She Stopped Breathing 45 Times an Hour, Then He Moved Her Jaw

Dr. Keith Schneider: On the AI part of the finance. Yeah, we're starting to see that on claims. It'll say denied and underneath in parenthesis AI generated. It's delaying timely reimbursement to either patient or us. It's not the way.

Jock Putney: You've literally added years to her life.

Dr. Keith Schneider: It was very emotional for her. Now she can breathe. She can actually her sense of smell has improved. The confidence, the strength that people achieve after jaw surgery is just really warming to my heart. That's the efforts that we need, man.

Jock Putney: Yeah. Yeah. Stay strong, stay fit, stay young. That's the pathway to peak performance, right?

Dr. Keith Schneider: Yep.

Jock Putney: Dr. Keith Schneider, welcome to the Pathway to Peak Performance. So great to have you in. Uh, really excited to have you here. You are a true peak performer all the way from Ohio today, uh, to speak with us.

Dr. Keith Schneider: Excited to be here.

Jock Putney: Yeah, I love it. Love it. So, let's start off by talking about, um, since you're, since we are like, uh, in the same sort of zone when it comes to working out. Let's talk about your routine and how you actually do it.

Dr. Keith Schneider: Yeah. So, I've been on this, uh, I've been doing like three month cycles right now. And so, like, first month's a lot of endurance training, like high reps. Uh, I try to still push the weight a bit, but it's like, you know, pushing 20, 16, 12 reps and doing a lot of circuit training. So, just like really, you know, hitting the body hard. Um, and usually I'll do that for the first month. Second month's like a lot of us, like time under tension, you know, really pushing it, like, you know, three countdown, one up, you know, hitting all the, all the, uh, muscle groups, but so critical to working the diet in this whole thing. And then last month's a lot of just build. So that's my build month. So hitting each muscle group individually and just really pushing the weight. I, uh, I run a 63-day with a 5-day, uh, deload and then so working through and just finishing up one of those right now in the tail end of it.

Jock Putney: Nice.

Dr. Keith Schneider: Um, which has been everything that you've talked about, that's worked into that 63-day and then we go into a calibrate, uh, phase.

Jock Putney: So interesting how you're periodizing your training, which is, uh, which is pretty cool.

Dr. Keith Schneider: Yeah.

Jock Putney: Keeps you fit, keeps the body fat off, keeps the visceral fat out.

Dr. Keith Schneider: Absolutely. You know, VO2 max is up.

Jock Putney: Yep. Yeah. Keeping that muscle mass happening.

Dr. Keith Schneider: Yeah. It's high protein all day. Just like, you know, keeping that energy, but you got to have good recovery because if you don't have good recovery, you're not going to be ready for the next day. So, that's where the supplements come in. And just making sure you're fueling your body well. I'm all about aging gracefully. So, you got to.

Jock Putney: Yeah. Amen. Right. I mean, that's that's the key to the whole thing, uh, is making sure that you stay in that peak zone as long as you possibly can.

Dr. Keith Schneider: Mhm.

Jock Putney: Especially for the work that you do, which we're going to get into and we're going to talk a lot about, uh, as a surgeon, that's, you know, that's pretty important. Um, and a lot of your colleagues I've seen over the years, uh, who haven't done that pay the price eventually, uh, for that with all sorts of, um, you know, physical, uh, conditions and things that make it difficult for them to actually continue to perform.

So, uh, the show is sponsored by KetoneAid, which is an exogenous ketone ester. It's the Veech ketone ester. And what's really cool about this is this is like this month marks the 10 years that the science came out, was published. It was available a little bit before that, but they published it in August of 2016. So, 10 years now have gone by since this has come out. This stuff is absolutely amazing. I guarantee you, for a guy that does what you do, once you try this, you're going to work this into your, uh, into your routine because it's that powerful. So, what I'm going to have you do is, you can see that this is, um, never been opened, right?

Dr. Keith Schneider: Nope.

Jock Putney: So, what I'm going to have you do is, um, go ahead and pop the top and take these two cups that have the water in them. We're going to dilute it a little bit. So, you take a capful. Uh, let's do, let's see here. You can go three, uh, or four if you really want to like zone in and check us out. So, up to you.

Dr. Keith Schneider: Let's zone in.

Jock Putney: All right, man. I love it. So, four and four, we'll do it.

Dr. Keith Schneider: All right.

Jock Putney: Um, yeah, this has been, uh, one of those things that's been an absolute game changer for me and I use it every single day without fail. So, uh, it's just an incredible sort of what they call the fourth fuel. So, if you went into dietary ketosis, uh, you know, you would, you'd be using ketones to fuel your brain. So, this helps from a cognitive standpoint and a performance standpoint, a recovery standpoint. One of the things that you mentioned with the Tour de France riders do is use this at the end of those segments where they're just absolutely depleted and they've got a ride the next day.

Dr. Keith Schneider: Wow.

Jock Putney: So, super powerful with regards to that. All right.

Dr. Keith Schneider: Okay. Here we go.

Jock Putney: Bottoms up, brother.

Dr. Keith Schneider: All right. Yeah, that's good.

Jock Putney: You like it?

Dr. Keith Schneider: Yeah. Yeah. Not bad. I like that. Supplement guys are always good. That's no big deal. Wow. That's good.

Jock Putney: Yeah.

Dr. Keith Schneider: Good aftertaste. I like that.

Jock Putney: Good. Well, you know what? Um, this is this is the stuff. All right. So, now that we got that out of the way, uh, let's talk a little bit about, um, your workout is consistent. Like you're doing it, but you're getting your recovery in. How are you getting the recovery in? What's your split look like? You got the cycles that you're doing, the periodization. How many days a week are you working out?

Dr. Keith Schneider: Yeah, I mean, I'm in the gym every day. Um, but I usually do, it's it's almost like total body almost every day. Working abs like every day as well, cuz that's just, uh, core strength is just so huge with the recovery, making sure my back doesn't get sore. It just supports everything. So, I'm usually lifting about four days a week. Those other two days I'm probably doing some cardio and then I always work abs every day. Yeah, just keeping that core strong. So, I can't stay out of the gym now. I need that. I need that sort of release. I need to get in there and just, it helps me get up and get the day going. I'm usually a 5:00 a.m. guy. So, 5 a.m. crew.

Jock Putney: Yeah. Dawn patrol.

Dr. Keith Schneider: Yeah. Dawn patrol.

Jock Putney: Yeah. It's so, I mean that's my favorite time to work out. Uh, you know, today we're going to have to actually, since we're up so early to do this one, uh, you've got to hop on a flight to get back.

Dr. Keith Schneider: Yeah.

Jock Putney: Uh, right away. So, what we're going to do is, uh, hit the workout at the end of the day and then pick it up first thing in the morning, which is going to be intense. Yesterday, I had a, uh, stair workout, um, that was pretty intense. And then, uh, after that, a long walk. I covered 20,000 steps yesterday. So, yeah, got my, uh, conditioning in for sure, which I think is absolutely critical to the whole thing.

Dr. Keith Schneider: I've always been a bit of an athlete, you know, growing up so many sports, soccer, baseball, lacrosse, and then like I was pretty intense with swimming and, uh, just always enjoyed the gym. And of course, life comes, that comes at you. You have kids, you sort of get your dad bod for a year or two and you're like, "All right, I got to get this. I got to take care of this. Let's get back on track." And so just getting back in there.

Jock Putney: Well, and you have kids that are at the age that are going to keep you moving, right? They're kind of at that spot, point in time where they're starting to want to do their own thing. Uh, having lived through that personally, it's an interesting transition.

Um, so, okay, one of the things about this show, as you know, is that we have a charity that you choose and all the proceeds from the views go to that charity. So, the charity that you chose is

Dr. Keith Schneider: Uh, United Way.

Jock Putney: United Way. Excellent. Okay, great.

Dr. Keith Schneider: Probably goes back to even my college days. We used to do beach volleyball tournaments raising dollars for United Way. Yeah. At the University of Mount Union. But yeah, so I think United Way would be really impactful.

Jock Putney: Super. All right, that's great. Well, all the proceeds from the views will go to them as they come in. We'll just keep sending them the checks. This should live on forever. So hopefully we'll be able to send them quite a bit.

Dr. Keith Schneider: Ah, beautiful.

