The Millionaire Dentist Podcast

Ep22: Special Needs Dentistry 

Listen to EP22 "Special Needs Dentistry" on Spreaker.

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On this episode, we discuss how you can make your practice more profitable by taking care of an underserved population and feel great about doing it. To help us44939909_10216698706007435_500573683820003328_n do that, we have veteran clients of Four Quadrants, Dr. Mike and Rebekah Glasmeier.

The Glasmeiers have two flourishing dental practices in the Nashville, Tennessee area; they also have three children, two of whom were diagnosed with Autism. They have turned the proverbial lemons into lemonade and by doing so have thrived in a very crowded dental market. Listen in and find out how they did it and hopefully, you will become inspired and follow their love of special needs dentistry by helping those who otherwise would have nowhere to turn for qualified and quality dental care.

Some of the questions we ask them:

  • What are some misunderstandings that people may have about raising kids with autism?
  • When did the light bulb go off to make your practice a special needs friendly practice? 
  • How long did it take to go from concept to reality?
  • What are the different needs for a patient with autism?
  • What are some of the extra cost involved?
  • Has it been profitable?
  • What would you tell a dentist out there if they are considering making their practice special needs friendly?

The Glasmeier's website

Couple Glassmeier-1555707

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Podcast Transcription:

Alan Berry: On this episode we discuss how you can make your practice more profitable by taking care of an underserved population, and feel great about doing it. To help us do that, we have veteran clients of Four Quadrants Advisory, Dr. Mike and Rebekah Glasmeier. The Glasmeiers have two flourishing dental practices in the Nashville, Tennessee area. They also have three children, two of whom were diagnosed with autism. They have turned the proverbial lemons into lemonade, and by doing so have thrived in a very crowded dental market. Listen in and find out how they did it, and hopefully you will become inspired and follow their love of special needs dentistry by helping those who otherwise would have nowhere to turn for qualified and quality dental care. Dr. Mike and Rebecca Glasmeier, thank you so much for coming on the show.

Rebekah Glasmeier: Thanks for having us.

Mike Glasmeier: Thank you.

Alan Berry: So let's start off with a little bit of backstory. I know that we're ... On today's episode we're going to be talking about special needs dentistry. And I want to kind of know your family's history, and how you originally came to this.

Mike Glasmeier: Special needs dentistry actually was not something that we initially started doing. I was more of a general dentist with focuses on cosmetic and sedation dentistry. And we started having children fairly quickly into my career, and two of our children happened to be diagnosed with autism. And we knew that it would be challenging from a parental perspective, but we didn't really know about the medical and dental obstacles that we would encounter. And along the way, we've found that the access to care for those particular types of situations is very limited, if not any. And watching other providers struggle to try to maintain that patient base has kind of been encouraging for me to want to try to get into it, and figure out how I can make the experience better for that patient base.

Alan Berry: How old are your children?

Rebekah Glasmeier: Ava is 11. Ty has just turned 10. and Jake is eight.

Alan Berry: So you've been dealing with autism for?

Rebekah Glasmeier: I would say the last five to six years.

Alan Berry: What are some misunderstandings that people that don't have people in their family with autism? What are some misunderstandings that you see people have?

Rebekah Glasmeier: To be honest, that can actually be applied to all special needs situations. Autism is obviously one form of special need. And what we see so many different kinds, I think there's common misunderstandings across all of them. One is the fact that you can cookie cutter treatment this type of patient base. And what I'm finding is that they're all different. They have different modalities and different ways to treat them and stuff like that. Autism is in my opinion, a spectrum disorder where children have different levels of autism. And there is no cookie cutter way to raise or treat these kids.

Rebekah Glasmeier: And what I'm meaning by that is, a lot of them have not just intellectual disabilities, but they can be medically healthy or not healthy. And that makes cases more challenging. So you're not just adapting to a behavior, but you're also adapting to a medical history. That definitely makes it more complicated. My boys are both autistic, and in both opposite sides of the spectrum. So both have common themes where they both have problems adapting socially to their environments outside of their own, and transition is a struggle. But when you start breaking it down, they're a lot different in how they communicate their concerns, how they deal with stress, their pain thresholds. They're a lot different from a sensory perspective, where one son deals really well with light pressure, whereas the other one deals with heavy pressure. And that's important to understand, because when we're doing dentistry, we're using a lot of heavy-handed sort of type procedures. And you have to understand how one responds. And one does not respond the same way as the other, which is kind of why we say we can't cookie cutter approach it.

Alan Berry: I'm imagining that you maybe have some friends that have autistic kids as well. Inside those groups, what is the general thought of the cause of autism?

