Latest / The Word of Mouth Podcast / Small By Design, Not by Default - How Dr. Fallah Builds a Practice Around Connection | WOM 018

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Small By Design, Not by Default - How Dr. Fallah Builds a Practice Around Connection | WOM 018 · The Word of Mouth Podcast

• Jeffrey Lunt: Welcome back to the Word of Mouth Podcast, your weekly podcast breaking down the business news and trends in the dental industry. I'm your host, Jeff Lunt, and today I'm joined by Dr. Bosma Fala. Dr. Falla is an orthodontist out of North Ridgeland Hills, Texas, who brings 22 years of specialized clinical experience to her field. A second generation dental professional, Dr. Falla holds the rigorous American Board of Orthodonics diplomat credential and possesses a deep research background in craniofacial development. At her practice, NRH orthodontics, She operates on the clinical conviction that patients deserve comprehensive whole person care where nothing gets missed or compromised. Her consultations look well beyond simply straightening teeth to assess jaw development, growth patterns, and airway health as a baseline standard. Dr. Fala also brings a unique depth to clear liner therapy. She trained at one of the first residency programs to integrate Invisalign and later served as an adjunct faculty, teaching the technique to future dentists. Guided by an liner-first approach, She routinely leverages her expertise to successfully treat complex cases with clear liners that other providers often claim require traditional braces. Welcome to the podcast, Dr. Falla. So excited to have you here. Thank you, Jeff. Appreciate it. Awesome. So let's start. Take us back to the beginning. What kind of was your reason for getting into dentistry and then beyond dentistry, more specifically into orthodontics? I just loved watching my dad growing up. My dad is an orthodontist. so I spend those summers in his practice helping, watching. as I I you know, I I I played the piano growing up, I was in swim, I was very active and arts was always something I appreciated and I enjoyed. ⁓ and I felt dynasty is the more I I learned about it. The more I realized it's a combination, I love science, I I love math. But like it's a it's a great combination for me. It has the the hand disturby part, the science part, the arts part. ⁓ so I knew dentistry, and I I love the feeling that you're helping patients, you're ⁓ you're giving back to the community and and really making a difference in some. Yeah, you know, in your patient's life. So watching my dad doing that, obviously. So I realized, okay, dentistry is really something I really want to pursue. and when I went into dental school, I was not really right away deciding on ortho because that's all I've known all my life. So I figured, you know, I need to keep an open mind. I need to explore all the other specialties. And luckily in dental school they do that. they expose you, they ha you have to do rotations and going through every specialty and you have to treat patients for that, ⁓ in that specialty. And that's when I'm like definitely ortho. Ortho is really what I really enjoy doing. I like the complexity of it. ⁓ it's a lot of thinking, a lot of visual thinking, a lot of physics and I love thinking outside the box ⁓ for cases and there's always something new you learn. So Well, okay, this is really something I want to pursue. I have more passion for this than any other specialty. And I practice general dentistry and that really confirmed that I definitely need to go back to school and become an orthodontist. So and here I am. Awesome. Yeah, I saw a graphic one time that broke down the word dentist into the D from Doctor, the E N from Engineer, and the T I S T from Artist. That it kind of blends all of those different professions together. ⁓ my gosh. I've never heard of that. But this is really yes, that is true. Yeah. So that ⁓ I mean, that's awesome. And I didn't even know your ⁓ father was a dentist. So is NRH Orthodonics is that did you take over his practice or is that something you started? ⁓ how did NRH Orthodonics come about? We started from scratch. I wish I was that lucky that I stepped into something and and I I think it would have been easier, but but I don't know. I I wasn't that lucky unfortunately. My dad decided to retire because I never really showed real interest in orthodontists. I decided okay, I'm I'm selling and he retired and moved on into ⁓ teaching. And actually he was one of the first Orthodonists that ⁓ were hired as a consultant for Invisalign when the company started. So that's how far back. I go with Invisalign on using their product ⁓ and learning from it, about it from my dad, actually. But ⁓ now I started my practice from scratch. I moved into the area ⁓ because of my husband's job. And I decided to really look, I I I looked around, I I tried to find something that I saw myself in it and to be part of it. And unfortunately I could not. And that's when I ⁓ ha was having this conversation with my husband. And he's like, I think you need to just go on and build what you really want to and and provide the care that you you you're passionate about and you wanna be part