Jock Putney: All right. So, um, let's talk a little bit about the work that you do in the practice of oral and maxillofacial surgery. What are the things that people need to know about oral and maxillofacial surgery that they don't know?

Dr. Keith Schneider: Yeah. So it's the surgical arm of dentistry. And so things that really, uh, differentiate us from the other parts of dentistry is, it's, um, one, pain control, anesthesia. You know, we can provide all levels of anesthesia from local to full general anesthesia, getting patients asleep, getting them through these experiences they don't necessarily want to experience. Um, so everything's surgical realm. So that's all our office work, basic procedures, you know, wisdom teeth, uh, extractions of teeth every day, supportive care to our orthodontic colleagues. So, you know, exposing teeth that didn't grow in the right way or too many teeth or baby teeth that are stuck that won't come out. Um, and then our hospital work's a lot more trauma based. So, I do full face trauma from, you know, the forehead to the neck. Um, a lot of head and neck infections, taking care of people that have acute issues that, you know, they just need that care right away.

Jock Putney: Um, one of the things that's not often talked about is the health of the mouth and how that impacts the rest of the body. Uh, there's a lot of talk about, you know, the gut microbiome, but if your mouth is, um, quote unquote messed up, like full of infection or the microbiome of your mouth is not intact, it doesn't really matter what you put through it, you're going to get some stuff down into your, uh, into your gut that's probably not very good.

Dr. Keith Schneider: Absolutely. The oral health does have such an impact on the body. So, not only are we assessing, diagnosing, and trying to treat some of those conditions, but also trying to restore people back to normal function. And that usually includes placing a lot of dental implants. So that's one of our primary services is placing dental implants, which are titanium root replacements that we put tooth on and it helps to rebuild that foundation, that function, so people can enjoy life and chew the things that they like and, you know, go out to beautiful places like this in San Francisco, eat whatever they want.

Jock Putney: Yeah. Well, it's so true. I mean, if you can't chew your food, you can't, uh, digestion. I mean, digestion begins in the mouth, right? And it's not often talked about, which is strange to me. I guess it's just that I've been working with, uh, oral and maxillofacial surgeons for so many years that it just seems like second nature. But, uh, the reality is that, um, yeah, it's often lost on people just how important that is. And, uh, unfortunately some of the patients that you see are so late stage that they have to have all their teeth removed and they have to go to the, uh, full arch replacement, which is where you guys take a fixed prosthesis and put it on a set number of implants to actually make sure that they don't have to take these dentures in and out, which is game changer for people, right?

Dr. Keith Schneider: Huge game changer. Especially once you can anchor those dentures in, you start to regain, um, the strength to chew. So when you get those fixed prosthesis, it's like 90% of your chewing strength is restored and so you can chew the things that you need to chew.

Jock Putney: Yeah. For people that haven't had a steak or something that's solid like an apple for years and years and years, now they're able to eat that, which is pretty cool.

Dr. Keith Schneider: It is. It's super cool.

Jock Putney: On the orthognathic surgery side, um, for those that don't know, uh, the term orthognathic surgery, we're talking about moving the maxilla and the mandible, uh, in order to, uh, make somebody look different. And it's pretty dramatic.

Dr. Keith Schneider: Yeah.

Jock Putney: Um, but there are also airway issues that are associated with this and it's pretty important for people to know that given the, uh, the now the data that's come out about sleep apnea and how it can affect you from a cognitive standpoint, these procedures are pretty important for a lot of people to actually be able to function. I mean, you really have to look at it now from a totally different angle. Before, people are just sort of like, hey, you know, I've got this recessed chin or jaw or I've got underbite, my jaw is protruding and we need to fix that. Um, now we're talking about airway, sleep apnea, all these types of things.

Dr. Keith Schneider: Yeah. So, orthognathic surgery really hits me to my core cuz, uh, I remember, you know, I took over my dad's business. He did orthognathic surgery for 40 years. Sort of pioneered it out in our neck of the woods in Min, Ohio. And I remember at age five sitting at his workbench in our basement and he would be making the splints for surgeries. And so the smell of acrylic to me, when I smell it, it flashes me back to childhood. It's so amazing. But yeah, orthognathic surgery is so impactful for people.

I have three goals with orthognathic surgery, which is essentially just jaw reconstruction and repositioning the jaws. So function for sure. We want to make sure the teeth are aligned, you know, so people have a good relationship of the teeth for long term. Uh, two is airway, because once we rearrange the people's jaws, we have the ability to increase their airway and being able to, um, improve that whole system. Most people are born with like a small upper jaw or a small lower jaw and so their nasal cavity's either collapsed or their tongue's in the back of their throat. And so this is where it starts to impact the sleep and, uh, the slow suffocation of sleep apnea. Third goal is, uh, facial harmony and balance. So we want people to look good after we're done with all this. So, making sure their face is balanced, the middle of their teeth are in line with their facial midline. Um, so those are sort of our three goals: function, airway, and cosmetic, um, sort of facial balance. And we can achieve all that with one surgery. Uh, we're doing these every week now. And it's just so impactful.

Jock Putney: Yeah. It's amazing to see the before and afters on those. It's just incredible. And then you think about it. How often are you actually moving the, I know there's a procedure where you can move the tongue forward also. How often are you doing that in those particular, um

Dr. Keith Schneider: Just did a case two weeks ago like this. So it was a woman with, uh, severe sleep apnea. So she was stopping breathing, I think it was about 45 times an hour, and so, I mean, literally a slow suffocation. Um, and so we moved her upper jaw, her lower jaw forward, but then we also had the opportunity to bring the tongue muscle forward. So the way we do that is we combine it with the chin bone. On the back of the chin bone is where your tongue attaches. So we advance that chin further out. It brings the tongue forward with it and then so that brings the tongue out.

Jock Putney: I can imagine on the follow-up to that, you have a series of them. On the follow-up to that, that must be absolutely incredible to see, like you can see that now that they're getting oxygenated, that the difference in what they look like, how they actually, uh, can communicate and all that kind of stuff. Must be

Dr. Keith Schneider: Oh, yeah. So neat. I mean, even with swelling, uh, this particular patient came in day four post-op, day four, just for a check, and she goes, "I can smell and I can breathe. I am so grateful." This woman, it wasn't a typical jaw surgery. She was 74 years old. She had been told she needed jaw surgery since age 19. And so it was very emotional for her. Um, in recovery she's like, "Why did I wait so long?" Like, but now she can breathe. She can actually, her sense of smell is improved. And, uh, now she, yeah, it was so amazing for her. The confidence, the strength that people achieve after jaw surgery is just really warming to my heart.

Jock Putney: Yeah. I mean, man, you've literally added, uh, years to her life. I mean, that's, I mean, if you just think about it, right? If you stop breathing 75 times per hour, that means that you're doing it, um, more than every minute.

Dr. Keith Schneider: Yeah.

Jock Putney: Right. So, that's pretty crazy. Slow suffocation for sure. That's got to have a huge impact. And there are all sorts of downstream effects of that, um, that are well documented. We can get into it if we want to. But let's move past that. Uh, let's get into some of the things I think are kind of interesting, because when you talk about orthognathic surgery, oftentimes the reimbursement for that, unfortunately, um, in certain states is really bad. So it's deterred a lot of oral and maxillofacial surgeons from wanting to do it. You either really have to have a passion for it, uh, because it takes a lot of time out of your surgical day, um, or you have to be reimbursed for it at a level that isn't always that great.

So, um, this sort of takes us to the spot where we look at the state of the industry. We've seen a lot of corporate practice of dentistry now that is not really doing all that well. Um, those models have not proven to be very effective. Surgeons are buying their practices back and you've stayed away from that, which is kind of interesting because it allows you to continue to see those patients the way that you want to see them. You're not on a time clock with a quota.

Dr. Keith Schneider: Yeah. So, I suppose this is sort of my altruistic nature. Um, you know, I just love taking care of patients. Knowing that I'm not going to get reimbursed well for one procedure doesn't deter me from not doing that because I know it's a good service. I give a lot of free care out to the hospitals too. Same way, I go in to see somebody that's in need. I may not get paid for that, but it's the right thing to do. And I think that's where people get off base. They forget that this is a customer service-based industry that's taking care of people and, um, when they start looking at it like dollars and cents, they sort of lose track. I've seen a lot of dentists just have their practices destroyed. They've built them up for 25 years, sell that off to a corporate place that loses that heart and, uh, maybe bring in another dentist that doesn't have any ownership to that practice and the customer piece falls apart and then it tanks. I've seen it time and time again.

