Howard Farran DDS, MBA

Howard Farran DDS, MBA Founder & CEO of dentaltown.com His area of expertise covers many aspects of dentistry, including the business of dentistry and clinical topics.
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Howard Farran, DDS, MBA, is a practicing dentist with more than 25 years of clinical experience, as well as a noted international speaker on faster, easier, more efficient dentistry. He has captivated audiences around the world with his innovative, informational, off-the-cuff and entertaining lectures for more than two decades.

08/31/2026

Episode #1732 : Dentistry Uncensored with Howard Farran, Howard sits down with Philippe Salah — PhD-trained scientist, co-founder of lingual orthodontics pioneer Harmony, and founder & CEO of DentalMonitoring.

From AI-powered remote monitoring to managing the patient journey end-to-end — from first observation all the way through retention — Philippe shares how technology is reshaping orthodontic care and what it means for practices competing in an increasingly crowded market.

🎧 A forward-looking conversation on AI, remote care, and the future of orthodontics.

Xylitol has long enjoyed a favorable reputation in dentistry. It is noncariogenic, widely used in sugar free gum and ora...
08/31/2026

Xylitol has long enjoyed a favorable reputation in dentistry. It is noncariogenic, widely used in sugar free gum and oral care products, and often presented as a healthier alternative to sucrose. New cardiovascular research does not overturn that history, but it does challenge the assumption that something good for teeth must automatically be harmless everywhere else in the body.

A 2026 analysis of 17,710 participants found that people with the highest circulating xylitol levels had a 57% higher adjusted risk of major cardiovascular events over six years in one cohort and an 18% higher risk over longer follow up in another.

That sounds alarming, but the distinction matters. Researchers measured xylitol in the blood. They did not measure how much xylitol people consumed. Humans also produce xylitol naturally, so elevated levels could reflect diet, metabolism, or both.

The concern is more than a statistical association. A 2024 European Heart Journal study also linked higher xylitol levels with cardiovascular events. Laboratory studies found increased platelet responsiveness, animal experiments showed increased thrombosis, and a small human study found that a 30 gram dose of xylitol sharply increased blood levels and platelet activity.

Still, none of this proves that chewing xylitol gum causes heart attacks or strokes.

Dentistry also needs to examine the benefit side of the equation. The ADA describes xylitol as noncariogenic but has been cautious about claims of a unique anticaries effect. Recent systematic reviews suggest xylitol gum may help higher risk patients, but the evidence is inconsistent, study quality varies, and some benefits may come simply from chewing gum and stimulating saliva.

For practicing dentists, this should change the conversation more than the treatment plan.

There is currently no evidence that normal xylitol toothpaste use increases cardiovascular risk, and ordinary xylitol gum has not been shown to cause cardiovascular events. But routinely recommending several grams of xylitol every day, especially to low risk patients, deserves more scrutiny than it once did.

Dentistry does not need to become medicine to learn from it.The 2026 Doximity Physician Compensation Report describes do...
08/31/2026

Dentistry does not need to become medicine to learn from it.

The 2026 Doximity Physician Compensation Report describes doctors who are highly paid but increasingly burned out. Seventy six percent said they would accept lower pay for greater autonomy or better work life balance.

That matters because income is only one form of professional wealth.

Medicine also shows how incentives shape behavior. Procedures are easier to measure and reimburse than prevention, diagnosis, counseling, and long term disease management.

Dentistry works the same way.

Change PPO reimbursement, hygiene compensation, associate bonuses, or scheduling incentives and behavior changes.

Ownership is changing too. ADA data show practice ownership declining while DSO affiliation rises, especially among younger dentists.

The real question is not solo versus DSO.

It is who controls the incentives.

Scale can improve HR, billing, recruiting, compliance, purchasing, and technology. Independence can also bury an owner in payroll, staffing, PPO frustration, and administration.

Scale is not automatically the enemy. Independence is not automatically freedom.

The financial squeeze is real. ADA data put average private practice GP net income around $215,000 in 2025 while gross billings approached $966,000.

