I recall taking an aptitude test in high school and I was really good at math, but there weren’t a lot of math careers—you could be an engineer or an accountant. There was no such thing as computer science when I was growing up. The aptitude test indicated I liked working with people, working with my hands, and was good with science. It had a list of four or five things that I could be, including a dentist, a vet, or an accountant. So, I applied to dental school not really knowing anything about it. I remember my first day hearing some students talking about a bridge and wondering if they were talking about the Brooklyn Bridge or the Verrazano Bridge!

I graduated from NYU College of Dentistry in 1978. The late ‘70s was a great time to be a dentist and I enjoyed it. It was kind of a new frontier because dentists were not taking insurance or allowed to do any advertising. And overhead costs were low—there was no high-tech equipment. I bought my first dental office in September 1979, 3 months out of my 1-year general practice residency, for $5,000. That included about 500 patients and all the equipment in the practice.

DSOPro: We hear you are an early adopter and technology geek. Tell us about that.

I guess I had a latent technology passion that was discovered by a good friend of mine, Nat Kaplan, who was a year behind me in dental school. We had one thing in common—we both lived at home with our parents. My dad worked in the post office about a block from NYU and his dad was a dentist in Manhattan. So, we both managed to get rides with our parents and avoid taking mass transportation, but it meant getting in an hour early. We were usually the only people in the lounge area and got to know each other every day before class.

Nat was very passionate about gaming, which back in the ‘70s was on an Atari 2600 with joysticks and everything. He got me into my first computer, an Atari 800. In 1981, my wife and I bought our first house when interest rates were crazy, like 18% for a fixed-rate mortgage. But I could get a mortgage with Citibank at a reduced rate of 17% if I agreed to participate in their “online” banking program. Online wasn’t a word yet; I have no idea what it was called back then. So, I connected my Atari 800 to a 300 BAUD Modem, the very slow modem they gave us, went onto my first session, and paid three bills via the computer with a dial-up phone connection. “Internet” was not a word back then either.

I was just amazed by the technology! I remember telling my wife, “You’re not going to believe what just happened! I just paid three bills using the computer!”

She looked at me rather unimpressed and said, “How long did that take?” And I said, “About an hour.” And she replied, “I don’t get it. I could write three checks and have them in an envelope and in the mail in 5 minutes.” And I told her, “Oh man, you don’t get it. This is going to change the way things are done in the world!” She said, “You’re right, I don’t get it, but knock yourself out.”

She’s always been supportive. Like when I dragged her in 1985 into the IBM PC product store in White Plains and we bought our first IBM PC/XT computers for the office along with a pretty trashy dental office practice-management system. They were each about $5K, which was a lot of money for us in 1985, but I really believed in this stuff.

I was always an early adopter. I was the first kid on the block with intraoral cameras, and then with digital x-rays in ‘98. In 2004, I was getting frustrated by not being able to find what I was looking for in 20-plus years’ worth of paper patient charts and documents. I had also read too many stories about dentists losing all their records in floods, fires, or other catastrophes and decided to digitize mine. There were no electronic health record programs commercially available, so my son-in-law and I built one together.

Fast forward to when our first grandchild was born in 2011 and we sold my practice and moved to California. That’s when people in the industry started asking me to do lectures and teach dentists about social media and how to post things on Facebook. It was a big unknown area and who better than Mark Zuckerberg’s dad, who was a dentist, to teach social media to dentists? I knew a lot about it, so I felt it was kind of my duty to share it. I also taught technology integration for dentists.

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I started advising my first startup, a company called Breathometer, in 2012 and from there things just mushroomed. I got calls from everyone with anything from a smart toothbrush to an idea for robotics in dentistry and whatnot. About 4 years ago, the folks from AngelMD, an established mini-investing portal for physicians, asked me to help them develop a dental arm.

I met Jeremy Krell (Revere Partners) at a dental meeting and thought he could help me with the mission of bringing 25 top dental industry KOLs to AngelMD. Jeremy said he had an idea for something along similar lines and wanted to make sure there was no conflict of interest, which there wasn’t.

Meanwhile, AngelMD’s involvement in dentistry was kind of small compared to what Revere Partners is doing. I joined Jeremy and Revere in 2021. I’m involved in projects with companies working on periodontal inflammation or oral-systemic-connection-based products and services.

Around then, I also became involved with Keystone Bio, which was a real change for me. They are developing a biologic drug, a monoclonal antibody, to eradicate Porphyromonas gingivalis, the major periodontal pathogen that we now know is linked to a variety of human illnesses—Alzheimer’s, heart disease, diabetes, digestive cancers, etc.

With my understanding of microbiology, I realized that the main obstacle to gaining acceptance, if the drug trials are successful, will be creating awareness in the profession and in the public. I convinced them that’s where I could help and joined as the chief dental officer. I’m now also doing the same type of thing for Viome, a company that has an early oral and throat cancer detection saliva test with 95% sensitivity. The saliva test analyzes the oral microbiome and the bacteria that are potentially causing full-body diseases. So that’s my real focus now.

At my age, I had the feeling my legacy would be that I was a good guy, good provider, and good family man but my claim to fame would be that I had famous offspring. Now I have a mission, because I really believe these things are going to revolutionize dentistry and bring the profession to the forefront as a primary care medical specialty. Somewhere along the line, dentistry got separated from medicine. Dental insurance is a separate product from medical insurance because they don’t consider problems in the mouth as really affecting overall health, although they are becoming more aware because there is more literature about it.

