Dentistry Uncensored with Howard Farran

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Podcast Transcription (Download Here):

Abbas Fazel:      I’m very well. Thank you. And you? 

Howard Farran: You’re a – actually well this is a great way to end the day. I got an Iron Man I do every year in Tempe. This will be my second one, so I had to get up every morning at 4:30 and either every morning I have to work out for three hours from 5 to 8. It is either bike for three hours or run an hour and a half, swim an hour and a half and then I have patients from 9 to 5 and I have to work through lunch. Just got here at home and it is a big treat to see your smiling face. 

Abbas Fazel:      I have been following your progress on Facebook, of course. I admire your will to try and accomplish that feet which is commendable. 

Howard Farran: I will be 52 this month and I spent basically 50 years raising four boys and working my butt off. I put my health on the back burner. And I see guys like you rocking probably a 10% body fat and a six pack and we’ll talk about all of those things. I just got back from climbing Mt. Kilimanjaro, the tallest mountain in Africa all because of you and thank you for helping put all that together. And then also I also want to ask you you are an instructor – Arizona has two dental schools and you are an instructor at one of those one day a week and you are the real deal because you are in private practice full-time and just do one day a week at the dental school. And when I was in dental school the full-time faculty were kind of one way and the guys who were in the real world and came in one day a week they were just – it was just so awesome to have guys like you. I want to tell you after I have been practicing over 35 years what are you telling the dental students? What is your advice for them as a lead dental school? Let’s start with your home country of Tanzania, which I just had the honor to visit with K2 Adventures and tell them all about how you got into humanitarian dentistry that is a big part of your life. 

Abbas Fazel:      Well, it all started out with a guy named Kevin Cherilla. He was a PE teacher at the school my kids went to and one of his ambitions was to open a travel company and take people on adventure travel. So in 2003 that is when it all began he started out by organizing trips to Tanzania to climb Kilimanjaro and my kids were in the school. We got a newsletter from him asking who would be interested in joining him on this trip. And of course I just jumped at the chance because it was going back to my birth country – Tanzania and the opportunity to climb Kilimanjaro which I had never done before. Both my daughter and I signed in on this trip and we fortunately accomplished the feet. We made it to the summit, just like you did. It was a great feeling, a great experience to be on the top of Kilimanjaro which is the highest – actually it is the highest free-standing mountain in the world. Everest is higher, but it is part of a range. It was an excellent feet. 

Anyway, so we stayed off and on in touch Kevin Cherilla and I. As his company grew he began taking people three times a year to Tanzania and then he ventured onto Peru where he took people to track Machu Pichu. 

Howard Farran: That is the highest mountain in South America. 

Abbas Fazel:      Machu Pichu is actually not really a mountain. I think it is just a hiking – yea, it is alongside a mountain but it is more for trek like a hike. I think it goes through some villages and places where a lot of the indigenous people live. It is supposed to be very scenic. It is not as strenuous as climbing Mt. Kilimanjaro. 

Howard Farran: What’s the highest peak in South America? 

Abbas Fazel:      I think it is the one in Argentina. I don’t recall the name but it is about 18,000 feet I think. It is not as high as Kilimanjaro but apparently it is a lot more difficult. It is more for vertical climb than Kilimanjaro is. 

So anyway, as he began going on these trips he got to know a lot of local communities – the local people and realized how fortunate he and his group were compared to the way – the conditions of the people, the local people that he came across. So he decided to try and help in one form or another so he would tell his clients that were joining him on these trips to perhaps bring in some items that they could donate. It started out with clothing, toys, things like blankets, etc. As he began doing this on a more regular basis he decided to form a non-profit company here in the US and joined forces with a lady called Kristin Sandquist who is an attorney by profession, but has a huge experience in non-profit organizations here in the US. 

Howard Farran: I had no idea she was an attorney. 

Abbas Fazel:      Yea. She is an attorney by profession. 

Howard Farran: Why does that not surprise me? She was such an amazing negotiator in Tanzania unbelievably thinking on her feet. 

Abbas Fazel:      She is I think the backbone of this. 

Howard Farran: Oh my god. If I had half her brain I would be the Dean of the dental school. 