Jock Putney: Yeah. I think the entire, um, piece of that is built on a relationship. And once that relationship starts to fade away, um, then you're no longer, you know, it's just not the same feel. Patients aren't receiving the same care and they don't feel the same way. You know, it's funny. I go to the hygienist four times a year. So, every quarter, I'm in there just because I want to make sure that I maintain my, uh, my oral cavity the best that I possibly can. And also, you know, I think the other thing that we need to talk about is oral cancer.

Dr. Keith Schneider: Mhm.

Jock Putney: One of the things that most people don't realize is, hey, the five-year survivability rate on a detection of oral cancer is pretty good if you get it early. I think it's better than 85%. But if you go past that and each little step along the way, it can turn south really quickly. Um, so that's something I'd love to get into.

Dr. Keith Schneider: Yeah, early diagnosis is so important. And yeah, encouraging people to go in for these consistent, uh, yeah, appointments, you know, every six months or even more if they can.

And, um, yeah, we work a lot with our dental colleagues, with our, uh, our medical colleagues to try to do, uh, proper assessment and make sure that we're doing good screening. We actually go out into the community and teach the communities, hey, here's how you do a self-exam, you know, when you're brushing your teeth. Like maybe it's not every week, but every month. Let's take a look around. Look at your tongue. Look at your palate. Teaching good habits to maintain. We spend so much time on our bodies on the outside, but sometimes we forget the inside, you know, looking in our mouths and all that kind of stuff.

Jock Putney: So important. And you know what? If you're seeing your general dentist on a regular basis, they may be able to detect something early enough so they can send it over to you for a pathology, um, and then figure out what they're dealing with. Or perhaps you're just avoiding it all the way, which is pretty cool.

Dr. Keith Schneider: We certainly do see people that don't have good dental, you know, routines. They only see the dentist every like 8 to 10 years when they have a problem or something. Unfortunately, I just had a situation where it was a farmer, um, and he was a young farmer. He was like 42 years old. Um, and he saw me because he had a loose tooth, but the reason his tooth was loose is it was sitting in cancer. And it was devastating to watch. And I said, you know, we do this every week. I got a team for you. Let's go at it. Um, and it's just helping them through that process. But some of them can be very devastating now, but early detection is the huge, is, yeah, got to do it.

Jock Putney: That kind of brings us to this talk about peak performance. So, you're living a peak performance life, right? That's how you've geared your entire life. Your profession is intense. To make it to where you are, you have to be the best of the best. Uh, there are very few slots available. Uh, there aren't that many programs. So when we're talking to you, we're talking to somebody who's been a peak performer all the way through. And how many years is it? 12, 14

Dr. Keith Schneider: 14, 14 plus high school.

Jock Putney: Yeah. 14 plus high school. So think about that. That's a huge commitment of time and energy and deferment on, uh, compensation. So there were years where you're in school, I mean huge costs associated with that and you're not getting paid, uh, the same way that you would if you come out into, uh, a regular practice. So this particular specialty is, uh, is like plastic surgery in many ways from a, you know, residency standpoint. Um, it's hardcore. It's heavy duty.

Dr. Keith Schneider: Yeah, it's an intense training, you know, but we love it. I train 19 residents right now as well. So it's fun to teach them the ways and show them how to be an incredible surgeon, but also set the stage for being a successful, you know, uh, practitioner once they're out.

Jock Putney: So yeah, I mean the notion of training residents. So in residency, uh, you have an intern, you have a resident, you have a chief resident, and then you go out into private practice and you're still going back and training people. You're still seeing people in the hospital for trauma. Let's talk about trauma cases. I mean, those are intense. Like you have a crushed orbit or a broken mandible. Uh, so when we say orbit, for the people that don't know that are listening on the show, it's like this is the cheekbones around the eye. Uh, you can have a forehead that gets crushed. I mean, what are some of the cases that you've seen over the years around trauma?

Dr. Keith Schneider: If you can picture it happening to a face, I've probably seen it. Um, so yeah, every week we're getting like a lot of broken faces and jaws. I fixed three broken jaws yesterday. Um, so one was just an old person that fell, one was car accident, and other was somebody punched in a bar. Um, so they just all come in from different ways. Um, but yeah, I've had very intense situations with major gunshot wounds to the face. I've had chainsaws and machetes to the face. Um, and, uh, we just sort of, a lot of puzzles to solve out there.

Jock Putney: Yeah, that's one thing that, oh man, when you hear some of those things, you go, "Whoa, gunshot, chainsaw, machete. That's pretty intense." And, um, these are true trauma cases where you're getting called, you get the call, hey, you got to get into the ER, and they're moving that and you're now managing the entire case at that point, which is pretty intense. In your residency, you have a general surgery residency. I mean, you're really doing all sorts of things that are way beyond what's happening here. You're going through all of that. Let's talk about it.

Dr. Keith Schneider: Yeah, that's the dichotomy of our practice. It's, uh, we're very much dental based in our private office more, and then we're much more medical based in our hospital presence and what we can impact there. And so yeah, it's working out those dynamics. But when we're training and now even, you know, I work so closely with my anesthesiology team, my trauma teams, my general surgeons, cuz a lot of these trauma cases, it's not just an isolated injury too. So they could have, you know, some other polytrauma where, you know, they have broken arms, broken limbs also with their face.

Jock Putney: So yeah, so car crash is a good example of that. When you have, now you're going to deal with an orthopedist or somebody along the way that you're co-managing the case together, it's pretty intense.

Dr. Keith Schneider: It's important to have relationships with all of our colleagues from a, uh, I guess taking care of patient perspective, but also I love this opportunity to build the relationships to build my practice. So, this is one thing that I train my residents. It's like, you may not get reimbursed, we were talking reimbursement, may not get reimbursed for that trauma patient very well, but what you do get reimbursed with is making a relationship with the nursing staff that's going to come see you. Making relationships with the doctors and really being a team. And that's really something I'm passionate about, is creating teams and being a part of that community.

Our practice is unique in a way that we really engage with the community. We help service some of the, uh, the sports teams, the Monsters hockey in Cleveland. Uh, we do cover some of the Browns, um, if they need it. Um, you know, so that's super fun. Um, we're engaged in all the athletic community, uh, the kids' school, high school sports. We're contributing dollars. We help them along. Um, and then the hospital privileges. I'm on staff at eight hospitals. So it's servicing all the hospitals around our offices to help just fill that need.

Jock Putney: Yeah. Yeah. I mean,

Dr. Keith Schneider: Nobody does what we do. There's not many of us around.

Jock Putney: Yeah. That's a heavy load. Uh, when you've got a family and you're doing that in an intense private practice that is growing, you're the main, uh, figurehead of that practice and then you're doing, um, training residents. You're doing all the stuff in the hospital. You're also seeing a unique patient base, which is the Amish.

Dr. Keith Schneider: Yeah.

Jock Putney: I've seen them actually arrive in a horse and buggy and that must be a really interesting experience.

Dr. Keith Schneider: It is. Um, you know, my family has a farm out east of Cleveland and so we've always been close with Amish people, actually, and it was a group of people I really felt were underserved. They don't receive timely care. Um, they're usually just getting taken care of when there's a problem, broken teeth, something like that. And so I really felt passionately about getting an office close to the Amish community where we could service them. I've actually toyed around with getting a little bus that shuttles back and forth like almost every week just to get people in. But, um, they're great to take care of. They're such good people. Um, they really feel, um, gratitude with the work that we do with them and it's nice to take care of them. They have, um, some will pay cash, others there's actually like an Amish health fund. So they'll just come in and we just bill their Amish health fund. Of course, everything's paid with the handwritten like checks and stuff like that. It's just very simple, but it's a very reliable group.

Jock Putney: Well, and they probably don't have on their end an AI based claims denial system, right? They're probably

Dr. Keith Schneider: Abs, absolutely. Yes.

Jock Putney: Yeah. You're probably getting paid faster through that fund than probably any other payer.

Dr. Keith Schneider: Oh, absolutely. Yeah. Yeah. I'm all for, like, um, 1% better every day. And I'm always thinking that way with my practice, too. Where can I carve out another 1% to help the growth in the business? Because by our business growing, we can do so much with that. We can implement more technologies. We can impact other communities. We can do things that others don't do if we can just keep growing that level, because then our base and our strength is just, uh, above others.