Rebekah Glasmeier: Oh boy. We could talk all day about what we as parents feel the cause of autism is. Every parent has a different perspective on it. Every parent has a different reason for their perspective on it. I believe it has a little bit to do with environment, and it has a little bit to do with the trends of our society and the way we've come down in the last 30 years. Just one of the very highly debated subjects are vaccines. And when I was my son's age, when he was diagnosed at the age of two, both of them at the age of two. I had seven vaccines my entire life. Now children at that age have anywhere from 20 to 30 vaccines. And although most children I adapt very well to those vaccines. If you're already compromise going into it, adding all of that at one time can be very detrimental to their health.

Mike Glasmeier: I try to use an explanation that's similar to cancer. We know that cancer is widespread prevalent, and there's a lot of different kinds. But we also know that everyone has kind of this unique set of switches. And it takes different types of things to cause these switches that turn off and on. Autism is similar in the sense that I feel like everyone has these predefined switches ,and there's different things that turn the switches off and on. Vaccinations is maybe one element of many, many things. There's a lot of environmental influences that are different than they were 50 years ago.

Mike Glasmeier: The switches have probably always been there, but there's different types of environmental influences as far as where you live, what you eat, how you eat, vaccinations. I feel like all those things kind of play a role. And there is no good easy way to predict whether or not that's going to happen or not. No one can really figure out what one was causing it. So in my opinion, it makes sense to go slow and steady. Now while you're still getting the vaccinations that you need, but you're able to create some sort of timetable or accountability to try to figure out what actually caused it, versus I give your kids seven vaccinations and hope they don't get autism.

Alan Berry: But it's such a gray area. I mean-

Rebekah Glasmeier: It is.

Alan Berry: ... does anybody really ... I don't know that anybody really knows the answer. Because if we knew the answer, we'd be solving it.

Rebekah Glasmeier: Absolutely.

Alan Berry: So what would you say has been the biggest challenges for you guys raising the two boys?

Mike Glasmeier: I would say the biggest challenge I've found is just being able to help my sons be involved with other children who are understanding and sympathetic to their situation. They kind of get lumped into that special needs situation where you can't touch them, you can't talk to them, you can't play with them because they're different. That's hard to get young children understand that they're different, and understand why. To this day, my 10 year old son Ty, he's never had a birthday party. He's never had a celebration. He doesn't really have a lot of friends, because he's very limited on what he likes.

Mike Glasmeier: His verbal ability is very limited. Things that most people take for granted are constant struggles for us. Taking our son to a restaurant, waiting in a long line, flying on an airplane or going on a vacation. These are all stressful situations that most special needs parents could identify with, but mainstream would not. These are all situations that are very hard to anticipate and manage. Our biggest goal was to be able to mainstream our children as much as we can in a society where they can be independent and take care of themselves. So I think to answer your question, it's more about having just acceptance from everybody else and being able to integrate them so they can be mainstream.

Rebekah Glasmeier: We have been lucky enough to have a great group of friends outside of our special need group of friends, who include our children in a lot of things. But I will tell you as the children get older, they are ... My children and ourselves are isolated more and more. Because as my children get older, their diagnosis and their autism is more prevalent, and you can see it more. Because as a two year old, a lot of two year olds are running around being crazy, three, four years old. Even five, six into kindergarten age. But when you have a 10 year old boy is on a baseball travel team, and you have a 10 year old boy that doesn't speak really and has no friends and stays on the iPad and stims, which is that repetitive movement, there's a huge difference between that age.

Rebekah Glasmeier: So as the boys have gotten older, it's become harder and harder. And the isolation of parents from groups of other parents is the most devastating part, I would say of the diagnosis. If you do not stay involved in groups of friends, because you do become more isolated, because you don't want to bring your child out around other children. Because maybe there is something that they do over and over again that you don't want to have to explain for the thousandth time. You isolate yourself. And that can lead to many issues down the road, depression and things like that. And that's huge in the special need parent world.

Alan Berry: So was there a catalyst or was there something that flipped the switch? Was it like, "Oh, hey. Wait. We're parents. We would love to be able to take our sons to a special needs doctor or dentist." Or what popped that light bulb off for you guys?