Abbas Fazel:      Probably. They joined forces and formed a 501c3 corporation and started inviting people to join the board and the company just grew from there. I came across them again. We crossed parts again in 2009 when they were trying to – when they were trying to help the local communities in these countries that they would arrange these trips to. One of the main focuses was an orphanage in Tanzania in the town of Moshi[ph] which is at the base of Kilimanjaro, Mt. Kilimanjaro. And it really took them at heart because there were kids there that had some severe debilitating diseases and life threatening also. And so they decided to literally adopt that orphanage. It was in a very dilapidated condition. They decided to help in any way they can, they could. And as it went on they decided that these kids had absolutely no – very little medical attention and none as far as dental went. They had a lot of dental problems that were causing them immediate concern because they were in pain to not get any dental attention. So they approached me and asked if I could maybe somehow be able to help in any way. Of course I jumped at the opportunity 1. Because there were kids with no dental access to dental care at all and 2. That it was in the country of my birth and I thought it would be a good way to give back to the local community. That is how it all began. 

Howard Farran: For a person watching this on video as opposed to a podcast, iTunes, when you say you were born in Tanzania most people would think you were African and you are Indian. I find it just so – I love history. You might want to go into a little bit of why there is Indians along there and it is – it all goes back to the spice trades from India to the Roman Empires. I think Rome was the first city that ____ and to transport the spice that was sugar and cinnamon and silk and clove you would literally have to have Indian families living every 100 miles all the way from India over the Africa, Somali, Kenya all the way to Rome. I just found – I found it the most fascinating over there learning about the ancient spice routes. You want to add anything to that? 

Abbas Fazel:      Yes. It was not only just the trade. Yea, a lot of the Indians would travel to the coast of Africa mainly to trade with spices. But also when the British colonized India and began colonizing the African – parts of Africa they weren’t countries then they decided that it needed help in the infrastructure – developing the infrastructure of these African parts. And so they brought in a lot of the – that is exactly how my grandparents go to immigrate to Africa because they were offered opportunities to help in the development of the infrastructure. Mainly the railway system – railways and roads of these African areas mostly East Africa. 

Howard Farran: That makes me feel better because I felt it was shameful that you were involved in transferring sugar all the way into Europe causing tooth decay when here you are one of the best dentists in town. Now I can associate you with railroads and roads and bridges and not sugar on the spice trades. 

Abbas Fazel:      Yea. So that’s how it began. They immigrated, settled in Eastern part of Africa. And that is where my parents were born and then that is where I was born. And once these countries were then divided by the British and once they gained independence the Indians that were – that had immigrated there were given the opportunity of either going back to India or settling in African in those countries or they were given British citizenship. My parents chose the British route and that is how I ended up going to England. 

Howard Farran: And you graduated from dental school in England. 

Abbas Fazel:      In England, yes. 

Howard Farran: Yea. I love the British model. Wherever they settled on earth they put the flag there – it was a British colony. They had a lot of belief and faith in that flag. 

I really like the humanitarian dentistry part for a couple of reasons. Number one Jerome Smith turned me onto that 20 years ago. He was a dentist and he said let’s go to Tiapas, Mexico and do some missionary dentistry. And I was just type A and I had four kids and a practice and lectured and I worked this in there. All the way down there I am doing all of these notes and all of this stuff. And you don’t realize how stressed you are and then you get off the airplane and you go into a village that basically doesn’t have running water or electricity or sewage. The Earth has 7 billion people in 220 countries and 20 countries look like us – 200 don’t and 3 billion earthlings live in $3.00 a day. You just sit there and it was a spiritual awakening where your stress just decompressed and you realized the meaning of life is humans helping humans. It just comes back and I followed Jerome to Odiag, Mexico, one of the 47 forums on Dental Town is humanitarian dentistry. I find so may dentists who on their bucket list is to do something like this, but they just have never seen a chance or the logistics or who is doing this. And to go on dental town and see these trips to Tanzania and the Dominican Republic and Mexico and Vietnam and there is Climb for a Cause with Danny Barabaro and it is just an unbelievable experience. 

Dentists – a lot of people used to say dentists have the highest suicide rate, but after the 10 year war with Afghanistan and Iraq and the soldiers just blew everybody out of the water. Their suicide rate is if you divide it by 10 it would be higher than number two. And dentists they are so stressed and I always think it is for two reasons – they spend way too much money – they live in way too big of houses – drive too nice of cars, 19 and 30 ____ they just spend, spend, spend and then when they are stressed out of their mind – are you hearing feedback? 

Abbas Fazel:      No. 

Howard Farran: And then to decompress they go to Hawaii for two weeks and rent a condo and drop another 20 grand and half of it is on credit cards and then they come back even more stressed. I just can’t – I just can’t tell you enough how many dentists are Type A and need to get out and go to an underdeveloped country and see that they are happier than Americans. It was amazing on those trips at night time they didn’t have Facebook and they didn’t have all of these things and they were just singing and dancing. I remember I was in Kathmandu, Nepal and the city literally turned off the electricity at dark because they didn’t have the oil to run it. All the kids went out in the street. They lit all of the trash cans on fire and they played soccer all night long. I saw more laughing and giggling with barefoot kids playing soccer in the street with their parents sitting out on the porch than anything I have seen in America ever. 