Jock Putney: When we first met, I was like, man, this guy really has a vision for providing care at a level that's way beyond. Kind of leads us into this notion of you also see a different population of patients that, I don't know, may be a little different in terms of how gratitude flows there. Um, so you're dealing with prisoners.

Dr. Keith Schneider: Oh yeah.

Jock Putney: Yeah. What's that like?

Dr. Keith Schneider: Um, we see prisoners in the practice almost every day actually. Um, we bring them in the back door. They usually are escorted with two guards each. Um, and, uh, for the most part they're actually really nice to deal with. I try not to figure out why they're in prison. Um, but, uh, we're contracted with two prisons and I service about another three jails and a lot of it's face trauma, but then also they need teeth out. So they come in to see me or some of our other providers every day. Uh, we get some teeth out and then we send them back to the facility. I'd say most, like probably 95% of them are really happy to be under our care. Um, there is a couple that come in with a chip on their shoulder. Um, but most of them are actually pretty nice people when it comes down to it. They just made some bad choices.

Jock Putney: Yeah, it happens. And, um, and thankfully they've got someone who's providing outstanding care to them.

Dr. Keith Schneider: Pretty wild. They come in, they're shackled, you know, uh, wrist restraints, ankle restraints, and then, uh, we get them in the chair and we roll out the red carpet for them just like we do all of our patients. I want my staff to do that with everybody. And I think they feel that.

Jock Putney: Yeah. And you know what? Maybe that's, uh, not the best, you know, they're not seeing you because they're in great shape, right? But the notion that they're having a great experience during that process probably, uh, restores a little faith and humanity for them, which is probably pretty good.

Dr. Keith Schneider: Yeah.

Jock Putney: Yeah. And good for you for doing the right thing for people.

So, let's talk about the intensity of the work that you do in the hospital side of things. You have a lot more staff working with you in that particular setting. Um, in the practice you've got to manage airway and, uh, you got anesthesia happening, uh, variety of types from local all the way from IV sedation to full, uh, general. So that's intense and that is stressful. So I think from a peak performance standpoint, there's a lot of mental that goes into this, right? Just preparing for a case, knowing what you're dealing with, you kind of get into a flow state around these surgeries.

Dr. Keith Schneider: Yeah. I mean, patient safety is so huge. And, um, I suppose trying to take the stress out of the scenario is the best. And that's where, you know, I've been told many times, how do you stay so calm? And because we're just sort of solving a situation, we're solving a puzzle, where we want to get into a very safe routine and know how to manage complications when they occur with grace. So, it's just a matter of making sure your team's confident and that comes from the leader. Leader's got to be strong. If the leader's not confident and they don't have that strength, then the team's not going to feel good about it. That's where surgeons can sometimes get into trouble. Um, and getting complacent. Uh, you know, when we hear about complications from anesthesia, which are very few and far between in oral and maxillofacial surgery practices, but the ones that occur may be situations where people got a little complacent. So it's staying vigilant, making sure that you are really, uh, engaged and hitting it every day. Don't take it for granted.

Jock Putney: Run your checklist.

Dr. Keith Schneider: Yeah.

Jock Putney: Make sure that you're in the zone and you've got all the facts in front of you. It's interesting because oral and maxillofacial surgeons are the only providers outside of anesthesiologists that are actually licensed to provide anesthesia to patients, which is, you know, you think about that, this specialty is intense. You're doing a lot of stuff and it's, uh, it's deep. Um, and I think that peace that you're talking about, that calmness, um, in mindset, right? Hey, I'm going to enter into this situation and things can happen. But staying calm in that moment, it's almost like a pilot where, hey, something's going wrong here, or an operator where something didn't quite happen the way that we expected in the plan. Uh, and now we're going to respond in this particular, this is our fallback position. This is plan B. Um, that's a real talent. You're right. Leadership is key.

Dr. Keith Schneider: It's funny you bring that up because, um, yeah, we equate anesthesia to flying a plane a lot. It's always the takeoff and the landing that are eventful and, uh, yeah, the problem solving along. So, yeah, training the residents. I mean, actually recruiting new people into residency. We're looking for somebody that can multitask, can handle that type of stress, can handle three things, eight things going on at the same time. Uh, because some people think surgery, like, oh, I want to be a surgeon, and but here's the responsibility and reality of what you're going to be doing and are you able to handle that. And so we're screening that out when we're doing interviews and even through their training to help, like, hey, this is what you're going to need to manage. And some rise to the occasion, others decide to do a more simple practice. It's beautiful that our profession can offer that type of flexibility. For me, I'm, you know, I'm all in. I'm so engaged.

Jock Putney: Yeah, that's, I think that's phenomenal that you're doing that. You just talked about people, uh, who go for a simpler practice. Uh, the reality is there are millions of wisdom teeth cases happening every single year and, uh, you know, there's some common myths that people just don't know about wisdom teeth. I think it's a good opportunity to cover it here because, you know, really in my experience, um, now I'm not speaking for you and I'm not asking you to agree with my opinion, but my opinion is that you definitely want to have your wisdom teeth or child's wisdom teeth extracted or removed, I guess, is a term that people use now. I would say extracted by an oral and maxillofacial surgeon. No doubt that is the best experience. You can make it happen faster, um, with less trauma and, uh, have the patient recover a lot better. What are some of the myths that people don't know about wisdom teeth?

Dr. Keith Schneider: I mean, as far as just the removal of wisdom teeth, the procedure itself, that is a primary service of ours, this is what we do every day all day long. So we make it so smooth. We know that the faster the procedure, and I don't say fast in a reckless way, fast and efficient increases, um, recovery. Um, it makes the recovery a lot more smooth. And the time to do it is, you want to be assessed probably at age 15. That being said, the youngest age I've taken wisdom teeth out is age 10, uh, because of growth issues. Um, but, um, yeah, the common myths, there are letting sleeping dogs lie. Oh, it doesn't bother me, so I'm not going to address it. Far from the case now. We know so much better and we know that you're going to recover so much better before the age of 25 than you would when you're 45.

Jock Putney: Yeah.

Dr. Keith Schneider: That then it starts to really impact your life. And you know, as we age, we're starting to need medications and we have some health compromises and things that you didn't have when you're 18 when you just recover like nothing.

Jock Putney: You nailed something that is really important. Fast in that particular setting is good.

Dr. Keith Schneider: Yes.

Jock Putney: Uh, because the faster you do that, the faster you get them out of anesthesia. If you've done it the right way, the less likely you're going to have to prescribe a narcotic.

Dr. Keith Schneider: Yeah. Um, so you know, hey, if you can just send the kid home with, um, ibuprofen and Tylenol. But yeah, that's an excellent point. Yeah, because there's less swelling, there's less injury to the tissues and yeah, the need for narcotics is not as much and we're so conscious with over prescriptions and things like that now.

Jock Putney: Yeah, I think if you have a kid who's exposed to something like that early on, uh, that may be a not so great thing for them later on in life, um, having had that exposure to those narcotics with the problems that we see today with regards to the epidemic of, uh, opioid, um, issues that's happening in the country. So yeah, it's fantastic that you try to do that. Obviously, there are some cases where you're going to have to prescribe narcotics, right? Is that

Dr. Keith Schneider: Yeah, absolutely.

Jock Putney: When we go talking about wisdom teeth, um, on the sedation side of things, I guess if you have them fully erupted, uh, oftentimes they're going to come out pretty easily, but you do have this nerve down below that's running in the jaw. You don't do it the right way, man, there can be some pretty serious consequences associated with that, right? Yeah. In order to get those teeth out, sedation is going to be pretty important, uh, I would imagine. Is that a fair assessment?

Dr. Keith Schneider: Yeah, I mean, wisdom teeth removal is very stimulating. Um, so yeah, I'd say 95 out of 100% of our patients go to sleep to make it easy and smooth. That being said, the anesthesia is for their comfort, not for ours, but it's definitely going to bode for a more smooth procedure. There's a lot of pressure applied and also when you're bringing out a drill, the section lowers, uh, that could be something that could be sort of like, oh, what's going on? Especially if you have to expose the tooth that

Jock Putney: Yeah, the sound effects can be very, uh, there's a lot of vibration, a lot of sounds. There's some cracking sounds with, you know, when they have to separate the teeth into pieces because of how they're impacted. Many teeth, there's just not enough room for them to begin with. So, they're growing sideways, upside down, backwards. Like, yeah, I've seen the scans where it's like, here's the tooth, here's the jaw, and they're literally growing into the other tooth this way. They're not going up, they're going sideways directly. It's the weirdest thing.