Rebekah Glasmeier: When it was time to take Ty, he was four. I had waited a little while. Mike had been kind of watching his teeth. It was time. He needed some work. And we tried to work on him in-office like you would do with your four or five year old if they needed work at that age. Not going to happen. Wouldn't even walk through the front door. Screaming, kicking, "Okay, it's over. What do we do now?" Oral sedation would work if we could probably get him in the office. He might even spit it out. I don't know what's going to happen. I don't think we were doing intra-nasal at that time. Intra-Nasal was not around. We couldn't find a provider anywhere that could help us. So we became the provider that could help. And my husband became credentialed with an outpatient surgical center. And literally Ty was one of our first patients that we took to that outpatient surgical center.

Rebekah Glasmeier: And the day we did that and I brought him home, I thought to myself that day, "If we as dental providers can not have a hard time with our own child, what in the world do all these other parents do? Where do they go?" Especially if a pediatric dentist can't help at that point, or you get to a certain place where they want to kind of kick it out to a specialist possibly. What are these parents doing? And the answer was nothing. A lot of kids that we have seen and teenagers have not been to the dentist before, or have been one time when they were very young, and it was a very bad experience and have not been back since. And I'm sure my husband can elaborate on that more.

Mike Glasmeier: Well, the first thing I did was kind of research who was actively seeing him. And the only thing we could kind of come to the conclusion with was pediatric dentists were kind of the go-to for training for ... Sorry, for treating special needs patients. My problem with it was, there were still pretty [inaudible 00:10:08] on their training as far as what they knew, and how they could treat. And what I've found in my encounters with a lot of the pediatric dentists around here is they would use some type of restraining to manage the patient. And I tried to think about this model as, it's my own son and I really had no interest in him being restrained against his will. I wanted to try to find another way to manage those. And sedation happens to be a big part of my practice. It is now big in special needs, but it was more for children and adults that just had some sort of fearful or anxiety experience.

Mike Glasmeier: I wanted to try to use sedation dentistry to kind of help facilitate the ability to treat them better, but also learn more about it. So it wasn't just if you're special needs, you automatically get sedated. The pediatric dentists I've encountered was either, you restrain them or you sedate them, and that's it. And I wanted to be able to kind of bridge that area together with us, that while those are main ways of doing it, we wanted to offer some alternative ways. Not just in the form of type of the treatment, but really more from a standpoint of empathy.

Alan Berry: I don't think any parents wants to think of brute forcing their child into being strapped in. In some ways it reminds me of how a mental hospital used to run. Because if they didn't understand something, they would just brute force it to try to correct it. And I don't think that worked then. And it doesn't work now. Was there any good resources that you found at the time that really led you on a path? Or did you just kind of a la carte, pick this up here, pick that up there?

Mike Glasmeier: Lot of this is self-discovery, self-education on finding out what's actually done in these types of therapies for this particular type of patient. But not only that, but how do we incorporate those principles that are being taught into the dental field, so we can make the child more comfortable? You really have to learn the patient, and they're all different in their own unique way.

Rebekah Glasmeier: You have to take the time. And I feel like that's why there's not a lot of providers like us, because it takes a lot of time and a lot of resources to make that small little appointment of just a cleaning work. A lot of people don't want to take the time to do it.

Alan Berry: So sometimes when you have a patient coming in for a cleaning, do they not end up with a cleaning? Because you guys want to make sure you're taking your time with the patient?

Rebekah Glasmeier: Absolutely. That happens a lot actually. We think we know. We've talked to the parent thinks they know. We're good to go, they get in here, not happening. So it can be frustrating from a management point of view, because I see the patient coming, I see what we're doing. And nine times out of 10 if it's just a typical patient coming in for a crown, I know we're doing it that day. But when there a special needs patient on the schedule, you really do not know if that treatment's going to stand, or you're going to change it. So we have to be prepared.

Mike Glasmeier: I was going to say, we don't usually try to push treatment a first time visit on a special needs child. We very rarely even push a cleaning, because we kind of feel like this child as well as the parent has to kind of go through an interview process. Because I'm sure most dentists can relate that sometimes managing the patient's easy. It's the parent that's the pain the ass. I think parents kind of come in with preconceived notions about what they want, and what they expect. And we can't fix everybody. We can't fix all situations. So that first appointment's critical. Kind of assessing what this child needs, what they've had done, how are their parents. All those things are kind of critical elements to try to determine what's the best course of treatment, and whether we treat them at all.

Alan Berry: What do you do as far as charging? So if somebody ... Let's say somebody comes in and the kid's not ready to do anything, and they're going to go back out the door. Nothing really accomplished. From the parent's standpoint, "Oh, I'm paying for that, or am I not?"

Mike Glasmeier: I mean, if we don't do anything, we don't charge it.

Rebekah Glasmeier: Well, that's true. [crosstalk 00:13:42].