One other thing that really blows my mind is that when you look at – there is a huge new area of health research of studying macroeconomic data. Before – like when you were trying to figure out anorexia-nervosa 30 years ago you are just studying it in America so you think all of these inbred American thoughts. Then when you start studying it around the world you realize wow, this disease really doesn’t show up in poor countries. What you see is that in the 20 richest countries they are so stressed they have five major spasms – the brain, the whole headache migraine – the TMD grinding their teeth, the lower back which is the entire chiropractic industry- the heart palpitations and angina and irritable bowel syndrome. And so many dentists look at the TMJ and they think oh my god they need braces or orator or night guard or if I just did the perfect equilibration they would be solved. It’s like dude, wake up. The person just got fired. They are about to go bankrupt. Their husband is having an affair with his secretary. Their daughter is on drugs. Their car doesn’t work. They are stressed out of their mind and a dentist thinks that he just adjusts the buckle cusp to number four that it is all going to go away and it’s not. In fact, the National Institute of Health just did a study on 1 million lower back chiropractic and X-rays and they chiropractors were like 51 to 49 on who was symptomatic and who was not showing that there was zero graphic evidence of a disease it is psychosomatic. They are stressed out of their mind. And I just loved looking at their teeth, looking at the lack of warefacets[ph] they didn’t the grinding and the Bruxism and god they are just so relaxed and happy and they are smiling and singing and dancing. It is just a romantic spiritual getaway. I hope you turn on more dentists to this type of experience. 

Abbas Fazel:      I hope so too. There are so many opportunities and it is not just in Tanzania, but so many other third world countries, under-developed countries where the need is so great. They would be so appreciative of any kind of help they can get. The area where I am focused on is Tanzania and again, what happened was when we first – when I was first approached by K2 Adventures I went ahead and called all the dentists that I knew. I approached the dental supply companies – Henry Shine in particular they were very, very helpful. Valley Dental at the time which is no longer in business, but it was at the time and they too gave me a lot of donated equipment. What we did was Project Cure helped us a lot too. They helped ship all of the equipment that we had acquired through donations. We also held fundraising events where we were able to raise money and buy supplies and some light equipment. And then we had it all shipped through project cure all the way to Tanzania. It took a few months, but it got there. 

We are fortunate enough to get funding from a private, local donor a family that gave us enough money to build from scratch the building that we housed the dental equipment in. And so we all went there. We took a builder, a technician, a dental technician and a few other volunteers and we all went. We set everything up. We did all the plumbing joined all the electrical lines, connected all of the equipment and were able to start servicing these kids. I have been going there every year since. Also, the dental school has joined in somewhat of a partnership and has allowed us to take six of their students each year to Tanzania and to work in the clinic there and all of these children. I mean those students are just so fortunate to be able to travel that far and experience the first-hand at the type of people that live there, the dentistry that they can perform and the help that they can provide to these kids. 

Howard Farran: It was great at night when we would go to dinner and a bunch of older dentists that had been doing it 25/30 years talk to a bunch of kids in school and those are great conversations – very rewarding. 

I want to touch on two other things I noticed when I was there. I want to go into the fact that there is a lot of intense fluorosis on the teeth. There is a lot of very dark modeling of the teeth. Coming from the United States I was thinking fluoridated water and it turns out that wasn’t the case. You want to talk about that? You know far more about it than I do. 

Abbas Fazel:      Yes. Even I was amazed. At first I thought it was the fluoride in the water, but apparently it’s not. It is what the local community there does is it uses a salt from a lake to tenderize the meat that they use to cook. And that salt contains an enormous amount of fluoride. They consume that. They consume the meat that has been tenderized by that salt. That is why it is affecting that population more than anyplace else even in the same – even in the country of Tanzania. That is where the source of the fluoride is from the salt they use the tenderize the meat rather than the water they drink from the water sources. 

Howard Farran: If that – that degree of modeling if it was from water fluoridation the ocean is 70% of the earth and it is naturally fluoridated at 1.4 part per million and the cities in America we go to half that amount .7 but that intense of modeling what would the parts per million fluoride be in the water? 

Abbas Fazel:      I am thinking it is over 2 parts per million about 2.5. 

Howard Farran: To have that much modeling. I was guessing three basing it on Casa Grande days. In Arizona we put fluoride in the water in Phoenix and Glendale and Tempe, but in Casa Grande they have to take it out and the highest ever I have ever seen is on the Navajo Indian Reservation in Tuba City naturally occurs at 44 parts per million their teeth were jet black. But for our listeners and viewers that type of extreme fluorosis how does that affect the teeth other than cosmetic which bothered – I noticed it bothered the girls the guys just giggled when they asked them. But how did it affect the teeth dentally? 