Revenue is not income.

The same principle applies to case acceptance. Patients are deciding whether the value they perceive justifies the price they face.

The answer is not better salesmanship. It is better translation.

Show patients what you see. Explain the disease. Present reasonable options. Explain insurance without letting the insurer become the treatment planner.

AI adds one more layer. If AI saves time, do we use it to push more patients through the schedule, or to improve diagnosis, treatment planning, communication, and patient care?

Technology does not make that decision.

Leadership does.

For years, dentistry has focused on AI as a diagnostic tool. A recent operation in London suggests the next frontier may...
08/30/2026

For years, dentistry has focused on AI as a diagnostic tool. A recent operation in London suggests the next frontier may be AI assisting surgeons while treatment is actually happening.

During removal of an 11 mm pituitary tumor threatening a patient’s vision, an AI system analyzed live endoscopic video and highlighted critical anatomy in real time. The surgeon remained fully in control. The AI did not operate. It functioned as a digital second set of eyes.

The patient’s tumor was removed and his vision improved, but one successful case does not prove AI caused the outcome. This remains an early clinical milestone, not evidence that AI surgery is already safer.

The supporting research is promising. Earlier systems could identify critical pituitary anatomy at real time speeds, and another study found AI improved anatomical recognition most among less experienced clinicians. That may be one of AI’s greatest early benefits, raising the floor rather than making experts superhuman.

For oral and maxillofacial surgery, the implications are obvious. Dentistry already has CBCT, virtual surgical planning, dynamic navigation, augmented reality, robotics, and computer vision. Eventually those technologies may converge so a surgeon can see planned anatomy, track a bur or saw, and receive warnings when approaching the inferior alveolar nerve, sinus, vascular structures, osteotomy boundaries, or tumor margins.

But accuracy remains the limiting factor. A 2026 systematic review found a weighted mean positional error of 2.58 mm in augmented reality navigation studies. A few millimeters may be acceptable in reconstruction. Beside a nerve, root, or artery, it may not be.

The real breakthrough is not autonomous surgery. It is AI moving from interpreting images before treatment to assisting clinicians during treatment.

When the digital second set of eyes arrives in your operatory, will it make you a better surgeon, or simply give you one more thing to trust?

The Retail Reset for Dentistry. Retail is being rewritten, and dentistry can learn from it without turning healthcare in...
08/29/2026

The Retail Reset for Dentistry. Retail is being rewritten, and dentistry can learn from it without turning healthcare into merchandising. The biggest lesson from companies like Costco, TJ Maxx, and even airports is not how to sell more. It is how to reduce friction, simplify choices, use technology intelligently, and design the entire customer experience as one connected system.

Patients experience dentistry the same way. Their journey begins long before they meet the dentist: Google search, reviews, website, insurance questions, phone call, scheduling, parking, reception, waiting, diagnosis, financial discussion, treatment, checkout, and follow-up. Every step either builds trust or spends it.

Research shows dental treatment decisions are influenced by far more than clinical need. Cost, fear, pain, aesthetics, convenience, communication, trust, appointment availability, and whether patients understand their options all matter.

A few lessons translate especially well:

Fast beats flashy. Clear beats clever. Run on time. Show patients what you see. Simplify complicated choices without hiding uncertainty. Use photos, scans, radiographs, and AI to improve understanding, not pressure people into treatment.

And never import retail scarcity tactics into healthcare. Dentistry should not create FOMO around treatment.

The economics matter too. Not everything valuable produces revenue immediately. A postoperative call, emergency appointment, great website, comprehensive exam, or extra five minutes explaining a diagnosis may create enormous long-term value.

But the ethical boundary is critical:

Optimize the business around the diagnosis. Never optimize the diagnosis around the business. That applies to solo practices, DSOs, and private equity alike.

Technology follows the same rule. AI should remove administrative friction, improve documentation, assist imaging, and give dental teams more time for the things machines cannot replace: judgment, empathy, communication, and trust.

Retail tries to increase consumption. Healthcare should ultimately reduce disease.