Mike Glasmeier: But we try our best to try to do some type of exam to kind of justify the time. But the reality is, there are some that simply won't cooperate. And we know that going in. There are some that will literally walk in and storm right back at out. And we anticipate that. And that's why some parents are like, "Why can't we just take him to surgery?" And it's because this interview process again, not only lets us get to know the patient, but the parent. And there are some that I don't feel like after an interview that I can meet their needs, or their expectations are unrealistic. So it stinks because yes, we waste time sometimes doing these things. Because we have no idea what we're going to get. But it's a critical element to try to do it right.

Rebekah Glasmeier: And every special need parent, mom and dad know getting those providers who understand your child or adult with some type of disability, is the most important thing having a provider. I'll drive as far as I need to, to get that provider. I don't care if I have to be in the car for three or four hours. And we do have patients that travel three or four hours to see us.

Alan Berry: You have this light bulb pop pop off, "Hey we're parents with a special needs kid. We also have a couple practices." How long does it take to go from concept to reality?

Rebekah Glasmeier: I remember for me, when I knew that we needed a new office was when I walked into our office one day, and there were I think three special need patients. And we only had four chairs. And three of the four were special need patients. One was screaming, one was crying. And the other one was being fine, but you could tell there were a lot of anxiety because of the screaming going on. And I just looked at my husband who was in his office, who was just really overwhelmed himself. And I looked at him like, "We just need more ... We need a bigger office." And he's like, "You're right, we need something more." So that's when that dream of our new office kind of came about.

Alan Berry: Besides a special need, you're growing in other patient areas as well. You're going to build this new practice. So from the get-go, this was part of the plan, was to integrate a special needs thought process to it.

Rebekah Glasmeier: Yeah. How can you see your typical smile makeover case, or your grandma who's 82, and she likes it kind of quiet and she doesn't like a lot of loud noises. How can I have grandma come in at 82 for her crown, and my special needs six year old severely autistic patient come in at the same time? I mean, how do you bridge those two people together? That was our biggest concern when building this office. And that's where two waiting rooms came around. That's where we, "Oh, we'll have two waiting rooms. And we're going to have this pocket door. And we're going to do this when we need to do this. And we're going to have these soundproof doors back here, and we're going to put it in this hallway." And so everything from the moment you walk in our new office was thought out about how we can see both of those patients at the same time.

Alan Berry: What did you use as a guiding post? Was it just you two communicating with each other? You were speaking to experts and other doctors, and just formulating this opinion? Or did you have an outside entity that was helping you with this as well? As far as the build out with the special needs patient in mind.

Rebekah Glasmeier: For me it was experience. When I would take my son Ty, to the doctors or to any appointment when he was before the age of seven. It was terrible. It was terrible. I would have a terrible headache at the end. Ty is a stimmer, so it's a repetitive movement. Ty also screams in a lot. Just randomly, he'll scream and it will startle. It even startles me sometimes. So I had all this anxiety. I'm like, "I wish there was just a room." Or, "I wish there was a safe place I could take him." And maybe some days you wouldn't need to shut the door because he's having a good day. But on the days he's having a bad day, and I still got to go, I wish there could be some type of door. But not a door where it's like we're not a part of that society out there.

Rebekah Glasmeier: Hence comes the sliding pocket door. The pocket door stays open 95% of the day. Every once in awhile we need to shut the door, because we're having a moment where we need to shut it. Because the mom and dad and son or daughter need a minute to calm down. But when it's done, we open the door back up kind of. And that's how our practice works. You take the time when you need it in this room, it's built for this. When you don't need it, open it back up because you are a part of society. You just might need a few minutes here and there.

Alan Berry: So really you didn't need any expert. You were the expert.

Rebekah Glasmeier: No. 100% it went straight off what I wish I had every time I went somewhere. What I wish I had from the grocery to a restaurant, to doctors offices.

Alan Berry: And what has been the patients' reactions to this?

Rebekah Glasmeier: I've seen people cry. I've had people that who don't have children on the spectrum, adult children on the ... Or the special needs. "What a wonderful idea. I would've never thought of that." I mean the outpour of, "I can't believe you thought of that." It's been overwhelming. It's been overwhelming in the six and a half months we've been open so far.

Alan Berry: It's also my understanding, you guys had news coverage here for for that as well, right?

Rebekah Glasmeier: Yes, we have. We've had two or three new ... Two news stations and two papers out in the last six months to visit us.

