Randy Garland, DDS

Exceeding expectations

What can you tell us about your background?
I grew up in southern Orange County and earned a bachelor’s degree in biology at San Diego State University in 1983. There I met my future wife, Kim, at the ripe old age of 20. We traveled with our backpacks around the world for 6 months shortly after I graduated. That gave me a real appreciation for other cultures and opened my eyes to the “real world,” after spending my life living in the Southern California “bubble.”

I started dental school at the University of Southern California (USC) in 1984 and became very involved in their Mobile Dental Clinic Program as a sophomore. I was elected as the student leader of that program in my senior year. We provided free dentistry to hundreds of children of migrant farm workers who had no other access to dental care. It was a great learning experience in compassion, patience, and leadership. In my senior year, the dental school started a new 1-year Advanced Endodontics Program for five select fourth-year students who showed considerable interest and aptitude in endodontics. I was accepted and was educated in-depth about retreatment, post removals, complex anatomy, and calcified canals. It was like an intro to an endodontic residency. After dental school, I chose to try my hand at general dentistry, but not before another 6-month travel adventure with my wife. After 7 years of general dentistry, I realized that my least stressful days were those that involved a lot of root canals. In 1995, I was accepted to the Graduate Endodontics Program at Loma Linda University. By that time, I had two sons, ages 1 and 3, so juggling the demands of school and being a father was quite a handful.

Do your patients come through referrals?
Yes, my entire practice has been based on generating referrals through developing a reputation for high-quality work and treating patients as I would want to be treated.

How long have you been practicing endodontics, and what systems do you use?
I’m going on 17 years of endodontics now, but have had a resurgence in my passion for practicing lately. I actually started using the ProFiles® back in 1994, a year before I went to Loma Linda. I was very surprised to see that only one of the current residents was using rotary files routinely and none of the faculty. That changed a lot in the next 2 years. Since that time, I have tried many different systems, but settled primarily on the ProTaper® series, sonic and ultrasonic irrigation, and warm vertical gutta-percha obturation.

Four years ago I purchased a cone beam CT machine for my office. For the first 21/2 years, I used it sparingly. I would use it when I thought there might be something I was missing. Then, in 1 week, I had two cases come back that were failing. I took scans on both of them and had missed a canal in each. One was on a maxillary molar and the other on a mandibular anterior. I realized at that point that I couldn’t tell what I was missing with traditional radiographs. I made a major philosophical change at that time and began taking CBCT scans on all cases that had significant potential for multiple canals. This covered everything but the maxillary anteriors.

I put together a 4-page document explaining my rationale, showed examples, and sent it to all of my referring doctors. Their response was a bit of a surprise. They loved it. They started sending me more cases simply because I had this piece of technology that could help solve some diagnostic dilemmas. Patients were not only impressed, but they understood what was going on with their teeth when they could see a three-dimensional image of it showing periapical lesions, vertical bone loss, etc. And the biggest bonus was how much it helped me with diagnosis and treatment. Sure, I found those extra canals. But I also saw fused roots on molars with isthmuses between them, root fractures, resorption, sinus involvement, supernumerary teeth, even the occasional tumor. I was under-utilizing a fantastic tool that was sitting right in my office.

Now, the new technology that has really stirred my interest is the GentleWave™ from Sonendo®. In a nutshell, this technology manages the same irrigants we’re using now, but combines them with multiple wavelengths of sound (sonic energy). The system does an amazing job of cleaning out tissue and bacteria from the entire root canal system, including the isthmuses, the lateral canals, and the tubules. I’ve been doing quite a bit of work with the system as well as working directly with Sonendo, and I believe that they are definitely changing the game of endodontics. It’s very exciting to be involved in something that could change the future of our specialty. I have implemented it into my Encinitas, California, practice as a new tool to help me perform endodontics at a higher level.

What is the most satisfying aspect of your practice?
I like the fact that I don’t need to “sell” anything. When I practiced general dentistry, there was definitely a feeling that I had to sell the patients on ideal dentistry. In my practice, I just inform the patients of what the problem is, and what I can do to try to fix it. They make an informed decision on their own, and it’s almost always treatment. If they would rather have their tooth extracted, I’m fine with that. It’s all just a lot simpler. Ironically, I find that doing root canals all day gives me very little stress. Most general dentists who don’t like endo would probably think that sounds crazy.

What has been your biggest challenge?
My biggest challenge has probably been running the business. If I didn’t have my wife to help with all the paperwork side of the business, I think I would prefer to just work for someone else and let them run the business. It took me about 13 years to finally get the perfect staff together. That has drastically reduced my stress level. I’ve even been able to delegate a lot of management duties to them, which has been great for everyone.

What would you have been if you didn’t become a dentist?
Good question. Either a starving musician or working in some area of science.

What do you think is unique about your practice?
My entire team has embraced the philosophy of exceeding our patient’s expectations at every opportunity. The staff is polite, friendly, and accommodating. We understand our patients’ fears and address them. There are TVs on the ceilings and headphones for them to enjoy during treatment. I pride myself in taking the time to give painless injections and achieving profound anesthesia. Treatment is thoroughly explained to the patients, and my highly trained and experienced staff work efficiently to keep the treatment time to a minimum. We strive to get compliments from every patient.

What is the future of endodontics and dentistry?
I like what I am seeing with the use of sonics and ultrasonics in the endodontic field. It just makes a lot of sense to me. I think there will be new materials coming out for obturation that will be able to fill the elaborate network within the root canal system. If we are doing less instrumentation, hopefully, we will see a decrease in the rate of vertical root fractures. Personally, I’m getting tired of referring patients to the oral surgeon for implants.
In general dentistry, I think there is already a big change going on with systems like Cerec that can fabricate restorations while the patient waits in the chair. I predict that new materials and software will continue to be developed that make that process faster, simpler, and even more accurate.

What advice would you give to a budding endodontist?
At the end of your career, the money you make or don’t make won’t really be a big deal. What will be important is how you treated all of your patients. You’ll want to be able to look in the mirror and be proud of the level of integrity that you treated every person with whom you dealt, including your staff. This advice was given to me by a retired dentist just before I started practicing, and it has guided me through a lot of the gray areas of being a dentist, boss, and business owner.

What are your hobbies, and what do you do in your spare time?
I’m an avid surfer and a mediocre tennis player. These, along with running regularly, provide the exercise I crave. To satisfy my creative and wild sides, I sing in an all-dentist rock band called Novocaine. We play at some local bars and occasional dental events, including our last USC Dental School reunion. I still have the travel bug, so my family and I try to get out of the country or to Hawaii whenever we can. Any chance I get to spend time with my sons, surfing together, or just hanging out, is a treat.