Dr. Keith Schneider: And that's what's nice about getting them out early before they're so impacted. Um, general rule of thumb is we want to remove them when the roots are about 3/4 formed or less. And so, usually we're just removing, you know, roughly around age 15 to 25 would be ideal. The incidence of nerve issues, about five in 100 temporary and one in 100 being permanent. But there's some high-risk findings on X-rays. It makes it very predictable. I can coach patients, say, "Hey, you have some high-risk findings here. We're going to get you through this. Here's what to expect." Or, "Nothing to worry about. But I know you see that close and your dentist was worried about that nerve, but there's no incidence or there's nothing here that tells me you're high risk."

Jock Putney: So recovery time, um, is something that everybody's always concerned with. What is a typical recovery time for wisdom teeth extraction?

Dr. Keith Schneider: Yeah. Um

Jock Putney: Or wisdom teeth removal. I don't know why, but Google, if you look it up, Google always calls it wisdom teeth removal. Where did that come from, by the way? I just need to know. I've never asked anybody that. Well, how did we go from extractions to removal?

Dr. Keith Schneider: I think it's just softer. Like when people think of extracting, it's like, I don't know, maybe an abrasive term versus removal. Like, yeah, I just removed something, you know, something from the cabinet. I removed it out of your mouth. I don't know. Typical recovery from wisdom teeth: peak swelling's 3 to 4 days after the procedure. So, um, limited mouth opening for a week to 10 days, then that's from the muscles. It takes two weeks for the gums to heal, six weeks for bones to heal, but average about day five people start turning the corner, getting over that hump.

Jock Putney: Just like working out, you know, it's like that third, fourth day, that's when you feel it.

Dr. Keith Schneider: It's all in the muscle. It's all muscle recovery. And so I use a lot of my workout sort of mentality when I'm talking to other patients, like it's muscle discomfort and that's why you're feeling it. Day three, day four. They'll feel good for two days and then all of a sudden three, four days they're like, "Oh my gosh, I'm so sore."

Jock Putney: Yeah. Yeah. Yeah. I think one other myth, um, is also dry socket.

Dr. Keith Schneider: Oh my gosh. The dreaded dry socket. And Dr. Google's really good about describing everybody's post-op course is dry socket. The term basically has come almost like Kleenex and facial tissue, like everything's a Kleenex, but, uh, any jaw pain is being prescribed or described as dry socket. It's just not the case. We rarely ever see dry socket anymore. It's such a thing of the past, but everybody calls, "I think I got dry socket."

Jock Putney: Well, what is dry socket?

Dr. Keith Schneider: So dry socket itself is an unhealed socket and they call it dry because you essentially look into where the tooth was removed and it's just raw bone. There's no clot. There's no fluid. It's just like almost like it's dead bone around where the tooth came out.

Back when they were taking out teeth with like mallet and chisel and a lot of other techniques, I mean these things were more prevalent. The procedures were taking longer. The techniques weren't as refined. And so now things are so predictable and so smooth, we just don't see it. And it's great when people don't have a lot of jaw pain. In reality, I mean, you're going through surgery, you're going to sometimes have some jaw pain. And it's usually because the muscles of the cheeks, they call masseter muscle. And those attach right to where the wisdom teeth come out. And so a lot of people are misled to think that's dry socket when it's just muscle pain and recovery. And so it's a lot of just coaching people through that process. So, if I could go on anti-dry socket, like, uh, you know, on Google, I would do that. We should do a podcast on anti-dry socket.

Jock Putney: Yeah. Well, you know, I think we've started it off right here. That's good news because you hear about it all the time. And also I think you really keyed into, or I don't know, tapped us into, um, a topic that is, there's a lot of not so great information available to consumers on, uh, the internet. Uh, YouTube probably is primary, um, but questionable stuff that's being said out there. And so the need to actually correct that and really give the right information coming from a truly qualified provider is absolutely critical.

Dr. Keith Schneider: Yeah, because I mean, as it comes, I mean people are jumping on chat. It's like, hey, assess these symptoms, boom, dry socket. Or, talk with your, I would love it to say talk with your doctor because they know your circumstances better than me as the AI-driven physician, but in reality that's what people are using.

Jock Putney: Well, I'm glad you went there because we were going to get here eventually. So AI, uh, as you know, I'm deep in the AI world and we created AI technology. I write about it every day. One of the things I wanted to ask you about is, we know that AI is going to play a role in diagnostics. Um, so we have a CBCT. So that's a complete, uh, scan of the entire, it's like a 3D scan, um, of the face, uh, the jaw and the area that you're working. Um, how do you see AI playing a role in oral and maxillofacial surgery moving forward?

Dr. Keith Schneider: A lot of our technologies have AI integrated into all of it and I'm so thankful for it. So, we are starting to partner with a company that does, um, some X-ray diagnostics. So, it'll take that 3D image and it'll say, "Hey, there's a cystic looking structure over here. Make sure to take a look at that," you know, and it usually tells us that by highlighting it on an X-ray. So, we just hit that button. Um, we do a lot of very specific implant guides. Um, so we do 3D planning for proper placement of implants. All of that software is driven through AI technology recognizing patterns of the jaws and the teeth and simulating crowns, uh, dental crowns that would go on top of the implants. It's really great and enhances the technology, and for me it's an enhancement. It's not a reliant, like I'm not relying on that to tell me what to do. Um, and it's a great adjunct to what we do every day.

Jock Putney: Yeah. So the diagnostic piece is there for sure and continuing. Then there's another side of it. Uh, I just wrote, uh, something and I'm not exactly sure when it's coming out, but we were talking about insurance companies, payers, which obviously you have to work with some of them, uh, are using AI to deny claims and, uh, it's been a pretty big issue. Um, one that has made it all the way to Congress, right? Yeah. So the idea here is that, you know, while the payers were really stacking up and gearing up for this, there's an asymmetrical sort of, um, uh, thing happening with, uh, both the practice and the patient. The patient needs to understand that the practice is actually your friend and your insurance provider isn't, in my opinion. This is just my opinion. And so that's the way I look at it. It's like, hey, practices need the technology that's like, hey, the minute a claim's denied, no, no, no, got to go back, because we know that if you just fight it, you can beat the machine. Uh, so that's technology that's coming. Also, the ability to, um, you have some technology inside of your practice, we don't need to name it here, but you have some technology inside of your practice that's actually, uh, developing pretty quickly, um, and has an AI capability which actually can provide a better patient experience for patients. And I think that's huge. Um, because ultimately I believe the patients just want to get through the experience as quickly and with the best experience they could possibly get.

Dr. Keith Schneider: Yeah.

Jock Putney: Um, everybody's got to get back to their lives and the impact of health care on patient and their lives and everybody around them. Think about a mom who all of a sudden has to have any kind of procedure. Now the whole family is sort of impacted by what's happening with that. Uh, the notion of AI in the practice being utilized from a claim standpoint, from a management standpoint, agents that can actually make things, you know, you're looking at all sorts of different systems, and then consumer-based, uh, AI that's actually able to book an appointment with you is pretty incredible.

Dr. Keith Schneider: Yeah. So, there's, um, one of my mentors trained me to make sure we're addressing three things with patients. Time, fear, and finances. And if you can address the time, the fear, and the finances, they will have a good experience. And so on the AI part of the finance, yeah, we're starting to see that on claims. It'll say denied and underneath in parenthesis AI generated. And so now we're starting to see that and it's like, what is this? They, you know, they're just processing through wordsmithing whatever the claim was and just giving automatic denials. It's delaying timely reimbursement to either patient or us. It's not the way.

Jock Putney: Yeah. And the funniest thing about that is that so they've got this advantage where it's denied. Right now you're waiting. So any kind of delay in the payment, you know, some of these payers are going to pay you what, you know, 30, 60, 90 days. So now they're delaying that whole process. So if you're in an asymmetrical relationship where your staff has to actually go through and resubmit those claims, they're denying it instantly and you've got to go back through that. It's adding cost to the actual overall system inside of the practice, which is not good for patients. So we're talking about trying to reduce cost of health care and yet here we have this sort of setup where CEOs of payers are actually, they're not there to actually manage the actual, um, health plan. They're there to manage margin.