Halitosis creates anxiety because patients often cannot judge it accurately themselves. They brush harder, scrape their ...
08/28/2026

Halitosis creates anxiety because patients often cannot judge it accurately themselves. They brush harder, scrape their tongue, switch mouthwashes, blame reflux, inspect their tonsils, or search for exotic systemic causes. The evidence points somewhere much closer.

Roughly 80% to 90% of persistent halitosis originates inside the mouth. The leading causes are tongue coating, periodontal inflammation, plaque retention, food traps, defective restorations, caries, oral infection, removable appliances, and reduced salivary flow.

The biology is straightforward. Anaerobic bacteria, especially on the posterior tongue and in periodontal niches, break down proteins and produce volatile sulfur compounds such as hydrogen sulfide and methyl mercaptan. But halitosis is not caused by one specific bacterium. It is better understood as an oral biofilm ecology problem. That changes the clinical approach.

First, confirm that genuine malodor exists. Organoleptic assessment, meaning a trained examiner actually smells and grades the breath, remains the clinical standard. A Halimeter can provide an objective VSC measurement and help document treatment response, but it does not measure every odor-producing compound and should not replace clinical assessment.

Then look where the probability is highest: tongue coating, bleeding and periodontal inflammation, restorations, open contacts, food traps, retainers, aligners, dentures, and xerostomia. Medication burden, mouth breathing, dehydration, smoking, and aging can all worsen reduced salivary clearance.

Treatment should follow the cause. Clean the tongue. Treat periodontal disease. Correct defective restorations and food traps. Address xerostomia and appliance hygiene. Therapeutic mouthrinses containing agents such as CPC, zinc, chlorine dioxide, chlorhexidine, or essential oils can help, but they are adjuncts, not substitutes for diagnosis.

When a patient says, “I have bad breath,” are we treating the odor, or diagnosing what is producing it?

Patients want excellent dentistry, delivered quickly, at a price they can manage. Dentists want the same thing. The old ...
08/28/2026

Patients want excellent dentistry, delivered quickly, at a price they can manage. Dentists want the same thing. The old business rule says good, fast, cheap, pick two. Dentistry is more complicated. The key distinction is efficiency versus rushing.

In a controlled study of 40 dentists reading bitewings, diagnostic sensitivity fell from 0.80 without time pressure to 0.50 under pressure. Sensitivity for caries dropped from 1.00 to 0.60, and for periodontal bone loss from 1.00 to 0.33. The dentists were not overdiagnosing. They were missing disease.

A scanner that saves five minutes is efficiency. Taking five minutes away from diagnosis because the schedule is behind is not.

Technology can improve the equation when it removes waste. Digital workflows can reduce laboratory steps, shipping, retakes, and turnaround time. Intraoral scanning is often faster than conventional impressions and generally preferred by patients. But digital does not automatically mean cheaper. Equipment, software, training, maintenance, and capital still have to be paid for.

Affordability is also more than the fee. Patients consider out of pocket cost, financing, missed work, number of visits, longevity, and the consequences of delaying treatment. A cheaper restoration that fails early may become the expensive choice. An ideal treatment plan the patient cannot accept creates no value at all.

Communication matters just as much. Research shows that trust, affordability, honest communication, respect for patients’ time, and better cost conversations are strongly associated with patient satisfaction. Sometimes the problem is not the price. It is uncertainty, poor sequencing, lack of options, or no realistic financial path forward.

The best dental practices do not simply “pick two.” They protect diagnosis and clinical quality while eliminating waste around them. Missing instruments, poor handoffs, remakes, scheduling gaps, repeated data entry, insurance surprises, and weak financial communication make dentistry slower and more expensive without making it better.

Quality should be the standard. Speed should become efficiency. Affordability should become value.

Dentistry has inherited a peculiar ritual. A patient reports diabetes, Eliquis, pregnancy, kidney disease, a knee replac...
08/27/2026

Dentistry has inherited a peculiar ritual. A patient reports diabetes, Eliquis, pregnancy, kidney disease, a knee replacement, or a remote stroke, and the office reaches for a medical clearance form. But the better question is not, “Does this patient need clearance?”