DSOPro: Tell us more about that, bringing dentistry and medicine together.

If I could look into a crystal ball, what I’d want to see 10 years from now is all healthcare under one roof. So, when you go see a primary care physician for a problem with your heart or blood sugar, the first thing they say is, “Before I do anything, you need to see a dentist and have any periodontal disease treated because that affects everything else in the body. If you are not in good periodontal health, we can’t control your other diseases.”

I’d also like to see the abolition of dental insurance, which I think has been a real burden on the profession. The quality of services rendered in the dental office are affected when a dentist proposes treatment and the patient asks, “Does my insurance cover it?” If they’re lucky enough to have dental insurance, they will go through $2,000 a year’s worth very quickly. Insurance companies basically devolved dentists from the self-employed gatekeepers of oral health into employees of insurance companies. We need to change that.

DSOPro: What kind of system would be better?

First of all, the two have to be related because of what we know now about the oral-systemic disease connection: the cost of medical care could be drastically reduced by improving periodontal and oral health. Some insurance companies are starting to realize this and may soon be on board with covering technologies like Keystone Bio’s, especially if their drug is approved and we begin to administer this biologic into the gums of people who have periodontal disease—which is basically half of all adults over age 30 and 80-plus percent of adults over age 60.

Patients coming in for recall periodontal maintenance visits will have this medicine squirted into their gums. This will increase the cost of a routine dental visit and, even with good education on the benefits, will meet a lot of resistance. It will also likely not be covered by dental insurance. But medical insurance coverage is the perfect answer if it can save medical carriers the expense of treating heart disease, Alzheimer’s, and cancer. They’ll be the big winners, along with the patients, and of course the dental practitioners who will then enjoy elevated standing in the healthcare community. So, it’s a win-win for everyone.

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DSOPro: Will that help bridge the gap between what dental and medical insurance cover?

Medical cross coding has improved, although it’s still nowhere near where it needs to be. I was an early adopter of electronic dental claim transmission in the early 1990s. And I was also a consultant for the MetLife and Blue Cross Blue Shield dental programs, so I know the insurance industry intimately.

The first cross-coding attempts began in the late ‘80s. I was placing implants and no dental insurance companies covered that. I took a course on how to submit medical claims and get dental implant procedures covered through medical insurance. I think I did about 10 claims and got paid on only 1 of them.

Nowadays, when dealing with medical claim carriers, it seems like there is an automatic rejection or at least a denial and a request for more information even if the dental office is using the correct CPT codes and diagnoses. It falls on the administrative staff to follow up and the likelihood of it getting resolved is small. Some companies, like Nierman Practice Management, which offers a terrific two-day program on sleep apnea and TMJ treatments, simultaneously teach the dental staff about medical billing and coding for those services because that’s the only way to get paid.

At Viome, we’ve acquired a company called Devdent, which is a real game changer in the medical/dental cross-coding space. They have simplified and streamlined the process so the dental office doesn’t deal with the medical carrier directly. The dental office submits the claim to Devdent in a format that ensures Devdent gets all the data they need: narrative, x-rays, periodontal charting, etc. Devdent then submits the claims, whether it’s for one office or multiple offices, and deals with any issues.

Viome is working with Devdent on their oral cancer detect and oral health intelligence test whereby patients spit in a tube to collect the saliva sample and mail it in. Using the correct CPT code, we’re getting reimbursements for the salivary analysis from major medical insurance.

Viome has had a B2C product for years now and has done around a half a million tests. Until recently, they were primarily a gut intelligence company. They send you a kit and using a device they include, you send them a few micro capsules of blood from your fingertip along with a fecal sample, and they provide an analysis of the microbiome in your digestive tract and your nutritional needs. They’re able to determine pathways that are or aren’t working, whether you are producing too much hydrogen sulfide gas, if certain things are causing irritable bowel syndrome, and other things related to your diet.

The patient also completes an online questionnaire about symptoms, and machine learning and artificial intelligence are used in combination with the mRNA data obtained to recommend treatment protocols in terms of diet. They do re-testing at regular intervals to assess whether their recommendations should change. They also create custom nutritional supplements.

Viome is now doing the same thing to analyze oral health by collecting saliva in addition to blood and fecal matter in a direct-to-consumer kit. They can analyze the oral microbiome and make dietary and supplement recommendations to help balance the growth of good oral bacteria and suppress the growth of bad bacteria in the mouth, which will have a positive effect on overall systemic health. This kit is not quite ready to roll out, but it will be very soon.

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Devdent is currently doing studies for us by submitting large batches of claims for the biome test to major medical carriers. Viome has also developed a program called Oral Health Pro with CDOT, which stands for Cancer Detect Oral & Throat, and provides cancer determinations for the oral cavity and throat in high-risk groups. Dentists will get much deeper reports on any evidence of oral or throat cancer with a 90% to 95% degree of specificity. It will also identify fungal activity. It’s suitable for anyone and it may become the standard of care to do this for every patient once a year. Patients will receive six different scores on their oral health along with details about how to improve their scores in terms of professional care, diet, etc. In addition, Viome is developing customized oral healthcare products, such as a toothpaste and oral lozenges, designed to further manipulate an individual’s oral microbiome based on their needs.

Getting back to my crystal ball, we’ll see dental offices and medical offices under one roof eventually. While that’s a long way off, this will help us get there.