Dr. Keith Schneider: Yeah.

Jock Putney: Uh, so denials play into their comp packages. If we take a look at, like, the CEO for United Health's paid $60 million a year, um, 500 and something thousand of that comes in the form of actual compensation. The rest comes in equity. Uh, so they're heavily incentivized to actually, they basically have a piece of the pie. So they want that stock, that margin comes on claims denial.

Dr. Keith Schneider: Yeah.

Jock Putney: So it's kind of a crazy scenario when you think about it, how things are working. There's a lot of talk about Josh Hawley, uh, senator in, um, Missouri, across the aisle, went over to Elizabeth Warren and said, "Hey, we got to break this up. This is not working well for the general consumer." Which I think is a great thing.

Dr. Keith Schneider: Yeah, I sit on the committee for governmental affairs for our oral surgery association and, um, yeah, we just signed on to a bill to try to eliminate the denials, uh, using AI. And so I'm interested to see where it goes. I think it's a moving target right now. But

Jock Putney: Yeah, I think at the end of the day, we're at that point in time where providers and patients are just not going to put up with that.

Dr. Keith Schneider: Yeah.

Jock Putney: Um, and you know, we're all kind of locked into buying insurance. Um, and so there's a better way. Um, the reality is that we want the best care. We want it from the best provider. Uh, and we want it to be, as you said, the least impactful on our finances. People are living, there are a lot of people just living paycheck to paycheck. They don't have the ability to come out of pocket for a lot of the things that they need and yet they need the care.

Dr. Keith Schneider: Yeah. All of this insurance stuff, you'll talk to surgeons, you'll talk to dentists, their answer is, I'm going out of network with all of them. I'm just going to go fee for service. Patient's going to have to figure it out on their own. For me, that wasn't my philosophy. My philosophy is I want people to be able to utilize their insurance. Their companies are providing this, and for me, I wanted to be an insurance-based practice. And we've built systems to support that through the practice.

Jock Putney: That's great because otherwise now that claims denial piece has to go to an app that exists for the patient to be able to do something quickly, otherwise they're into this whole thing. And we know that, I think the leading cause of bankruptcy in the United States is around medical bills that the patient can't pay.

Dr. Keith Schneider: Yeah. They don't understand these conditions. They don't understand how to fight that. And they're entrusting in us to help them, um, to advocate for them, to be able to explain things thoroughly and fight for them with the insurance companies. And, um, when they're left to fend for themselves, I mean, simple stuff probably goes fine, but if it's anything complex, they don't know how to defend that.

Jock Putney: That's a really refreshing way of looking. I've, you know, seen so many providers go say, hey, I'm just going out of network and let the patient deal with it. They'll submit it on their own and they'll do whatever they, and in reality that's just kind of leaving them to navigate in the wilderness, uh, without a compass. We're going to advocate for our patients. We're going to be insurance based practice that basically helps people. They don't understand their explanation of benefits. They don't understand what they're covered for. Um, they don't have the, uh, eligibility and the pre-auth and all the things that you guys are doing in order to make that possible. So this is a really important distinction about your practice. Not only you providing the highest level of care, but you're also making sure that that finance piece is handled. And then we talked about the time piece. You're trying to be as efficient as you possibly can inside of the practice to provide that care to them with the highest level of quality, uh, with the least amount of downtime.

Dr. Keith Schneider: Yep. Yep. Yeah. It makes for a good recipe for taking care of people.

Jock Putney: Yeah. You know, the world is changing and changing quickly and having someone like you that does what you do is pretty cool. I'm pretty impressed.

Dr. Keith Schneider: Oh, thank you.

Jock Putney: You're looking at the whole picture, which, um, I think is where we got to go.

Dr. Keith Schneider: It's fun. It's fun taking care of people. It's fun interacting with everybody. So, we love what we do. We try to make it easy for everybody.

Jock Putney: That's great. So, oftentimes people wait too long to have a dental implant placed, so the tooth, whatever, you know, and now they've had some resorption of the bone, so they've lost bone. Um, and that's going to lead to the need for, uh, bone grafting. Um, which is really an interesting thing. So, you have a sinus lift for if you're up in the, uh, maxilla, you're going to have to lift the sinus up to put that bone graft in, um, and create the space so you don't perforate the sinus. What is that material that's being used for bone grafting?

Dr. Keith Schneider: Yeah, typically we're using one of two different types of bone graft. One's called allograft, which is, um, cadaver bone. And, um, everybody's always concerned maybe there's cells inside the bone. There's no cells. It's been treated so all the cells are removed, so there's no rejection. It's used as a scaffold for your body to make its own bone. And then we also use cow bone or bovine. And so those are typical types of graft materials that we use more regularly. It's really great. You know, historically we've always had to take bone from other parts of their jaw and then use it to rebuild other parts. And the bone grafting materials and our protocols have become so smooth, you don't have to really do that anymore. It makes it much more comfortable procedure, less morbidity. Um, so it's, yeah, real smooth.

Jock Putney: Yeah. And you see a lot of patients now, they have single implant requirements, uh, maybe two implants, um, and then you go all the way out to the people that have let the whole mouth just completely go and you have to have all their teeth extracted. That's pretty rigorous. Um, when you get into that, that can take up quite a bit of time in a schedule.

Dr. Keith Schneider: Yeah. So, um, I mean, we're always trying to head things off before it becomes a major issue. Replacing teeth one at a time as you go is going to be the rule of thumb. Replace them as you go. So, if you lose your teeth, let's get it replaced. Um, implants are great in that we can use them to restore single teeth or we can use them to do multiple teeth. So, we'll place like two and put three teeth connected to the two. Um, or we can do full arch replacement. There's nothing that feels like your natural teeth, though. So, if you do a full arch replacement, it's a full amputation and then you're putting a prosthetic on there. So, it's like imagine walking on a prosthetic leg. Is it going to feel like your leg? No. Is it going to function like a leg? Maybe. Um, so, you know, when we're talking to the patients, "Oh, I just want all my teeth out and I want them replaced," they need to make a very thoughtful decision on that because it's not going to feel the same. And so, but it's an amazing procedure when we do need to do that. So, we only do full arch replacement when we need to. Um, some of the corporate, uh, places that do that, and that's what they do. They put people in that box. This is the service we provide. You're coming in here, you're getting all your teeth out, you're getting this done. You know, in the private practice, we don't need to do that. We can work with the dentist. We can get people through situations. Let's just rebuild this half and let's keep your natural teeth over on this half. Everybody's situation's different. And then we have all the tools to help them along the way.

Jock Putney: I think that's a really important distinction too, because if everything you have is a nail with a hammer, right? That's the only thing that you do. Implant centers that are geared towards just all-on-X cases or whatever we call it, full arch replacement. The reality is that there's a secondary component to that. You hope that a patient at that point in time who hasn't had great hygiene previously, uh, now is going to do the things they need to do. They're not going to smoke. They're going to keep getting it cleaned. Uh, they're going to do all the things that they need to do in order for that to maintain. Um, because arch replacement is often sold as it's the permanent end of the story and you're good. But what happens when you're doing that early on, you have years to go. What are some of the things that can happen?

Dr. Keith Schneider: Yeah, I mean our 10-year studies see, uh, prosthetic fracture, uh, about 10% of the time. So that'd be the teeth themselves. Our hope is that the surgical piece, the dental implants are in the bone. They're stable. Um, but if there's abnormal wear and tear, there's something's going to happen. You know, I'm having to rehab some of these old cases from, you know, other surgeons or, you know, old cases of my dad's that just didn't, uh, weren't stable over time. You know, I always talk to patients about it like knee and hip replacements. Under normal wear and tear, probably going to last a lifetime, but I'm sure they know somebody that's had to have a knee redone. You know, the long-term studies on most prosthetics is 20 years. So, yeah, it's not a forever thing. And I think people are misled to think, "Oh yeah, I get new teeth in a day and I don't have to worry about it ever again and I never took care of my teeth and I'm not going to have to take care of this." Not the case.

Jock Putney: Yeah. The crazy thing about that, too, as you think about some of those organizations are going straight to pterygoid, zygoma, or zygomatic implants. I mean, they're attaching up into the cheekbone. There's nothing left after that.

Dr. Keith Schneider: Nope.