of. So that's how this story started. Yeah, talk me through that a little bit. So you said you can't you couldn't find somewhere that really embodied what you wanted. What was kind of the core vision, core philosophy, the the real underlying ideology that surrounds the building of NRH orthodontics? Well, great question. I think the advantage I had, and I encourage everybody when they it's to it's really important, whatever we choose to do as a profession, to really choose something. Okay, what is it that I want to do? What is it that I like and I dislike and And I think that goes to any field. And in my field specifically, in my profession, I obviously you have corporate options, you have private options, and and I explore both. And corporate, yes, it has a lot of advantages, but for me, I did not want somebody to dictate the treatment for the patient. And and that was one of the main reasons I became a doctor, because I really wanted to help the patient. I wanted to do what's really best for the patient. ⁓ So for me, private was really the the path I had to go through. And then in private, there are so many options as well. Multiple locations, big practices, or you want to be more of a boutique, small practice. And that's when I chose because I worked in the big practices, and again, they have advantages and disadvantages. And you, as a practitioner and a healthcare provider, you need to choose and ⁓ decide what's best for you and what really reflects your values and what you stand for. So I chose a small practice because so I tell patients it's small by design, not by default. ⁓ I chose a small practice one location, but for me that is my purpose. I chose this profession is to really make a difference and connect with my patients, get to know my patients, spend time with my patients. I do not want to see a hundred patients a day. At the end of the day, I'm just exhausted and have no idea what decisions I made. I've been in that. I've been in that position. And I did not, it did not make me feel good. I was just burned out and not happy with myself. why did I even go to this profession? It's not that that was not my purpose. My purpose is to really connect with my patients. That's actually one of my my drives is to really get to know the people in my life and hopefully be a positive. Force and a positive effect, if any. Yeah, especially I see all ages and we all need that. And I feel that nowadays we even need it more than anything. ⁓ we're being very ⁓ isolated. So I look forward to the appointments. I look forward to seeing my patients and communicate with them. even though in my model and my practice, because I wanted to implement the remote monitoring where so it gives my patients more flexibility with their schedule. I never feel separated from my patients. I still I feel I see them every week because I'm still talking to them and communicating. Even though it's virtually, I'm still having a connection with them. ⁓ And that's a that's very important for me as a practitioner is to connect with my patients and to really get to know them because it's not just about teeth. There's a lot more into it. And we have to pay attention to it and see what else is going on that I can and improve. Absolutely. I love that idea of small by design, not by default, because I think a lot of people see a smaller practice and they think, ⁓ well, they just haven't been able to grow. But the best practices we see are the ones who design whatever they want to be, whether it is a big practice or a small practice. But for you, being small by design allows you to. Create those connections to really understand what the the patients need. And then ⁓ like you mentioned, it's not just about teeth and orthodontics. It goes bigger than that. We see studies have shown if you have a straight smile, a good looking smile, you're more likely to make sales, you're more likely to land jobs, ⁓ and s and ⁓ confidence goes up. And so all of those things in interlace with all different parts of life, and so it it is bigger than teeth. Mm-hmm. ⁓ absolutely. Absolutely. It's really I t I tell my patients, orthodontics is yes, you do end up with straight teeth, but the goal we do what we do is is to really maintain place your teeth or and b your bite in the right place so you can hold on to your own natural teeth as long as possible. And then having them straight and beautiful is is actually the cheery on top that. Yeah, that will happen. Totally, totally. ⁓ so you mentioned you moved into Northridge on the Hills ⁓ because of your husband's job. What do you love most about serving the the NRH community? A lot of things. It's ⁓ I I love the diversity of my community. I see patients from all walks of life. ⁓ the you know, ⁓ the busy parents, the single parents. I love it. I I just feel I have a purpose and I'm here to help them. ⁓ we have I get to know not just the parents, I get to know the grandparents sometimes, you know? and that is that is amazing because I love seeing the kids connecting with their grandkids, ⁓ being a working parent, you know, and and having my own parents help me out with my own kids when they were growing up. So But also it gives me because being because