Abbas Fazel:      Well, they had a lower incidence of carries, but yea it was mostly aesthetic. It did cause some brittleness on the teeth. The enamel is more likely to chip off. 

Howard Farran: I looked in so many mouths I couldn’t count them. I didn’t see any boned out rotten teeth. 

Abbas Fazel:      No. I didn’t. 

Howard Farran: Yea. It was amazing. 

Abbas Fazel:      They had lack of oral hygiene and perhaps some gingivitis, etc., but certainly not bond out teeth. Right. But we did find that the people that – the children that lived outside the orphanage had lesser incidence of mottle teeth and fluorosis and more decayed teeth because they had access to a sugary diet. The diet of the orphans that live in the orphanage they are restricted to what they can have because they can afford very little. But we did find a difference in the children that lived outside the orphanage they had a much higher incidence because they had access to sodas and carbonation – carbonated drinks and sugar items. 

Howard Farran: The carbonated drinks it is the acid. It is lowering the neutral water of 7 down to like 4 which promotes ____ . I also want to tell our viewers that in America to get fluoride in the diet it is fluoridated water. In the older communities like Europe where these cities were built thousands of years ago the water supplies a lot of these cities would have maybe 50 to 200 different water treatment facilities and a lot of places in Europe actually fluoridated their salt like America iodized their salt when Truman was the President. They passed a law that said all salt had to have iodine in it to get rid of goiter because it was a nutritional deficiency. So we iodize our salt many communities in Europe fluoridize their salt to lower decay. And Tanzania is getting naturally fluoridated salt from the river bed. It is just way too high. It is a very efficient mechanism. 

I also had another interesting – I used to love the macro-epidemiology. One of the first things that turned me onto this was ever since they started recording when boys go into puberty it was just like back in 1945 it was age 16 and it stayed age 16 until this day. But girls were trending down and it got so bad that by the year I think 95 or 2000 10% of the girls in United States and France were reaching menarche at age 10 and it was freaking everybody out. Both United States and France knew it was our food industry putting all these hormones in beef and chicken and milk it was all man made. Everything is man made in so many people’s minds. Americans couldn’t do anything about it because in America our government money comes first and everything else comes never. But France actually pulled together and pulled all of the internet connection problem  there is a problem with – where did you lose me at in this story? 

Abbas Fazel:      About the hormones. 

Howard Farran: So France pulled out and banned all the hormones out of their food supply. I think about like 95. They knew that the girls lowering menarche would stop and start coming back up. Ten years later it had actually gone down even further, which was solid evidence that it is not the hormones in our food. So then epidemiologists started looking around the world and saying is it going up anywhere. And it was. It was going up the age for girls reaching menarche was going up in Somali and Ethiopia and areas that had famine. So then the evolutionary biologists figured out that if your diet is really, really rich that would be a good time to drop an egg and be fertile and have a child and if you weren’t having a good food that would not be a good time to reproduce an offspring. I love this international data. Americans always blame obesity on McDonalds. You hear it all the time. In fact, there are even people who want to tax it like cigarettes for obesity. But I have lectured to dentists in 50 countries and they all have a McDonalds on every corner and Europe basically doesn’t have any fat people. You realize going around the world that the only place you find fat people is in cars. In Europe they walk to the McDonalds, they eat the same thing you and I do but then they walk home. And then in the morning they have to walk one or two miles to catch a bus or a train and then it only gets them within a mile or two of their work and then they walk a mile or two to work and back track. They just move. They move all the time. It is not the food it is the complete I drive everywhere in a car. 

Then I went to Tanzania and I did not see a single McDonalds in the cities we were in. What were the two cities we were in? 

Abbas Fazel:      Moshi and Arusha. 

Howard Farran: And those were Moshi was a – which is the one that had about a million people? Moshi? 

Abbas Fazel:      No that is Arusha. 

Howard Farran: Arusha had a million people and it didn’t have a McDonalds and I noticed there were basically two body types. There was bigger people that were obese and then there were just skinny people with a hard six pack. And they were both doing an equal amount of walking and it made me realize there has to be a genetic component to obesity because you could definitely see the similar diet, the similar walking, the similar moving and two body types one more heavy like a lion and one thinner like a cheetah. Did you want to talk about that? 