Jock Putney: Once you're up there and you're into that, what else can you do? You're going to, I don't know where you're going to attach it, right?

Dr. Keith Schneider: Yeah. So, our last salvage technique at this point is what it's revisiting the, uh, subperiosteal implants. So, there's a newer reinvented technology which is called subperiosteal. So, it sits right on top of the bone, but now we can do a bone anchored. So, we have these like almost mesh framework that goes up on the jaw, gets screwed into the jaw, and then you have these little struts coming through that you can attach teeth to. That is the ultimate end of the road. So yeah, we've gone from full arch to zygomatics and then now just the subperiosteal after that. That's where they're looking at just removable pieces and, you know, soft diets.

Yeah. And so weird to see the patients that, when they're edentulous, all their teeth are gone, they're just sort of have that sunken look, and then all of a sudden when you restore them, it's like, whoa, they just look like completely different people.

Jock Putney: Yeah. I've seen that so many times over the years where it's like, wow, I mean, this doesn't even look like the same person.

Dr. Keith Schneider: I always love this picture. It's, um, they show it at some conferences, but it's a picture of somebody's, it's a woman's face and, uh, she's missing I think a lateral incisor and she's also missing an eyebrow. And, uh, they show the picture and say, "What's the first thing you see?" It's the missing tooth. And they're like, "Do you see that she's missing an eyebrow?" You're like, "Oh yeah, she's missing an eyebrow." Like you don't even, teeth, they go right to the smile, right to the teeth. It's so impactful for people.

Jock Putney: Yeah. I mean, you think about it, right? And the smile is like the first thing that we can determine. It says so much. I think so many of those patients or people have lived their lives in isolation because they can't go out, they can't interact with people. So, I think that's really an important point. You get to a certain point that you're sort of like out of the norm of what's going on. So, uh, pretty intense.

All right, time to check in on those ketones. Did you feel any difference?

Dr. Keith Schneider: I'm feeling engaged.

Jock Putney: Yeah, I'm feeling more. Yeah. Right. Yeah. You missed your 5 a.m. workout.

Dr. Keith Schneider: I know. Which is, I find that if I miss my morning workout, uh, it's almost like a thirst.

Jock Putney: You know, you notice it's almost like you get thirsty. You're sort of like, okay, uh, the rest of the day just doesn't go as well. So, it's tough when you're traveling. You're coming from an east coast time zone to the west coast. You miss your workout. Kind of tough to determine like, what am I actually. But it's good to hear that you're feeling a little locked in.

Dr. Keith Schneider: And yeah, my pre-workout I think you usually take helps me to sort of like get the day going, locks me in, like to get things, um, get things started. So I think I'm used to that sort of routine. Take my pre-workout, give it about 30 minutes, 15, 30 minutes, and then like go ahead and I'm focused. Like, and people in my gym, they're always like, "You are so focused." I was like, I am, I feel good. Let's go.

Jock Putney: Does your pre-workout have beta alanine in it?

Dr. Keith Schneider: It does. Yeah. I've gone to some non beta alanine, but I don't mind just the little tingle. It's fine.

Jock Putney: For some people that is almost like a niacin flush. It's a little too itchy and too much for them. But beta alanine can be pretty powerful. Um, it's interesting. You also have a nitric oxide component to it as well. Yeah. So you get the vasodilation, you're starting to really get into it. You start moving the body, you're pumping the blood, heart rate goes up, uh, you're contracting. Well, it's one thing too people don't really realize about working out, the movement of the muscles actually moves the lymph system, which doesn't have like a heart, like, you know, we're pumping blood. The lymph system doesn't have that. So by actually strength training and lifting, you're actually moving the lymph system, which is pretty important to health, right?

Dr. Keith Schneider: Yeah. Yeah. I mean, you're circulating all that back through. I mean, even if I'm feeling just a little under the weather or something, I go for an intense workout, I usually feel so much better. It's like rinses it out.

Jock Putney: Yeah. Pretty intense. One thing I want to talk to you about is actually training and diet. You know, you had mentioned nutrition being so important. So, we always focus on, there's this heavy focus on macros, right? Okay. Well, I've got my x amount of protein, x amount of carbs, x amount of fat. And I kind of believe like, you know, protein is kind of a fixed thing based on body weight, uh, and lean mass. Uh, fat should be probably, it doesn't deviate that much. Uh, it should come from quality sources, sometimes from the protein. Uh, and then the difference between where we are in our periodization is going to be what's happening with carbs and what kind of carbs we're eating. Give me a sense of what you're doing in your diet.

Dr. Keith Schneider: I probably, I mean, I guess you consider vegetables as a carb, but I'm only eating carbs like three days a week. So I'm minimizing most breads. I, you know, sweet potato and I'm eating it. Maybe some tortillas, some corn-based stuff. Um, that's usually what I'm eating as far as like my carbs. But yeah, I carb cycle.

So, you know, maybe I have a high carb day and then I follow that with like a no carb day. Um, and I really just like, your body is just eating all that visceral fat to fuel itself. Some months when I'm in my intense workouts, like I can feel it. I was like, I need some carbs to get through. You know, your body speaks to you, but usually I'm cycling. So, about every like 3 days or so, I'm eating carbs.

Jock Putney: It's almost like the Vince Gironda steak and eggs thing where on one day a week he went in and had this massive, uh, probably back in those days they're eating pasta and stuff like that. I can't take the pasta, just, I mean, blows my joints up. I don't eat it anymore.

Dr. Keith Schneider: I know. Yeah.

Years of Italian food. Now it's like don't eat any of it.

Jock Putney: Yeah. I mean I'll take the sauce, right? I mean even though the tomatoes probably aren't the thing that I'm really, you know, that from an acidic standpoint not really great for me. But, um, and that may be the Scottish heritage, right? I don't think any Scotsman were eating tomatoes back in the day.

Dr. Keith Schneider: No. Maybe it's in our blood or

Jock Putney: It might be. Yeah. Um, yeah. So the reality is that, um, you know, the diet piece and then the macros underneath that, uh, I mean the micros underneath the macros, often missed. So you talked about supplementation, making sure, I can tell you're getting in the things that you need in order to support the complete system, because what we need to understand is that it is a complete system and all of the, uh, proper minerals, vitamins, everything need to be present. How you get them really should typically come from a whole food diet.

Dr. Keith Schneider: Yeah.

Jock Putney: Uh, sometimes we have to supplement a little bit.

Dr. Keith Schneider: Yeah, I definitely like whole food diets for sure.

Jock Putney: I mean, you got to get that heavy on the protein.

Dr. Keith Schneider: Um, definitely enjoy the fats. Love nuts.

Jock Putney: The protein side of it is, you know, once you clue into it and you realize how powerful it actually is. I mean, everybody's talking about protein diets now. Um, the other day I was talking to somebody about protein donuts. I'm like, come on now. Seriously, that's like the worst thing to possibly do. Like, don't do that, you know? But now, it's really interesting to see how people have moved away from

Dr. Keith Schneider: I eat a lot of eggs. I just got a new chicken coop outside my house. I got six chickens. We're pumping out some fresh farm eggs from, uh, Shaker Heights, Ohio. But yeah, a lot of, I eat eggs every morning, you know.

Jock Putney: I do too. I do too. And I try to get the best I can. Thankfully, here we have, we don't have chicken coops, but we have access to local eggs that are really high quality. And the choline from that and all of the stuff that's inside. I mean, egg, if you think about it, is such a perfect food. It has the right amount of just about everything that you need. Um, and so, yeah, I eat a lot of eggs. It's a big piece of my diet.

Dr. Keith Schneider: Yeah. Shows, man.

Jock Putney: Yeah. Hey, I'm curious. How many eggs a day do you eat?

Dr. Keith Schneider: Uh, I do about six.

Yeah. Yeah. Yeah. It seems like it's a lot, but it's so easy to eat.

Jock Putney: It's so easy. I like mine poached because I don't want the yolk to get oxidized in the scrambling process and I don't like fried stuff. So, I stay away from all fried food. I don't eat anything fried anymore.

Dr. Keith Schneider: No, nothing fried.

Jock Putney: Yeah. Everything is baked or, um, you know, steamed. Yeah.

Dr. Keith Schneider: Baked and steamed.