of me being a working parent, I think I can relate to the working parents and I can see when they can't make it to that appointment. I always make a point of communicating with them and filling them in, hey, this is what's happening, this is what's going on. Because I think for all of us as working parents, we always have that guilt feeling and that we're missing out. We're missing out on our kids' care. but I think I can relate to my community just because I am a working parent as well. and then we have the teachers, the ⁓ the you know the everyb everybody. We have the financial planners, we have the doctors, we have the lawyers, we have ⁓ people in ⁓ yeah, no, the firefighters, y you know. ⁓ it just it's a it's a good feeling to get to know everybody and get to see them and run into them, you know. Hey, you know, hey, is that you, Dr. Wall? And sometimes they can't recognize me because they always see me with with my loops and my my mask. And they're like, I recognize them and they're like, who's this lady friendly lady, strange friendly? And it's like, it's me. You don't see that usually, I know. But it's it's a it's a good thing. Yeah. That community that's built around that's something that we love about dentistry is ⁓ an orthodontics is that it does create a community because the businesses are so locally focused, they're such a tight knit radius around who goes to the dentist where. And ⁓ it's it's unique in that way that you get to know your dentist, you see them twice a year at least, and ⁓ and your orthodontist you see more frequently during treatments and and it it does create that real sense of community, which is amazing. It is. It it is so fulfilling, Jeff. And like I have and and and and for us, we're very lucky and fortunate that we see a family, you know, we see the the oldest child and then the middle child and then the youngest child. So I have families in my practice for a long time. And like for example, yesterday, the youngest one was just done and I felt I felt like a breakup, you know, like The skid like I'm gonna miss this family. I've been seeing this family for a long time. And I got so close to them. I got to know them. I know everything about them. And it is such an honor to get and a privilege, honestly, to to get to experience that. But also it is very and they said, Well, so we're done. I said, Not no, you're not done. You can always come back and visit and and stop by because I it just makes my day when my patients die ⁓ okay, I was b passing by and I figured you know, just say hello. ⁓ my gosh, yes, please come in, you know, fill me in, what's going on? And but it's it's yeah, and I feel like I tell everyone, it's like a parent who's having their kids graduate and move on to college. You're happy and proud of them that they have achieved, but also it's a bittersweet, you know. Yeah, yeah. And I think that speaks volumes to the kind of care that you're giving to your patients, where they are they feel like that is ⁓ that kind of community feeling where they they want to come back. They they felt like not only was the the service you provided in terms of the orthodontic treatment good, but the service you provided in terms of just taking care of them is enough. And that's something also that's unique about dentistry and orthodontics is you get this long tail Of where you might see parents and then children and then grandchildren of the same family. ⁓ and in orthodontics, you'll see all the brothers and sisters, and ⁓ you really do get to know your patients in a way that's pretty unique ⁓ in the industry. You talked about like teachers and firefighters, and they work with people, but it's just a different dynamic because they don't have that longitudinal relationship like you do with your dentist. Mm-hmm. ⁓ so let's talk a little bit more about your treatments. So you do primarily Invisalign. I know you do some braces in certain situations, but I'd love for you to just kind of talk me through, explain ⁓ your philosophy beh behind Invisalign, maybe some of the things that are misunderstood. How you got started, you mentioned your dad was one of the first advisors for Invisalign. So let's let's talk through that. Yes. So Honestly, so in in training, we get exposed to every tool in the market, really what's out there. ⁓ and and that's that's a huge advantage you get during your training because you you really get to experience everything out there. And when I got out of residency, finished residency, I practiced. ⁓ I was an associate in a practice. We did a lot and there's some stuff I didn't even get to pra to learn in residency, so the the orthodontist taught me. I learned a lot from her. and when I opened my practice, now I because I have been associating in different places, I kind of started, okay, narrowing. Okay. This is the kind of practice care patient care I would have. This is the the the schedule I would like to run because for me this is what helps me optimize patient care. And then you need to decide as a doctor, okay, what are the tools that I'm going to use to help me. ⁓ take care of the patients, right? So like a lot of orthodonts I thought, okay, we can do it with aligners and then we can do