Abbas Fazel:      Well, yea. As you said it is probably genetic that – you know that has to do with the differences in their body weight. Most people in poor countries, Tanzania as an example, they do walk, they do bike or they run. You know – and that is why there are so many top athletes middle distance and long distance runners that come from these countries because that is what they do is they would get up and they would live 10, 15 miles from this school their home would be far out. If they had to – if they could – if they had to make the office or the school in time the only way they could do it unless they could afford a bike or a motorcycle they had to run. I’m not sure about the genetics that causes the people to be obese. I’m not a geneticist unless you know why they would be obese. 

Howard Farran: I just thought it was interesting. We do have 3.6 million genes, I am sure some day they are going to see there is a diet, exercise and a genetic component to a lot of these diseases. You see around the globe the one thing you do see around the globe is that the three fastest growing diseases on earth are obesity, diabetes and dental decay. Last year I was in Hong Kong, Kathmandu and New Delhi those three cities for the first time in the history of their civilization opened up a pediatric dentist specialist who specialized in children and I remember talking to Kathmandu dentists that were my age in their 50s or 60s they said their first 10 years they never saw a child under 10 with a cavity. They never saw one. Then the whole country went from drinking water to Coke and Pepsi and the teeth just went south. I hear that all over Asia, Africa, Latin America when everybody was drinking water and walking you just didn’t have these diseases. And now everybody switches water for soda it has just gone to hell in a hand basket so that was amazing. 

We are halfway through. I got you 32 minutes down. I get you for 28 more minutes. I think guys like you especially guys like you who – you just – you remind me of Mother Teresa and Mahatma Gandhi. You are a humanitarian. You are the All-American boy but you are so humble and I don’t think you give yourself enough credit that you have been practicing dentistry for 37 years. You teach one day a week.  What would a 60 year old worldly dentist who has been around the world – you have lived in London, Tanzania, the United States, you practiced dentistry 37 years, you see these kids coming out of school 25 years old they got $350,000 in debt. Since this last recession has been a kicker. Lehman day was what August 15, 2008. Here it is 2014 and the economy you can only describe it as pathetic, apathy, it is not really stinking it is just flat. If your daughter or son was walking out of dental school today with $350,000 in debt what worldly advice would you give them? 

Abbas Fazel:      Actually, you mention it, my daughter just graduated from the dental school. She fortunately I was – we were able to provide her with some funding. We had made allowances over the years to help pay for her tuition. She still has a debt. It’s not as big as $350,000, but it is still there and I mean – the first thing I told her is don’t go and buy a new car. You don’t need one. Your car is five or six years old. It is adequate. It will take you from A to B. A lot of – I mean years ago that is what dentists did and that is how they got into huge debts is they would go – because they saw what their potential income was going to be like. Well, first thing they do is buy a fancy car and a fancy house. Before you know it they would be way up to their neck in debt. She is pretty savvy and smart. She is not going to go out – she is content with the car – she is still living with us. She is not going to buy a house right away. She needs to get her footing in place. She needs to get some experience. Become a better dentist. In spite of all the schooling you get you still can’t – you can’t be a top notch dentist without a few years of experience behind you. She knows that time will come when she can afford those niceties in life. For the time being you have to start slowly and not just jump into fancy goods. It is just not necessary. 

Howard Farran: I want to say as far as being a good dentist depending on what procedures you do it takes – you have to do a thousand of anything to really get good at it. And everybody teaching on the circuit whatever they are teaching they have done about 10,000. If you are on the circuit teaching endo you have done 10,000 units. You are teaching implants you have placed 10,000. A kid coming right out of school they have done maybe 100 fillings and you got to do 1,000 fillings just to be good. I also noticed a couple of trends with the guys versus the girls. There is 2 million dentists around the world. In the 20 richest countries they are all men. And in the 200 poorest countries 1.5 million of the dentists are women. It is amazing in the United States there is no money in teaching. It is all women. All the money is in medicine and military and marketing and Hollywood and Wall Street and interns and banking and finance and it is all men in suits and ties wanting to make six figures. I am very excited that dentistry has gone from a male dominated profession to now 45% of last year’s graduating class from dental school was female. I think the female touch to healthcare is going to be amazing. I think – I literally cried in Kathmandu. I met this woman dentist. She had two helpers. She had been practicing she was my age she had been practicing 30 years. I asked her I said well, how much money do you make in US per month in your office. And she says I am so lucky, my husband is an engineer and has a good job. My office loses about $50 US a month and he has always smiled and subsidized my job. So here is this woman working her butt off for 30 years and losing $50 a month in Kathmandu. That’s just a woman mindset. 

