I’m still a huge Empress fan.  But you have to bond it into place and dentists don’t always want to go through that technique sensitivity of isolating and etching and priming and air drying and light curing before they can cement it.  So this whole concept of this monolithic restoration and when Glidewell came out with the BruxZir in 2009 or 2010, that met the needs for a lot of dentists for posterior crowns but it certainly wouldn’t do it in the anterior of the mouth cause it was ugly.   In the last four or five years with most of the major ceramic companies, and Ivoclar just released theirs, with these HT’s, these high translucency zirconiums, especially if they’re multilayered pucks so there’s built-in an adherent translucency as its milled.  So we’re seeing finally to a point where we can get almost Empress and EMAX type aesthetics, very very close to EMAX aesthetics with a material that is twice as strong as what we’ve seen with these materials in the past.  So that’s huge in those materials.  And then it’s also made with the evolution and the technology in milling, it’s made these restorations very affordable.

So in the past, in the 90s when Bill Dickerson was using Lee Culp and I was using Matt Roberts, they were doing amazing stuff but it was expensive and the average dentist or dental practice didn’t want to pay those type of fees.  So they weren’t getting the aesthetics that I think we were getting and paying for and now with the technology changes again in milling and materials and digital, it’s kind of evened the playing field.  I hate to say this but it’s gonna even the playing field with these monolithic restorations where dentists can now have very aesthetic restoration that is very affordable and that’s a huge change.

Q.        How would you define digital dentistry and then what effects would it have on practices?

A.         Well, digital dentistry from the dental practice side, whether they mill it in their own office is kind of irrelevant.  But digital dentistry, taking digital impressions which I’m a huge fan of, it’s more accurate, it’s more affordable, less remakes.  And then if the dentist wanted to go into milling, in these days they could almost buy – there’s probably give or six different milling machines.
From the lab side, digital dentistry has become really almost every posterior restoration is now digitally designed.  Even if I took an impression and sent it to the lab thinking that they’re gonna pour, model and wax it and press it or build ceramic on it, the lab is turning that into digital dentistry so they can mill these restorations.  I tell people in my lectures that if you think dentistry in the dental practice is moving fast, and of course everyone agrees, on the lab side it’s probably moving 20 times faster with the change in printing and mills and the abundance of materials that we’re seeing out there.

Q.        What do you think the consumer thinks about that?

A.         I think it excites the consumer because they’re reading about it.  In even non dental journals they’ll be an ad or an article or editorial that pops up every once in a while on digital dentistry.  Someone, I forget what magazine, it was a non-dental magazine, it just talked about digital x-rays and I was like we’ve been using those for 20 years but they made it sound like it was brand new.  I think the perception with all the changes that’s going on around us in the world, the perception that the dentist uses things that are digital, that it means that it’s state-of-the-art and they’re keeping up with the changes.  So hot topic, good marketing opportunity for practices and clinicians.

Q.        What do you believe the role of corporate dentistry is moving forward?

A.         Man, it’s gonna be very interesting.  Corporate dentistry, it’s obviously changing the whole environment and architecture of what dentistry is today.  What I’ve seen – we’re not gonna compete with them pricewise, the private practitioner, the fee for service dentist.

But let’s look at the retail store industry.  Nordstrom’s is doing really, really well. Bloomingdale’s is doing really, really well.  Walmart is doing really, really well.  The middle class being the Macy’s and the Penney’s and the Sears are struggling.  I think that’s what we’re gonna see in dentistry.  Corporate dentistry is going to eliminate this middle class and there’s gonna be dentists that are either gonna have to make a decision that they’re gonna be the Nordstrom’s or they’re going to be very high service oriented and not buy into these low fees and low service or they’re going to have to work for somebody.  We see this with the dentists, I work with 50 young dentists every year and we just met two weeks ago, we meet again next week, and 90% of them work for a corporate dental office. 

So I think they’re sucking in these young dentists.  I look at these young dentists, they owe $350,000 and all of a sudden they go to work, they’re 26 years old, they make $150,000 a year, it’s the first time they’ve ever really made any money so they buy a car and they buy a condo and they buy a boat.  And they never get out of that rut of being able to go to the bank and buy a practice or own a practice.  It’s going to be interesting how that plays through.  But I think we’re gonna see a loss of middle class.

We see that in dental laboratories.  They’re not gonna compete with Glidewell on price and they’re not gonna compete with Utah Valley Dental Lab on service.  So they’re kind of lost in the middle.  And I think that’s what we’re gonna see in dental practices as well.

Q.        What do you think is the most important thing you’ve done or do to market your practice?

A.         Well, the best obviously is direct customer relations, word of mouth in my existing practice.  They’re already a captive audience there.  You treat them special and they want to talk about it.  So that’s been the best.  The website, we have a new website, the website has been very good for us because of the before and afters and they’re our before and afters so they get to see some quality dentistry as well as they see a lot of dentistry when a patient googles cosmetic dentistry or veneers or any good dentist or they hear about it and they go to the website.  And then Google reviews has been really good for us.