it with braces. And even with braces, you have so many choices of braces. and I decided a certain type of braces and then I decided, okay, I'm gonna do aligners. ⁓ but having the privilege of using both, I started actually sitting back ⁓ And comparing. Every time I finished a case, I review it. I review it and see, okay, this is how I when I treated with aligners, this is the finished case. And then ⁓ when I treated with braces, this is the finished case. And my my standard is always if I submit this to my ABL, which is a American ⁓ board of orthodontics, which is something we strive for as orthodontists in practice. Okay, every case we want it to be an a board case, right? which is the optimum level of of of care. How is this really is this really good? And I noticed that the cases that I'm treating with aligners is just, it turns out so much better. Better patient experience because they're not having all these emergencies and poking wires. Hygiene is much better than ⁓ the braces. ⁓ I I felt like as a as a as a as a doctor I have more control over the movements and efficiency. And that's when I'm like, okay, this is a great product. I really need to get good at it. I really need to get good at this. And you really know the ins and outs and how to use it and really perfect my skills on that. So I started investing in more continue education. I and then I signed up for a fellowship in ⁓ provided by Invisalign. ⁓ I did a fellowship in using aligners for treating more complex cases. So I started investing time. money and energy into really becoming better at it. ⁓ and I felt it just yes, I can still use all of the other tools, the braces, the buttons, the brackets, the the you know a distilizer ⁓ appliances that we have, but I felt like okay, now I can really combine everything and use when I have a case and I look at the case, okay. I have an end result and then I need to use all the tools that I have to really get to that end result. And I feel that that what makes makes it in challenging, but also makes it very fulfilling because you're continuously pushing yourself to do better for the patient, really. What what's out there that is gonna serve the patient ⁓ and get the best results, the safest results. And the faster results, right? So instead of going longer and longer. So that's when I decided, okay, I'm comparing my aligner cases with my braces cases and I'm seeing the aligner cases just check a lot of boxes. A lot of boxes. And then a liner, you know, another thing that I every orthodontist has a challenge was, okay, we finished treatment, everything looks perfect. Here's your retainer. ⁓ Make sure you wear it. You have to wear this retain, you know, and That's when we lose patients because they have never been trained to do that. And then the most critical time is when patients get done and they have no supervision. ⁓ and that's when I started seeing, okay, some patients come back a few months later sometimes, sadly to say that. Sometimes a couple of years later because they're they lost the retainer and now they have the shifting or they stopped wearing it because they just felt like okay, I wasn't I wasn't keeping up with that and they come back, Dr. Fall. I haven't been wearing my retainer and I have my teeth shifted sign. I need to go back in treatment. And yes, I'm happy to see them, but that's bad news for me, really. As a healthcare provider who was really investing so much time and energy into helping my patients achieve a goal, and that goal is not there anymore. So I felt like okay, what can I do that I can use but also help? why patients pick up good habits. And definitely aligners what the answer for that because tell patients, I want you to make every mistake on the ⁓ you know in the books, losing them. You're not getting hold of them. I want that to happen now because I want you to learn from this. I don't want it to happen later when I give you that retainer when you're not aware of the circumstances. ⁓ if this happens this you know then I have to deal with it. ⁓ so Retention was a huge portion ⁓ or a a huge factor in my decision to really okay, what can I do? Because I've seen it in my own practice. Patients who were treated with aligners hardly had any issues with their retention. Patients who are treated with braces, they struggle. They struggle with time, so they're not. It makes a ton of sense. ⁓ from my perspective. I had braces when I was younger. And the transition to wearing my retainer was not a smooth one, ⁓ I'm ashamed to say, but it's because braces are just on your teeth. You don't ever have to think about them where then you get a retainer, you have to put it in, take it out. But with aligners, you are taking it off to eat and those kinds of things. And so you're in the practice of thinking about effectively retention of like I need to put this back in my mouth at certain times and ⁓ It's kind of on your mind. And so you get in good habits of taking it out, but then putting it back in. which I think ⁓ it makes a ton of sense clinically. I'd never thought about it like that, but that is an awesome reason to go the aligner out. Honestly, Jeff, I I I think the metaphor I always tell my patients, because