Alan Berry: And how did they find out about it? Are you putting press releases out? Or is it just word of mouth? They just-

Rebekah Glasmeier: I have this great little guy to my side here who people can't see. But his name is Mack, M-A-C-K. And he is a golden retriever who is three years old who is a service dog turned therapy dog for our office through somewhere here in Nashville called Retrieving Independence. And not only was he fine in a dental office, he was fine with the noises. Totally fine with the patients, totally fine being grabbed by some patients, by being petted by some patients. But mindful that he was being serviced at the same time. So it was a natural fit for him. He belongs in the dentistry world.

Alan Berry: Maybe some people are listening and thinking about doing similar. What was the cost involved? And I mean, I know that probably the biggest cost is time.

Rebekah Glasmeier: Yes. You have to be able to give two, three, four hours a day to the dog. You have to do all the training up front. You have to maintain the trainings throughout the dog's life. You have to maintain weight. You have to maintain all veterinarian appointments. And you can know after time it gets kind of like, "Oh my gosh, we got to go back to the vet." There's a lot involved. There's a lot involved.

Alan Berry: Do you remember the cost? Did you buy the dog.

Rebekah Glasmeier: Yes.

Alan Berry: Right?

Rebekah Glasmeier: So a service dog typically will run anywhere from 25 to $30,000. The cost of a therapy dog is about half of the cost of a service dog.

Alan Berry: It's not a cheap endeavor.

Rebekah Glasmeier: Absolutely not.

Alan Berry: But I'm guessing worth it?

Rebekah Glasmeier: Oh, 100%. 100%. He was worth it before I even after the first week. You know at first I was like, "It's a huge amount of money." But after the first week and I saw what he did with some patients I was like, "Oh, totally worth it."

Alan Berry: What are the different needs for a patient with autism as opposed to a patient who doesn't have autism?

Mike Glasmeier: What I find is, most autistic patients typically have heightened levels of anxiety and tend to have an aversion to medical providers in general. They are like normal children in the sense that they fear the unknown, and they want to be in control. But the difference is on autistic children, they tend to be more driven by sensory issues. So things such as smell, noise, touch, lights can really significantly change their perception of their surroundings, as well as dictate the tone of the visit. I find that a lot of autistic children are also on medication that cause alterations in sleep or mood, as well as side effects that carry along with those. A lot of autistic kids that are on mood altering medications have issues where they're more cavity prone, gum issues, dry mouth. And then you factor in that typically with a special needs patient, autism being one of them, oral hygiene is less than ideal.

Mike Glasmeier: So that in combination of potential medications, having sensory issues, the fact that they probably haven't been in a long time, it creates a multitude of problems. Going back to sensory, most of these children are very sensitive to the sounds of the drill more so than your average person. The suction devices we use, the bright lights in an operatory. And even more importantly that people forget is the textures of everything we use. We use paste and glues, we use adhesives, all those things generate anxiety. So again, most people think of it as just, "It's a kid and it's an anxiety thing." But they're kind of forgetting about medications can cause problems.

Alan Berry: Kids with autism, are they able to brush their teeth by themselves? Or is that a parent responsibility? Or does it depend?

Mike Glasmeier: It's mostly the parent doing it, but that's one of our goals. Our mission is to help that child become more independent. We can't do that alone, so this is where it becomes multi-disciplinary where we work really close with the parent. But this is where we incorporate the therapist. A lot of these autism patients have different types of therapy, whether it's ABA or occupational, or feeding, or behavioral, or all the above. We try to work with the parents to better communicate to the therapists to help them be better at it. I would say about half of them, we can get them to undertake that where they can do it their-self. There's another half that does not. But we feel like we're making a positive change as far as that goes.

Alan Berry: I would think that it'd be fairly difficult to floss, for a parent to floss a child's teeth. Or is that just unreal to expect that-

Rebekah Glasmeier: Probably unreal to expect that at first. So I'll use my son as an example. Within the last year, we've started using a spin brush. Before it was just a toothbrush, because, "Oh my gosh, you turn that spin brush on. It makes that noise, get away from me. I don't want it. I'm not doing it. Now I don't want to brush. Now you bring the regular toothbrush towards me. I don't even want that now." So you really have to start to get them used to the noise. Let them touch the brush, but don't brush their teeth. That could take months of doing that before they let that brush come near their mouth. Finally, when he lets me get the brush near his mouth, "Well let's just try,." If he tolerates it. Positive reinforcement, positive reinforcement. So I tell that story to all of our parents.

Rebekah Glasmeier: This is how I got Ty over a four year period of time to go from a regular toothbrush to a spin brush. Ty now has no sensory issues with the mouth for the most part with the brushing his teeth. So we don't need to floss just yet for him. But flossing will be the next thing I undertake. But yeah, flossing probably does not happen a lot at all.