The other thing I have noticed is the suicide rates. Women dentists almost I only know of one case where a woman did it and she was mentally ill. The difference is the women dentists always marry men who have an equivalent amount of education. They are 30% of married dentists they marry doctors, physicians, lawyers, engineers, bankers, finance and the men notoriously will get some hot looking chic who is  a waitress at Hooters who will never make a dime her entire life. And the really good looking woman married the geek introvert lawyer, dentist, physician because they saw money and they just spend, spend, spend. The dentists are all whining about their $350,000 in student loans when the men are all going to go marry a non-income earning person and buy a house that costs one or two times more than their student loan debt and then buy a fancy car yet they are emotionally anchored to this student loan yet which they ought to be grateful for because if they had worked at McDonalds and saved up for dental school it would have taken them 20 years. In rich countries poor people have access to other people’s money in student loans and stuff like that. Now they get to become a dentist on debt and they would have saved up for it at $5.00 an hour and now they get to pay down their student loans and make $150 an hour. I bet you your daughter will probably marry a brain surgeon, Wall Street broker whatever and basically won’t even – 

Abbas Fazel:      She is dating another dentist. 

Howard Farran: See. I mean my god is that a fact check or what. And the dentists in dental schools – and she looks rocking hot in a pair of Levis and she is a waitress at the Waffle House they will marry her and oh my god. It is insane. The message here being lower your spending. We are all going to die. You don’t need that big house. My car I’ve got money. My car has 100,000 miles and it has never blinked. Nothing has ever gone wrong. My boys said to me the other day well your car is 10 years old it has got 100,000 miles. Dude I live 3.0 miles from my dental office and 3.5 miles from Dental Town and my car has never blinked ever why would I need a new car? 

I got you for another 20 minutes. I am two thirds down only got a third left. Give them more worldly advice. 

Abbas Fazel:      Worldly advice. Well, you know again material things are just not necessary. Be humble. Be – be appreciative of what you have and travel. You can only find out how other people live an dhow fortunate you are if – I mean the US in my opinion is the best place on the planet earth to live in. But yet a lot of people just don’t seem to be able to appreciate that because they still want more because they think they don’t have as much as they should have or as much as they are entitled to or whatever reason. Until they look at and see how other people in societies and other countries live that is when they realize that what they have is second – 

Howard Farran: It is grotesque what we have in America. I want to key in on an example from you. Since you did graduate from dental school in London you hear a lot of people in America saying gosh, right when England’s dentists are getting out of the NAH system and it is a complete failure and they are all going private now the United States is going into corporate dentistry and Obamacare and this and that. Why don’t you talk about the two different delivery systems of dentistry in the United States versus England. NHS and what your thoughts are on NHS versus private insurance and where it has been and where you think it is going. 

Abbas Fazel:      I have mixed feelings about both systems. I mean really they have advantages and disadvantages. The National Health System at least provided access to everybody. Being that you were a millionaire or an unemployed person with no money at all because the government provided for you. In a way, in a sense that is a good thing because you are providing care – much needed care to everybody. And in a system in a private system such as here obviously if you can’t afford to go to a dentist and dentistry isn’t cheap people may have severe toothaches and they can end up in emergency rooms. That can cost the taxpayer a lot more than they would bargain for. That is the sort of an advantage is access to the care for everybody. 

The disadvantages are that with everybody seeking care you are inundated with a lot of patients. You cannot provide the quality for the kind of services that you want to for the reimbursement that you get from the government because they dictate what they will pay you for the services that you provide. It is obviously not enough because the materials, the lab costs, etc. to provide good dentistry it costs money. So that is the disadvantage is that the quality – 

Howard Farran: That is a national – that is a human characteristic of over-simplifying complex things. I think it comes from Einstein’s’ e=mc2 it just take this unbelievably complex thing and simplified it to a little equation and people over-simplify everything. These big complex problems there is no simple thing. I would like to add a couple of two cents on that. It was Churchill who said my book I just wrote is uncomplicated business understand people, time and money. And with Churchill you said you know if your people are uneducated and sick you are not going to have very good workers. You can’t grow an economy when everyone is sick and uneducated. I would say the greatest societies I had ever seen were Scandinavia, Denmark, Norway, Finland, Sweden where education and healthcare is free. They have almost the lowest criminal rate because everybody still has hope. My kids change their major every six and a half nanoseconds when they were in college. As long as the kids stay in school night school, try different things eventually his tires are going to hit the road and they are going to peel out. When they are sick and not feeling good they can always go to the doctor. I just want to say one thing going around the world America is the oldest healthcare system. It was complete laissez faire free market and it is the most expensive. It is about $7,000 per year per person and 50 million people don’t even get coverage. Then after World War II about 20 countries all started a national healthcare system and they all had different variables. It is amazing that the best healthcare system I have seen was actually Taiwan because it is the newest. It is only 10 years old. Taiwan and Singapore had a chance to look at all the pluses and minuses of Canada and New Zealand and England and Germany and France and Italy and all of these great countries. Their doctors are more incentivized. They work longer hours. They make a lot of money. Everybody gets covered. I am really paying attention to Taiwan. Have you seen the Taiwan or Singapore newer systems? 