all of us like play something, either a sport or musical instrument, whatever, I say you cannot wake up one day and run a marathon. And this is what we expect patience in ortho, like, okay, here's a retainer. Now I want you to go out there and run the marathon. I want you to be the best, you know, you you can handle this. Or you can practice for that marathon, or you can practice for that game, or you can practice playing the piano or the trumpet, whatever it is. I don't expect you to one day to wake up and just got it. We'll do it. Okay. ⁓ so I think it's a it's a it's a great training tool. Is it easy? No, I tell patients I'm gonna be very honest with you. You're not I'm not gonna give you this and tomorrow you're gonna call me. ⁓ I got it. There is a learning curve, but I want you to go through that learning curve while you're being supervised and supported. Yeah not when you're on your own. Yeah, it makes a ton of sense. And another thing I wanted to just touch on that I thought was an interesting point is you using all of these different tools. You wouldn't hire a contractor to come and build a house if he only has a hammer or he only has a saw. You want a contractor who has all the tools to build the house. And so having the being doing that fellowship with Invisalign and getting certified and acknowledging that that's a great tool and a superior tool in terms of longevity and retention, but also acknowledging there are other tools. Sometimes we start with braces or use braces along the way, the buttons, those kinds of things. And so I think that that is a phenomenal ⁓ philosophy of NRH in terms of treating patients and really achieving the best patient outcomes. Yes. Yes. So along with that, I would love to ask, is there a new technique or new technology that's kind of coming down the line that you're starting to introduce that you're really excited about ⁓ with with patients looking looking into the future? You know, a lot is coming out. I mean ideally it will be great if we can from that monitoring ⁓ the digital because I see a lot of out of state patients as well. ⁓ I mean the technology is great, which is giving the patients access to care. ⁓ even though they're not within the radius of the practice, they can still come in and fly in for you know, I have patients as far as Boston, so I'm located in Texas. So the technology is great, but sometimes I feel okay, when is the next time can you be in town for me to do an actual scan? So where the technology is moving is that scan they do with their phone ⁓ can be now used instead of the scan we do in the office. So I think that will be a huge improvement. ⁓ so that's one. ⁓ two is the kind ⁓ of ⁓ of movements and efficiency with aligners. I mean there was a huge learning curve with aligners. They have been there's a lot invested in the into the research and development of aligners. So we can do a lot more with aligners versus 10, 15 years ago. I can I mean I do impacted teeth exposures with aligners. ⁓ so there's a lot you can use aligners to do and And that's due to the research and development that have been invested, like fixing ⁓ you know, skeletal ⁓ malocclusion, mandibular advancement and they used to have the wings, now we have the boxes and so there's a lot that has been improved and which makes it exciting because every time I'm like, ⁓ this is a new thing, ⁓ this is much better. What can I do differently? And ⁓ the CBCTs, which is the comb beam x-ray, has been a huge addition. Obviously, this has been in the in the field for a long time, but I feel when you start using it, you're like, how could you all ever use a 2D if you have access to 3D? And I love the 3D because it gives me a better analysis and ⁓ of of of what's going on and really dig deep and see and look into the airway. just so it's just one simple scan with lower radiation that what can possibly be done and you can just extract so many so so much information from it. Looking into the airway, looking into how ⁓ you know impacted teeth, positioning of the impacted teeth. This is this in the you know lingual part, the palatal part. I'm going a little bit technical. I'm so sorry. But It's just the information that we can gather from a simple scan that will help me do a better diagnosis and a better treatment time and treatment plan for the patient. Yeah, you mentioned ⁓ the advancements in aligners. And one of the things that we've been impressed with ⁓ with your practice is that there isn't a case that you've that you say is too complex for aligners. I think that's maybe a misunderstanding a lot of people have about aligners is they think it's only for really simple cases. And maybe that comes from a lot of those like box deliver to your door aligners where they were just more simple cases. ⁓ but talk about that just a little bit. Yes, I think A lot of it is the training, honestly. ⁓ and investing a lot in in the training and discussing cases with your colleagues and ⁓ seeing how to do things differently and and like I said, keeping up with the research, yeah I mean it it's great. There's a lot of orthodontists out there really investing in research and and and keeping up with ⁓ this is the best protocol for that