Mike Glasmeier: This is a very, very slow process. This is not something in six months we expect them to change. Again with the sensory issues, we kind of train parents to do what I call priming the senses, where when you take an electric toothbrush, you don't think much about it. But the vibration and the sound, and the feel, those are all things, those are all obstacles that they have to encounter. And it can take months to years to overcome that. Would I like to be able to floss the three and four year old? I absolutely would. But I also know realistically that we're not going to overload them. Because that's the other part of the problem is, some of the providers that aren't trained in special needs try to do too much all at once. And this is a very slow process. And it takes years to get them there.

Alan Berry: Is there anything with the taste of toothpaste that-

Rebekah Glasmeier: Oh, yeah.

Mike Glasmeier: It's not just the taste, it's the texture.

Rebekah Glasmeier: The texture than probably the taste.

Mike Glasmeier: The taste, yeah. And the texture. No. Some people don't like the gritty taste, but they don't realize that autistic kids with sensory issues, that gritty toothpaste is comparable to nails on a chalkboard. They absolutely just despise it, can't tolerate it. I've had children in my earlier career where we were doing stainless steel crowns on baby teeth. And I've unfortunately had removed those, because the child cannot tolerate the smooth texture of the crown or the metal itself. Those were failures that I learned along the way that all those things have to be factored in as well.

Alan Berry: Is there special special need toothpaste that takes on that texture and makes it to where it's more palatable for them?

Mike Glasmeier: I keep it really simple with a parent. I am ecstatic to see the child use anything. So I always say, if you can find anything that your child will tolerate, that is a great starting point. I mean there are some that are better than others. Some are all natural. Some don't have the abrasiveness. Some don't have the fluoride in it. Some don't have flavors. Some don't soap up, which we call a surfactant. I'm to that point where right now we just establish a baseline and find something that your kid will allow, and we can build off that.

Alan Berry: So how do you handle a training your staff? You have a ... You're interviewing for one of your positions. Do you bring this up as far as their comfort level or their understanding, their knowledge of special needs kids? How do you .. And from the interview process to once you have them hired, how do you do the training?

Mike Glasmeier: Well, there is no formal training than I'm aware of where someone can just go and take a special needs class. I believe this training is based more on the ability to identify with the patient. I always say the same thing to all my employees, I expect sympathy and empathy. And I always make a running joke about that, because people don't understand the difference. And my definition is sympathy is the ability to feel bad for somebody, which is great. But I feel like empathy is the next step, which our practice can not only sympathize, but we can empathize. And when I think of empathy, I think of being able to identify with that person. That is probably more important than anything else. The dentistry we do is not really much different than anybody else's dentistry. But the ability to manage the patient behaviorally which using sympathy and empathy, I feel like we can work with most patients. There is no formal training that I'm aware of.

Alan Berry: I'm assuming there's no CE on this topic, right?

Rebekah Glasmeier: There probably is there somewhere.

Mike Glasmeier: There is a particular organization that focuses more on special needs. I go to their annual meeting typically, and they do have topics on special needs dentistry. As far as kind of a regular going every couple of months and getting sort of training, I have not found that there's much that that exists. That is a very underserved population. And in the field itself there is ... It's not technically a specialty. So there has not been near as much time reserved and education for that type of dentistry.

Alan Berry: And I know you guys are busy. But if you ever get the extra time, I'm sure you guys could come up with a course, a book, or something that you could share. Or why not make some money from it as well? For other dentists out there that there in maybe a similar boat, but they don't have special needs children, and they want to understand this better. Have you ever thought about that writing a book? Or is there books out there already that cover this specifically? I'm not talking about broad sense, but this very niche area that you guys are in, can you go on Amazon and buy a book?

Rebekah Glasmeier: No.

Mike Glasmeier: I'm not aware of any book. And I don't know if I have the patience to write a book. I'm more of a let's work in the trenches kind, and figure it out kind of guy.

Rebekah Glasmeier: I could see us down the road definitely as our practice grows more, expanding on that. I've had people say, "You have got to come up with a toothbrush and a toothpaste, and a book."

Alan Berry: Yeah. And it's one of those things where it's a win-win, because not only are you helping people, but I would believe it'd be very profitable as well. And I'm not saying that you would do that for nefarious reasons of just making money. But I think that that would be part of that equation, because you're talking about a niche niche area, but it seems to be expanding continuously. Autism as we spoke earlier, autism is not going away, because we don't a 100% understand it. Nor are we solving the issue. So it's not going away. It's only going to continue.