Abbas Fazel:      Yea. I have not unfortunately. From what you describe I wish that the Congress here and the president and congress, etc. could work together to provide this country with a system that would be good and reasonable in costs and access to it. 

Howard Farran: Well, they’re not. I think it is funny in America people who are proud to be a Republican or proud to be a democrat I mean it is like one robbed the bank and one drove the get away car. They are in collusion to insanity on their highway to hell. I can’t believe people love one of those two parties. I equally hate them both. Let’s not get into religion, politics, sex or any of the controversial things. What else? We are down to 12 minutes. What would you tell a dentist who is not just coming out of school, he has been practicing 10 years and he is just kind of flat in this malaise economy that is not really going anywhere. It is not rising or sinking. It is flat. You have done it for 37 years. You have seen it around the world. What advice would you give to that 30 year old kid who is just flat? 

Abbas Fazel:      This is what I did – I found when I started doing dentistry it was mostly restorative, fillings, etc. But then you reach a plateau where you can only do so much. What I would suggest is to expand your abilities. I went to USC in 2006 over a course of a year each month and trained to become more proficient in oral surgery, extractions, placing bone graphs, membranes, etc. I wouldn’t call myself an oral surgeon, but I certainly am able to do those procedures and place implants. So that has really expanded my practice. I don’t have to refer as much as far as implants go. That is one area of dentistry which is growing in demand. So that is what I looked into. Now there is another growing area is sleep apnea. It is a dentist that can provide such treatment to these patients. Just expand your horizons. There is so much more that you can do. Don’t limit yourself to restorative or endo or what have you. Be able to do more than – 

Howard Farran: If all you can do is a cleaning, exam, X-ray and filling and crown that’s one of your problems. That’s flat. Back to implants. Are you using – have you gone from 2D panos and Xrays to 3D CBCT conebeam[ph] – what are you using and are you using it for just diagnosis or are you also making surgical stints? 

Abbas Fazel:      No surgical stints too. I have the Facilitate software on my laptop. Actually this laptop that I am using right now. 

Howard Farran: It is called Facilitate? 

Abbas Fazel:      Facilitate yes. It is the Astrotech what used to be Astrotech now it is ____. I use the Astrotech implant system and – 

Howard Farran: Astrotech? Okay. 

Abbas Fazel:      Yea. That is an implant system. I started out with the Nobel Biocare System and then I went onto Astrotech. They have their own software which is called Facilitate which is similar to Simplant. Simplant is the more widely known software system. I can download the images from the CBCT scan. 

Howard Farran: Which CBCT scan did you get? 

Abbas Fazel:      I don’t have one. I send them out. Yea, I send them out to other facilities where they get the scanning done. 

Howard Farran: How much is that costing the patient and are they paying for that or is insurance paying for that? 

Abbas Fazel:      A couple of hundred dollars. Sometimes they will have to pay out of pocket sometimes their medical insurance might cover that. 

Howard Farran: Do you request a certain type of CBCT? 

Abbas Fazel:      Yes. 

Howard Farran: What do you – 

Abbas Fazel:      They convert it so that it is compatible to the software that I have. I download it into my software program so now I am able to view the images in every angle even a 3D model of their jaw. And then I can virtually place the implant into that patient’s mouth basically – virtually and then once I am very comfortable with how it looks in every angle, every position, every whichever way you look at it I can then send that information to a lab. There are many companies – I send them study models – accurate study models of the patient and they will create a guide or actually the software creates the guide. So then they manufacture it based on the design that I have. 

Howard Farran: Guidewell just stopped doing surgical guides. I mean they are the biggest lab in the United States – North America. Probably the biggest lab in the world. Modern Dental is the largest one in China. Guidewell is about 5% of market. Mike Tutola just told me that they would have to charge $600 or $700 for a surgical guide it is too much money. They stopped doing it. So who is making your surgical guides? 

Abbas Fazel:      I actually send it – it is a company that is a subsidiary it is called materialize. It is a subsidiary of Astrotech. They do charge a few hundred dollars but it includes the drills. The drills come with the stops. They send me the criteria of which drills to use in what sequence and the patient – I have the patient pay the additional fee that they charge. I don’t make any money off of it. Say for instance the charge was $550 for the surgical guide and the drills the patient just pays that amount. I don’t always use a guide. It is not necessary it is a bit of an overkill. I only use it when I really see the need for instance if it is very close to a sinus and I will ensure that I place it in exactly the most desirable position. Or if it is multiple implants three or more to be done then I will definitely use a guide. I do transfer that cost to the patient. I explain to the patient I show them the computerized images of how I virtually place those implants they are very impressed that it is accurate in placing those implants. 