It is, “What medical information do I need that could change whether, when, where, or how I perform this treatment?”

A July 2026 JADA review recommends looking at ASA status, disease stability, symptom severity, and procedural risk rather than relying on diagnosis alone. A controlled hypertensive patient receiving a composite is very different from the same patient undergoing multiple extractions under deep sedation.

Anticoagulants are a good example. ADA and CHEST guidance generally supports continuing anticoagulant and antiplatelet therapy for routine dentistry and limited oral surgery because bleeding can usually be controlled locally, while interruption can increase the risk of stroke, MI, embolism, or stent thrombosis. For the typical patient undergoing one or a few uncomplicated extractions, routinely stopping Eliquis is generally not recommended.

The same principle applies elsewhere. Diabetes has no magic HbA1c cutoff that automatically requires clearance, antibiotics, or referral. Pregnancy itself generally does not require OB clearance for indicated radiographs, local anesthesia, restorations, root canals, periodontal treatment, or necessary extractions.

Consultation becomes more valuable with recent stroke or coronary stenting, decompensated heart failure, active chemotherapy, significant immunosuppression, dialysis, recent transplantation, severe kidney or liver disease, or when sedation substantially increases physiologic risk.

Prolia is another example. Osteoporosis dose denosumab is not the same risk as high dose Xgeva for metastatic cancer. Drug, dose, indication, duration, comorbidities, and planned surgery matter more than the medication name alone.

The most useful office rule may be this:

“I need the physician to tell me ______ because if the answer is ______, I will change ______ about my dental treatment.”

08/26/2026

Episode #1731 : Dentistry Uncensored with Howard Farran, Howard sits down with Dr. Erin Sheffield — board-certified oral and maxillofacial surgeon, international speaker, educator, and founder of The Doctor Is ALL In, a retreat for women doctors.

From difficult third molars, coronectomy, and bone grafting to antibiotic stewardship, trauma-informed care, and the honest realities of burnout and imposter syndrome — Dr. Sheffield brings both surgical precision and rare human insight.

🎧 A candid conversation about clinical excellence, authenticity, and building space for others in rooms that weren't built for everyone.

For years, dentists argued in simple categories. Flowable was easy to adapt but weak. Packable was strong. Bulk fill was...
08/26/2026

For years, dentists argued in simple categories. Flowable was easy to adapt but weak. Packable was strong. Bulk fill was a shortcut. Snowplow was brilliant or reckless. The materials changed. The arguments often did not.

Today, “flowable” and “packable” are increasingly handling descriptions, not reliable predictions of strength or longevity. Modern highly filled injectable composites can perform well in selected posterior restorations, while conventional composites still generally have a mechanical advantage as restorations become larger and more heavily loaded.

A 2025 systematic review found encouraging results for highly filled flowables in selected Class I and II restorations, but still advised caution with extensive restorations, heavy occlusion, severe wear and bruxism.

Bulk fill has also held up better clinically than many expected. A 2025 meta analysis of nine randomized trials involving 632 posterior restorations found no significant difference in failure rates compared with conventional incremental composite.

Flowable liners are another example. They can make adaptation to gingival boxes and internal line angles easier, but systematic reviews have not shown that routinely adding one improves long term restoration survival.

Snowplow remains plausible, but unproven superior.

The bigger lesson is that restoration success depends on much more than viscosity. Isolation, bonding, curing, matrix adaptation, remaining tooth structure, occlusion, caries risk and operator ex*****on may matter more than whether the syringe says flowable or packable.

The better question in 2026 is not, “Flowable or packable?”

It is, “Which material, for which tooth, under what load, using what adhesive and curing protocol, for which patient?”

If two excellent dentists get durable results using opposite techniques, maybe we should spend less time debating the composite and more time studying the operator.

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9633 S 48th Street, Ste 200
Phoenix, AZ
85044

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