Q.        So how important to your practice is social media and what specifically do you do in that realm?

A.         Well, social media has been huge for us.  The practice and myself were not using it to its full potential.  I just hired someone to overhaul basically all of my social media content.  And right now in my practice we’re using Facebook, I have a personal page as well as a practice page.  We’re using LinkedIn and Instagram has been pretty big for us actually.  Showing cases, telling stories with the cases has been big.  So those are the primary, Facebook – and then Google reviews.  We ask for Google reviews and Yelp reviews.  We actually have a QR code that if the patient says yeah, I’ll do it when I get home and they may forget about it, they can actually scan the QR code and it’ll go right to a Google site so they can provide reviews.

Q.        What advice do you have for today’s dental students?

A.         I tell them to pick a path.  Don’t deviate from that path but be patient.  And that’s the thing they struggle with. I just had this big conversation two weeks ago with this whole group of almost 50 dentists and they all want different goals.  Some of them want to be a cosmetic dentist, some of them want to place a million implants a month.

The second one is find a mentor.  What’s interesting Mike, and again you’ve been in dentistry a long time too, is these young people are really great at accepting advice and asking questions because all their life they haven’t really had to try to figure it out on their own.  I was telling the story to this group and I said I used to ride motorcycles as a kid all the time.  And the oil carburetor of course, not fuel injected.  And when something went wrong with the carburetor, I’d take it all apart, I would try to keep track of everything, I’d clean everything, I’d put it back together and it didn’t start.  And I looked down and there’s a spring or a screw on the bench.  And I’d think god darn it and I’d take it all apart again and I would do it again two or three times till it finally ran.  Where today, and I still ride motorcycles, when I have a scenario and I just put a new water pump in my bike not too long ago.  I just go to YouTube and I can type in not only the water pump but the year of the bike and it shows me exactly how to do it.  So this whole trial and error for the newer generation – they just haven’t gone through this.

So to go back to one of your first questions about how education has changed, before when we were telling these dentists in my generation this is what you need to do – this, this and this.  They’re not really good at taking advice.  The ones that did accept it and learned from my mistakes and Ron Jackson’s mistakes, they’re the ones that took off and did really well.  It’s the ones that said I’m gonna take a little bit of that but I’m gonna try my own thing and do this and this because that’s what I’ve always done all my life.  Working with these young dentists, which I love, they are just like sponges in accepting knowledge from others.

Q.        There’s been several watershed moments in dentistry from bonding to tooth color materials and so forth.  In your opinion, what’s the next big thing in dentistry? 

A.         Well, I think if we look at these biocompatible materials or bioactive materials.  We have some but they’re still very youthful in the evolutionary process.  I think if we can get to a point where we can use a cement or restorative material that truly arrests caries, truly counteracts the acid demineralization of the pedicle layer in the mouth, I think that’s gonna be huge.  That’s gonna change dentistry forever.  We’re not quite there yet but we’re getting there.  I think that’s probably gonna be the most exciting thing.

That and when we get to the point where we can truly use dentin and enamel as a restorative material.  Whether it be stem cells or whether it be something that’s artificial dentin and enamel but reacts just like dentin and enamel.  Can you imagine if we had a Cerec block or a puck like we mill our zirconium out of, if that was truly dentin and enamel.  And if we had a scanner, instead of just scanning the prep but actually scan the shade and the density of the dentin and the enamel and then we mill it out of dentin and enamel and we cement with a material that is truly bioactive and biocompatible that actually fuses this new artificial dentin and enamel to the existing dentin and enamel in the tooth – we’re gonna get there eventually.  But I think the start is these bioactive cements and bioactive restorative materials.  That’s gonna be huge.

Q.        So there’s a lot of talk in the dental business about life balance.  So when you’re not in the operatory or lecture hall, what do you like to do?

A.         Well you’ve known me a long time.  I’m a work hard, play hard type of guy.  I ride off road motorcycles, I still do that.  We have a season out here in San Diego because it gets really hot in the desert, I do all desert riding.  So from October to – we say Halloween to Easter.  So I’m still very active in camping and riding motorcycles.  I still surf quite a bit, just went last weekend.  My two boys, are 19 and 23 now so we get to do more adult things.  I just went surfing with my son and his friend down in Mexico.  And I still snowboard.  I probably got in around 50 days this last year.  So I’m still very, very active.  Again, you’ve been part of my life for the past 20-odd years, I’m really good at the balance of working and playing.  I tell people even in my seminars, okay when 5:00’s over, I’m no longer a dentist.  Don’t go to the bar and ask me questions.  Ask me questions now cause when we go out to the bar, I’m just David Hornbrook the surfer kid, motorcycle riding, snowboarder from San Diego.  And that’s worked really well for me because I can turn off dentistry when I need to turn off dentistry.

Q.        That’s terrific.  David, thank you very much for your time.  I appreciate it and it’s great talking to you.

A.         It was great talking with you, Mike.