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Show Notes

Dentists take the course. Fill the notebook. Nod at all the right moments.

Then they go home and do nothing with it.

Dr. Jamison Spencer has watched that happen for 25 years, and in this episode he tells Dr. Erin Elliott and Jason Tierney exactly why it keeps happening. Along the way: PRF and why he refuses to stop talking about it, the fear that keeps good dentists from helping obvious patients, an AADSM membership number that should bother all of us, why direct-to-consumer companies aren’t the villain, and his new book, which he cheerfully calls a cookbook.

Fair warning. If you’ve been getting ready to get ready on dental sleep medicine, this one stings a little.

What’s on the Menu

• The myth of “20 years of experience”
• PRF, and why there’s no smoke and mirrors
• Why courses don’t change practices
• The “what ifs” that stop good dentists cold
• 3,000 members. 200,000+ dentists.
• Direct-to-consumer as proof of demand
• Treat 100 people before you touch insurance
• Practical Dental Sleep Medicine (free audiobook code inside)

“20 Years of Experience” Is Sometimes One Year, Twenty Times

Spencer’s been saying it for years:

“There’s a big difference between 20 years of experience and one year of experience repeated 20 times.”

He watched it play out when sleep showed up. A chunk of the TMD world called it a fad and put their heads down. The people paying attention noticed that a lot of TMJ patients also had sleep apnea, and you can’t unsee that.

Then he nearly did the exact same thing to himself.

A Spencer Study Club member kept pushing him to look at PRF. Spencer had lived through prolotherapy, wasn’t impressed, and blew him off. The guy kept coming back. Spencer finally bought the book, went into the literature, found more evidence than he expected, and started doing it.

Twenty-five years in and he still got talked out of a position he was certain about. That’s the point.

PRF: No Smoke and Mirrors

The thing Spencer likes most about PRF is how boring the mechanics are. Draw the patient’s blood. Spin it in the centrifuge, in the room. Put it back in the same patient.

“There’s no smoke and mirrors.”

Nobody disappeared into a back room. Nothing got switched. No sourcing questions about whose cells these were.

The part that got his attention: it doesn’t seem to depend on whose hands are doing it. Dentistry is full of techniques that work beautifully for one gifted operator and nobody else. Spencer says roughly 150 to 200 dentists have now been taught to perform PRF injections and the reports keep coming back the same. He’s careful not to oversell it, and then he tells you about patients who were quoted joint replacement as their only remaining option and are now pain free without it.

Erin’s a believer for personal reasons. Golf gave her a bilateral tennis elbow bad enough that she stopped doing extractions and could barely lift a glass. She got injected, was told to skip the ibuprofen for eight weeks, and at week seven she was ready to call it a failure. Then it was gone. It hasn’t come back.

Meanwhile most orthopedic surgeons have never heard of PRF. Spencer describes a hand surgeon calling it “fringy” in one sentence and mentioning a friend from training who does nothing else in the next.

Square that circle.

What Actually Separates the Dentists Who Make It

Jason asked what the successful dentists have in common. Spencer pointed at Erin.

She heard about something. She took the course. Then she scheduled a patient.

That’s it. That’s the whole differentiator.

“I know I don’t know everything, but I know enough to get started.”

Erin books a patient for the week after any CE course, before she takes it. Reduced fee or free. Ready to go.

Spencer’s least favorite question from a dentist who just took his course is what he charges for the procedure. His standard answer:

“When I used to suck like you do, I charged a lot less.”

He’s joking. Mostly.

The “What Ifs” Are Doing More Damage Than the Procedures

Erin has a name for it. Dentists get a case of the what ifs. They think through every terrible outcome before they think through a single good one, and they talk themselves out of helping someone.

She posted about using an ampule to reduce the gag reflex and got a wave of questions behind the scenes. Did they sign a consent? Do you have acupuncture licensure? Her guess about where those questions were coming from was correct.

Here’s the kicker: Spencer got licensed as an acupuncturist in Idaho because he thought he had to. His license lapsed by accident. He went in front of the Board of Dentistry to plead his case, and they asked him who exactly told him a dentist couldn’t do this for dental purposes.

Then there’s the one that should be embarrassing for all of us. A meaningful number of dentists believe that making an oral appliance for themselves without a physician’s prescription is an FBI-level crime.

To be clear, none of this is an argument for practicing outside your training. Spencer is the guy moving toward ultrasound guidance specifically so that nobody he’s ever taught calls him with a board complaint. Safety is the whole reason he’s careful.

Anxiety isn’t the same thing as safety. His reality check on oral appliance therapy:

“How many people have I killed with oral appliance therapy? Zero.”

“I Can’t Do Sleep Because of Medical Billing”

Erin’s rebuttal is the best one in the episode.

Practices sell clear aligner therapy at $5,000 all day long without flinching. Nobody looks at the trays and asks how a piece of plastic costs that much. Somehow the same practice can’t say $2,500 out loud for a device that treats a life-threatening condition.

Spencer got a call from a boutique concierge practice in Georgia saying medical billing was the reason they couldn’t do dental sleep medicine. His question back was why they could talk to patients about every other thing in the practice.

Some of the blame lands on the education side. When someone at a podium describes Medicare and insurance policy in the same tone they’d use for board-of-dentistry law, dentists leave the room believing they’ll get in trouble for things that aren’t illegal.

Time is the other excuse. Erin’s answer is to look at what the time is actually going toward. If you can’t find an afternoon to train your team or treat one patient, look at what’s on the schedule instead.

3,000 Members. 200,000+ Dentists.

Jason went to his first AADSM meeting in 2006, when the organization was proud of having 1,000 members. Today it’s somewhere around 3,000. Spencer notes it’s been roughly 3,000 for years, because about as many people leave every year as join.

There are more than 200,000 dentists in the United States. The AADSM is a worldwide organization.

Spencer’s not guessing about the opportunity. Working with a DSO in North Carolina, he’d see one or two dead-obvious cases in the morning and one or two in the afternoon. Not “I wonder if.” Snoring, bed partner has watched them stop breathing, the whole picture.

…