Rebekah Glasmeier: No, and the dog too. Having a service animal, having a therapy animal in office.

Alan Berry: I'm talking about the whole package. I'm talking about everything that-

Rebekah Glasmeier: Yeah. [crosstalk 00:28:28].

Alan Berry: You guys do here.

Rebekah Glasmeier: Yeah.

Alan Berry: McDonald's it, not in a negative way. But being able to set up a template to where you could sell this template to other practices.

Rebekah Glasmeier: I know it's a good-

Mike Glasmeier: I think it's a great idea.

Rebekah Glasmeier: It's actually a really good idea.

Alan Berry: But where did you get the time, right?

Mike Glasmeier: That's a problem, because I'm in the trenches all the time. So that sounds great in theory.

Alan Berry: What would we call it? Special needs dentistry? Is that what you're calling it?

Rebekah Glasmeier: Yeah. we call it special [crosstalk 00:28:48]-

Alan Berry: Would that be fair? Okay.

Mike Glasmeier: Yeah. I would say special needs dentistry.

Alan Berry: And you can give me percentages or you can give me actually dollar numbers as far as when you built this out, what extra amount went to being able to do this? And I'm going to guess you've made that back and then some, or you are going to. But what ... So if somebody listening to this and thinking, "You know what, we're going to be doing a new build out and maybe we'd do this too." What would be a ballpark in cost?

Mike Glasmeier: I would not call it a really significant investment. I mean we have a sensory room that's specifically targeted for our special needs patients.

Rebekah Glasmeier: And was our biggest cost right there.

Mike Glasmeier: And there's not major features on there. I mean, we have an isolated room. We have a lot of learning aids and educational aids that are in there. They're not significant costs. If I was going to guess on our sensory room, arbitrarily I would say probably-

Rebekah Glasmeier: I would say I probably spent three to $7,000 ... Well, five to seven.

Mike Glasmeier: I was [inaudible 00:00:29:41].

Rebekah Glasmeier: I would say five to $7,000 just on the things inside that room. But to even have the idea to build that room, like if you're going to build it that way, that was a cost. Because we had to build a room on top of a room that was isolated. So that costs us more to add that into our architectural plans. And we kind of changed it a little bit too.

Alan Berry: But it sounds like to me it's not really ... Because when you think about the overall, what you spent. And you have a beautiful facility here, what you overall spent, it was really minuscule.

Rebekah Glasmeier: It actually is.

Mike Glasmeier: It was.

Alan Berry: It's more about the time, energy, and effort in putting the thought into doing these things. Is that fair?

Mike Glasmeier: Absolutely. Yes.

Rebekah Glasmeier: Yes.

Alan Berry: So if a dentist was out there thinking about this, it's like, look, don't ... Yeah, it's going to cost you a little bit more. But you don't really have to think about that. Think about more, are you willing to put in the empathy, and the time, energy and effort into creating this space?

Rebekah Glasmeier: Absolutely. That's where your cost comes from. Yeah.

Alan Berry: Well, with the exception of Mack over here. He was pretty costly.

Rebekah Glasmeier: Well, that's true. Yes. Mack was costly.

Alan Berry: Let's say there's a couple to ... I don't want to make it about money. But you guys are ... You're business people. You're running a business for profit, because you have bills and all those things. So has it been profitable? I understand that emotionally, I'm sure it's done you well. You go to bed at night feeling like you've done some good in the world. But has it been ... The bottom line, is it a profitable thing?

Mike Glasmeier: I would say it is. And one of the simple reasons is because typically these are children or even adults that require comprehensive work. It's very rare we're going in there and just doing a cleaning. It's normally oral surgery and root canals, and crowns and bridges and fillings, all those kinds of things. It's fairly uncommon to see them come back for regular checkups, seeing Our goal is to establish regular checkups on people. But the reality is about half of them don't. So we may see them every couple of years, and it doesn't take much for things to deteriorate. So we are typically doing more comprehensive treatment, which does generate more profit from a revenue perspective. I feel like there's a bigger reward as far as just being able to make a change in this child's life just because there are so few people to do it, that it is profitable from a monetary perspective.

Mike Glasmeier: But emotionally it feels fantastic to be able to change a kid's life and their parents' perception of what a dental visit should be. I will also argue that most parents feel that if you can manage their child, they want to be managed by you too. So it's kind of an indirect way of capturing a family. So that's definitely a profitable sort of situation where you treat a difficult situation, and you make money off of it. And you capture the family, because they know if they can trust you with their special needs child, they know that they can trust you.