Jock Putney: Yeah. And if I'm using any kind of oil, that's like if I'm needing to put extra fat into my diet, it's going to be olive oil. That's it. Needs to be really high quality and it's going to be untouched. It's going to come the way that it came in the bottle and it's going to be used in that, uh, meal totally unheated. We know the heat oxidizes those oils. It's pretty intense.

Dr. Keith Schneider: Yeah. What it can actually do, man.

Jock Putney: That's the efforts that we need, man.

Yeah. Stay strong, stay fit, stay young. That's the pathway to peak performance, right?

Dr. Keith Schneider: Yep.

Jock Putney: Awesome. Okay, so we're going to wrap up with a tough topic. Um, and that is what we're seeing in the market today. We talked a little bit about it, but you have resisted this big push and a lot of people have gone this route. It's a corporate practice of dentistry. Uh, so what we call dental services organizations, and in the medical world, uh, it's a managed services organization or medical services organization. These are backed by private equity. The goal of private equity is simple. Squeeze everything down, get the most EBITDA out of it, repackage it, sell it off, get the money back, go back out and do it again. Uh, so you resisted it.

Dr. Keith Schneider: Yeah.

Jock Putney: Uh, the bloom's come off the rose on this and, um, now we've got a supply side issue where there are a lot of oral and maxillofacial surgeons that don't want to go into that model. These practices are having a tough time staffing locations. Um, what are some of the other downsides of dental services organizations?

Dr. Keith Schneider: I guess we sort of started to talk about, it's again taking the heart out of the practice. It's not being managed with that same tender love and care piece. Um, that's one thing. Um, I think the dentists and the oral surgeons that sell the practice, they're seeing sort of that payout, like it's almost like reimbursement for all their years of hard work, and I just have to have five years and then maybe I'll retire or maybe I'll stay on. But it's not being managed by them. Uh, they're not doing all the hiring and firing and so they lose that small business piece that made us such a great profession to begin with. And that's one thing I feel passionate about. I want to be able to manage myself. That's why I got into this, take over my dad's business and then growing it. He was a single practitioner with, uh, probably about five staff and, uh, we've grown, now we're at currently three locations. We have five surgeons and almost 65 staff and we're going to keep going. And I always felt really passionate about, uh, developing a practice where I could support surgeons. We didn't have to rely on a corporate model to do that. Like we can manage it ourselves. And I suppose if you were to break it down, um, what some people would consider an individual DSO is, but we're self-managing ourselves. We're not looking for payouts working with private equity groups. And I've just seen that relationship get tarnished so many times.

Jock Putney: And there are some practices that have done very well in that model. I mean, in fairness to them, right? They didn't want to manage those things. They didn't have business training. They didn't understand how to do all of those things to really maximize their practice, uh, and maybe provide the highest level of care. So, there's also some of that too, but I think, um, it's clear now it's maybe not the model. Um, but then again, these are opinions. You know, we're expressing opinions in the moment. Uh, I reserve the right to be wrong.

Dr. Keith Schneider: Absolutely. It's, uh, yeah, I went to a panel discussion on point counterpoint, private practice versus DSO. We do know that the dental DSO market has really fallen out. There just wasn't enough for the private equity groups to be profitable. So now they're really targeting oral and maxillofacial surgery over that. And we're starting to see the pendulum swing away from oral surgeons as well. There's just, it's not there. The thing that really deterred me out the gates is, I was sitting at a social setting. I was just waiting for some to-go food at a bar and I just overheard a couple, uh, finance guys right at the other end of the bar and they just, "Hey bud, did you hear about this whole, uh, dental market? Are you tapped into this yet?" And the way they talked about it was just so disheartening for anything I believe. It was literally they just want to pay out and then they were seeing it dollars and cents. It's an investment. They want a return. And I understand the point, like where it's supporting a surgeon or getting a payout, but it's just the heart and it's not who I am. And I couldn't take it. I was like, I left with such a bad taste in my mouth that day. I was like, never doing it.

Jock Putney: Yeah. I think, you know, the one thing that's pretty evident is they've got some pretty great salespeople, uh, on that side that, you know, that pitch you on the benefits of it. They're not volunteering the information about the downsides of it. Um, so yeah, we'll see what happens. I mean, it's going to be an interesting thing in the industry. I think anytime where you have something that's, you know, really just focused on money, it doesn't align with care. It just doesn't, those things don't meet each other. They don't really mix. It's sort of like going back to the thing you talked about with orthognathic. Hey, I'm going to do these cases because I want to do these cases because they produce great results.

Yeah. That says a lot about who you are as an individual, as a peak performer.

All right. Uh, one thing I want to touch on before we go. If you're talking to a kid today in the world that we live in today, you've got some children of your own. What are you going to say to somebody about, uh, you as an athlete? Uh, what are you going to say about how to live your life, things that you should aspire to? What's the pathway to peak performance for kids these days?

Dr. Keith Schneider: Wow, that's a huge big question. Um, I love it. Following, I mean, following passion and engagement. I think, um, being proud of yourself and what you do every day. When I put my kids to sleep every night, um, I take that moment and reflect with them and I want them to feel proud about who they are. So we'll talk about that. I say, what were you proud about today? And just trying to really reflect and then grow from that, like, oh, I could have done this a little bit better. But I want them to feel fulfilled in every part of their life. And I'll ask them too, I'm very humble with them, say, is there something I could have done better for you today? And, um, just sort of like engaging with that. Um, but I think finding passion for what you are and helping to support kids with who they are inside. It's not who we want them to be.

I was blessed and I reflect on this with my dad. My dad and I, I took over my dad's business. I went to the same college. We were in the same fraternity and he never did, he didn't push me to do any of it. It was just a natural engagement that I had. He was there to support me. And when I graduated college, he said, "What do you want to do with your life?" I had some direction, but I was a little bit lost at the time. He's like, "You want a one-way ticket to Hawaii? You want to go explore the world? Like, what do you want to do?" I don't think that's a good idea. I think I'm going to get a job and I'm going to sort of start to center myself and really engage. So, supporting kids to be who they want, who they are, um, and loving them every day for it. And I think when they have that love behind them, you know, with their heart and direction, then that's going to be a beautiful thing.

Jock Putney: Yeah, that is so true. And everybody who hasn't felt a little lost at some point in time along the way. That's why I always say the pathway to peak performance is never a straight line.

Dr. Keith Schneider: Yeah.

Jock Putney: There's always some sort of, you know, uh, twist and turn to it. And how we get to that maybe happens early in life and maybe it happens later in life. Maybe we have to, you know, skin our knees and, you know, elbows and fall down a few times, have some failures, all those types of things in order to figure out. But I truly do believe that everybody has greatness within them. And going back to some of the people we talked about earlier who maybe made a bad decision

Makes me grateful for the opportunity to, um, to live my life every day where I'm trying to do something that I feel is great for patients. The work that I do, um, is really about enhancing the, you know, I want to leave a mark, just like you do. I want to leave a mark on the world and I think it's super important and that's clearly what you want to do.

Dr. Keith Schneider: Yeah. Yeah. I did give the fluff piece for the kids. I'm tough on them, too, though. So, it's tough love, too. You got to push. Like, hey, work hard, play hard. You know, my daughter wants her, uh, you know, Coach purse. I was like, you're going to have to earn that purse. Like, so I have her doing chores and tasks and building. You know, they have to have a foundation of work ethic. And I said that stronger work ethic, it's probably my strong German and Scottish roots. But, yeah, they got to work hard, play hard, too.

Jock Putney: Yeah. You know, it's funny. Uh, it's two Scottish guys, uh, in heritage. I think that's sort of, um, yeah, I mean that work ethic is absolutely critical. Um, if you don't have it, and we can remember being a kid and having my paper route and, man, there were days I just didn't want to do that, but you know, you did it and it set you up for like the notion of sometimes you do things you don't want to do and you get it done. You make it happen.

Dr. Keith Schneider: Yep.

Jock Putney: Yeah. Well, it's been an absolute pleasure to have you in and I'm so grateful that you came all the way from Ohio to come see us. You know, it's a rare treat to have somebody who has, you, this principled, has the vision that you have and the commitment to really seeing it all the way through. That's a, you know, you're a fantastic guy and, uh, we're truly grateful to have you in here.

Dr. Keith Schneider: I appreciate you having me and thank you for the kind words. It's an honor to be here.

Jock Putney: Awesome. Yeah. Thanks, man.

Dr. Keith Schneider: Thanks.