and this is the best protocol of this, which is great. Because it's helping us clinicians, you know, do a better job and help the patients. So there's no yeah, pretty much right now I've reached the level like every case can be ⁓ treated with aligners. Do I need some, you know, utilities y you know, to use like buttons and brackets here? Yes, absolutely. Sometimes it's not a hundred percent aligners, but that's where the skill comes in and figure out, okay, when to do what. ⁓ I feel like if if it ⁓ the the expression I give for that, if you give me Michael Jackson ⁓ Michael Jackson, well I wish I can dance like him, but I don't. ⁓ Michael Jordan's basketball and you expect me to play as good as he is, I'm not. I I just so I have the tool, I have the ball, and you g you can give me his shoes too. I'll never be him. ⁓ I think it's it's very very similar. You can give me aligners, but if I don't know how to use them, it's not. So people think, ⁓ Invisalign doesn't work. It's it's Invisalign is just the product. At the end of the day, the doctor needs to be knowing how to use it. and and that that takes work. That takes a little bit of planning. So when I'm having a consultation with a patient, I always tell them there are many factors that are ⁓ involved in the success of the treatment. Obviously doctor experience and expertise. you know, what we're using, ⁓ you know, clinical research is gonna help me of deciding what what is needs to be done in this case and not. Patient compliance in orthodox patient compliance is a huge factor in the success of treatment. And then fourth is like how your body responds to treatment, because sometimes you have the expertise of the doctor knowing what they're doing. Patient is very compliant, still treatment doesn't work. And that's because sometimes the design is is the d How it was done is not the best way for this patient. So I need to go back and reassess, which takes me to this remote monitoring. So the weekly patients are scanning and I'm really comparing, okay, this week they're here. Where are they in the design process? Are they ⁓ you know, are they on track with the design or we're not on track and we need to? And then I have to make a decision. Is this due to compliance or is this due to you know, design that I need to go in and and change. and if it's due to the design or whatever, even the compliance I need to, that means I need to be more supportive for my patient. I need to communicate with them and cheer them up, you know, remind them of the importance of this for them. but if it's the design, I need to know as soon as possible because that means I need to change my design. And that's when I call the patients back and say, okay, we need to regroup. Ne now I need to go to plan B. My plan A didn't work on this design. I need to change it and and move on to plan B. ⁓ and and and that again comes with just doing so many cases and you learn, you know, maybe the movement usually works in 80% of the cases, but you still have those 20%. That specific design doesn't work and you have to do change it. Yeah. Yeah, I love that. and that makes a ton of sense. And again, I think using those tools. ⁓ but leaning on Invisalign ⁓ and align and clear aligners allows for that better retention long term. So I think your your everything you've said makes perfect sense to me and ⁓ I'm excited to be able to share this with with the people who need to see it because this is this is what people who are looking for this kind of service need to hear. ⁓ one thing that I think maybe we ought to look into is ⁓ rebranding you as the Michael Jordan of Clear Aligners. Or the Michael Jackson of Clear Aligners. Yeah, I'll take ⁓ up. ⁓ Great. Well that's a lot of skills. I I don't think I can master, but Yeah. I I think ⁓ that that would be an accurate description because you do just do amazing work with your aligners and ⁓ so excited about this conversation today. ⁓ we'll just finish with the lightning round. ⁓ So there's three questions. We'll just get a quick answer for each and then wrap up the wrap up the episode. But ⁓ what is the number one thing you wish you could tell more people in your community about your practice? We care about your success. Awesome. What is the most rewarding part of your day? When a patient today, she was tell she told me I had a patient, an adult patient. She said, Of all the doctors I go to, this is the only appointment I look forward to. And the last one is describe NRH orthodontics in three words. Compassionate integrity. Thank you so much for being on with us today, ⁓ Dr. Fala. is if people are looking for ⁓ aligners or to connect ⁓ in terms of learning more about aligners ⁓ from some of our dentist listeners. What is the best way to connect with you? All platforms. They can text us, they can ⁓ email us, they can call us. It's awesome. Awesome. We'll ⁓ link all of that information in the description of the ⁓ podcast. ⁓ we're on YouTube, Apple, Spotify. ⁓ so if you're looking for those links, that's where they are. And ⁓ we are so grateful to have you on Doctor Fala and ⁓ So excited to continue to watch the growth of NRH orthodontics. Thank you so much, Jeff. I appreciate it. You take care.