Howard Farran: It is amazing when you go around the world. There is basically no dental insurance in Asia, Africa and Latin America. The United States and Canada are about the only two countries where the dentist pays a lab bill and incorporates it into the fee. Once you leave the United States and Canada everybody has the lab direct bill the patient. The dentist doesn’t even get involved with it. So that is interesting how you pick that up. And also I would give anything if you would create a one hour online CE course here in our backyard ____ where you just walk through a case or two because I think dentists would love to see you do that. That would be amazing. 

Abbas Fazel:      I have already quite a few cases in my computer that I have stored. Either I can go through those cases or a new one that comes in perhaps. 

Howard Farran: Let’s do it. The two fastest areas that I see exploding is implantology and endo because 50% of the general dentists don’t want to touch a molar and they are shy, most dentists have the personality of an engineer, a scientist a teacher. They are wickedly smart, but they don’t like sales. They aren’t sales people. They don’t like to close. And a tooth ache you don’t have to sell. They come in, they are in pain, they hurt and we are in this flat economy and they refer a $1500 hot tooth that wants treatment now to an endodontist and so I see the – we have 250 courses at Dental Town and the endo courses are just exploding. The other one is society is changing gears where people just don’t want to have a removable tooth. They don’t want a partial. They don’t want a denture. They don’t want a – they cringe when you tell the you are going to file down three teeth and the neat thing about implants is you are not filing down the adjacent teeth ____ [00:56:09] and lactobacillus cannot eat this implant. Even periodontal disease remember you can have a whole mouth full of perio, extract all the teeth and the gums heal up beautiful, firm and pink in a week. Gum disease is a huge interaction with the cementum and the tooth. A lot of people say that implants get periodontal disease, but it is a completely different type. Most of the bone loss is from the flexing of the implant. Do you see classic periodontal disease around implants? 

Abbas Fazel:      No. Not in my opinion. 

Howard Farran: It’s different. 

Abbas Fazel:      I don’t. 

Howard Farran: I am not a periodontist either, but the point I am making is that when I go into nursing homes in my backyard and see people that I treated over the last 27 years so many of those root canals, build ups and crowns they go into the nursing home, they got rheumatism, they got dementia, they got Alzheimer’s. Their diet at the cafeteria is all macaroni and cheese and cottage cheese and pumpkin pie it is a carb fest. They all get infected with root surface decay. In a year and a half their lifetime of dentistry is turned to mush. And then there is those two shiny titanium implants and everything is snapping down on them. Men the average male in America lives to be 74. The average female lives to be almost 80. I really don’t care about doing root canals and crowns in old men because you know they are just going to go to the refrigerator and fall over dead some day. But the women just keep living on and on and on. Those implants and crowns – 

Abbas Fazel:      Sorry. We got disconnected for some reason. 

Howard Farran: That’s okay. We were at 58 and a half minutes. We are down to one minute. Dr. Abbas Fazel, wrap it up in 60 seconds. 

Abbas Fazel:      Well just let everybody know that it is being a great profession. I am privileged to have practiced both in England and in the US and to try and tell people that there is more to life than just making money to try and help people in need and to – if they wish to participate in any of our humanitarian projects you know, to let us know. 

Howard Farran: What is that website? K2 Adventures.org. K2Adventures.org and all of this on our podcast all of these information links will be in the notes. Also, I was wondering I would love for our doctors to come and visit you or you come and visit us and show us what you are doing with this implant software. 

Abbas Fazel:      Absolutely. I would love to. 

Howard Farran: You want to come down to ____ or you want all of us to come up to Scottsdale? 

Abbas Fazel:      I could maybe arrange to come to Ahwatukie. 

Howard Farran: We would be honored. I would love to look at that new software. 

Abbas Fazel:      Alright. Maybe we can arrange it with your secretary and see what we can come up with. 

Howard Farran: The only thing bad about you coming down is I know you won’t bring a dozen donuts. 

Abbas Fazel:      No, I hate – I don’t like donuts. 

Howard Farran: You are a clean eater. I watched you eat for a week. You are a clean eater. I should only eat what you eat. Thank you so much for an amazing hour. When you can come down to Ahwatukee and show us that software we would love it. 

Abbas Fazel:      Okay. I would love to. And thank you. It has been a pleasure. 

Howard Farran: Okay. Thanks, Abbas. Bye-bye.