Alan Berry: And I'm sure as you guys have seen, it's generational. So-

Rebekah Glasmeier: Absolutely.

Alan Berry: ... once the family gets in the door, you're getting the next gen. I mean, unless you guys do something-

Mike Glasmeier: Which is ironic, because that's the name of our practice is Generation Dental Arts. So there's a reason for that.

Alan Berry: Oh, is that ... Okay. That makes sense.

Rebekah Glasmeier: That's why.

Mike Glasmeier: But I will say, one thing that I've found along the way, along with talking with other providers is in our experience, a lot of the special needs tend to be in lower socioeconomic status. I would venture a guess and say 60 to 70% of our special needs patient base has some type of government aid, or Medicaid, or something like that. Which most people know that the reimbursements are significantly lower. So you have to be able to manage it appropriately. Could we make a profit running just special needs only taking Medicaid? No, we can't. But we've found a way to still be profitable in our practice, and still serve that population.

Alan Berry: Yeah. I hate putting the profit side to it, because I know that wasn't your intent. That's not the reason that you did it. But if it's a a secondary thing that happens then, okay. I guess I just ... Hopefully other people or other dentists will be encouraged by it. Maybe they're not as kind as you are. They don't understand, but it's like, "I could add an extra 5% to the bottom line. And then if I'm doing good ... " I don't know. Well, okay. So let's say we got some dentists out there that are ... I don't know that we're going to change the world today. But maybe in their mind they're starting to think, "Oh, maybe this would be a good thing." What would you say would be their first steps? Or what should they consider? If you were talking to a dentist at a convention or something, and they found this very interesting. And they're like, "Okay, Dr. Mike, this sounds great. You're going to ... We're going to stop talking here in a few minutes. But what do I do next?"

Mike Glasmeier: I would start by interviewing people to get a better understand of things. Again, there is a lot of good resources for the special needs field in talking with teachers, therapists, physicians. More importantly than all of them, parents. We got a lot of our ideas too by just talking with parents to better understand their particular situation. Parents that we encounter are typically fairly well educated on their child's disabilities. And they know what works and what doesn't. I also feel like pediatric dentists are an outstanding resource. They are typically better well versed in handling that population due to the fact that they do serve kids. So they understand better about communication barriers and anxiety about things that are new.

Mike Glasmeier: They also typically have great office designs that cater to children. So I feel like they're a great reference as far as designing protocols and handling unique situations. I think there's special needs organizations out there. One in particular that I work with that I feel like they have a great deal of resources. There's plenty. It's just kind of putting it together, assembling and asking questions, and interviewing.

Alan Berry: Well, what's that agency?

Mike Glasmeier: It's called The Special Care Dental Association. And I've been with that organization for about two years.

Alan Berry: So if you Google that, it'll come up?

Mike Glasmeier: Yes. I think they call it the SCDA.

Alan Berry: What if somebody wanted to reach out to you guys? Would you ever ... If a dentist was inquiring, just wanted some more information, is that even appropriate for them to reach out to you?

Mike Glasmeier: Absolutely. Again, we're still new to this too. Even though we've been in it for a couple of years, it is newer to us. We'd be more than happy to help anybody that was interested in it. We felt like this population is so underserved that we would do anything we can to try to help make that access to care better.

Rebekah Glasmeier: You can always reach out to my husband and I. Through email's the best way. And see how ... Just to talk to us to get advice about how they could handle a situation. I have already had providers reaching out to me. Since I've gotten Mack, I want to say the last six months I've had three different providers reach out different offices in Tennessee, and ask about the dog and how the dog impacts. And then also asked about our special needs dentistry that we do here. And I love talking to them, because I learn something from them too. It's the funny thing about it is, there's no specialist here. We're all just trying to come together to figure out how we can service this population.

Alan Berry: Thank you so much for coming on the show today. I really appreciate your help. And if you're listening at home, just look down the show notes. I have some links to some photos and some videos to a the Glasmeiers' practice, and a some other links that you might find of interest. Thank you so much for coming on the show today. I really appreciate it.

Mike Glasmeier: Thank you.

Rebekah Glasmeier: Thank you, Alan.

Alan Berry: That's all the time we have today. Thank you to our guests for their insight, and for sharing some really great information. And thank you to you, the listener for tuning in. The Millionaire Dentist Podcast is brought to you by Four Quadrants Advisory. To see if they might be a good fit for you and your practice, go on over to fourquadrantsadvisory.community, and see why year after year they retain over 95% of their clients. Thank you again for joining us, and we'll see you next time.