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Dr. Geoffrey Hall shares how general dentists can excel in ortho.
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AUDIO - HSP #211 - Geoffrey Hall
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VIDEO - HSP #211 - Geoffrey Hall
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Geoffrey Hall, DDS explains why general dentists can do orthodontics, and shares the Smilefast story.
Dr Geoffrey Hall
BDsc (Melb) CertOrth (Uni of Penn)
Dr Geoffrey Hall received his dental training at the University of Melbourne in 1983, and pursued his postgraduate orthodontic training at the University of Pennsylvania in 1988 and completed his degree in 1990.
Dr Hall has an extreme passion for orthodontics. He practices at his busy South Caulfield practice in Melbourne, specializing in adult and children treatments including early treatment, conventional, short-term and lingual braces, Invisalign and aligner systems, and interdisciplinary treatment, including orthognathic surgical cases.
Dr Hall was the first dentist and orthodontist to use Invisalign outside the United States.
Dr Hall developed a short term cosmetic orthodontic treatment called Smilefast practiced by many dentists not only throughout Australia but internationally. Dr Hall lectures both nationally and internationally on Smilefast and personally trains dentists to use this innovative digital indirect bonding system. With the success of Smilefast’s unique digital indirect bonding system, Dr Hall has also developed a company called Precision Digital Indirect Bonding Systems (PDIBS).
Dr Hall has been on the teaching staff at both the University of Melbourne and the University of Pennsylvania, and he has been involved as an orthodontist at Monash Medical Centre in the Craniofacial Unit. He has written many articles and is a co-author in a lingual orthodontics book. Dr Hall regularly participates in webcasts on various orthodontic topics and is a sought after lecturer nationally and internationally –he has been the keynote speaker for various international orthodontic congresses.
He brought the Seattle study club to Australia, was founder of the Australasian orthodontic study club, the new horizons dental study club and the Victorian interdisciplinary study group.
Dr Hall is a member of many associations including the Australian Dental Association, Australian Society of Orthodontists, American Associations of Orthodontists, and various Lingual Orthodontic Associations.
www.smilefast.com.au
tel int-613 95248900
cell int-61-411660032
email geoff@smilefast.com.au
Howard Farran: It is a huge honor for me today to be interviewing Geoffrey Hall all the way from Melbourne, Australia. I just saw your lecture two or three months ago, and I saw you in lecture ... We both lectured actually in Melbourne, Sydney, and Brisbane. Was that the three cities? I was blown away by your presentation, everything about you. Thank you so much for joining me today because when I was listening I said, "Oh my god, the American's got to here this." Today you're talking to mostly Americans, thousands of them as they're commuting to work. I want you to start with, are you a general dentist, or are you an orthodontist?
Geoffrey Hall: I'm actually an orthodontist. I actually did my orthodontic training in America at the University of Pennsylvania back in 1990. To be honest, I'm 75% American.
Howard Farran: Do the Australians recognize a U.S. dental school? Is it accredited back home, or did you have to go to ortho school back in Australia?
Geoffrey Hall: The orthodontic training was accredited here in Australia because I was a dentist first in Australia, that's the degree that they utilize, similar to your board registrations in America.
Howard Farran: Usually Americans, they don't accept licenses from other countries. I always think those are rackets to support the teacher's unions, especially when they're from countries like Australia, Germany, Japan, Korea, countries that have dental schools that are just as good or better than America. I want to get right to the point. Your an orthodontist.
Geoffrey Hall: I'm an orthodontist, yes.
Howard Farran: This is how I could sum up the 9 specialties. Most of the time when you deal with an oral surgeon, he or she don't care what you do. He figures your going to pull the easy ones, you'll send the impacted wisdoms you don't want. They don't even care. You talk to an endodontist, they'll show you everything they know. They assume you're going to do the incisors, and you may do molars, you might not do [re-treats 00:02:23]. It seems like with all the specialties, they're just there to help you. They want to show you everything they know, all that kind of stuff, and then there's the orthodontist. It's like, this is the closed society, you should not do. They literally say to you, "You know if you want to learn ortho, then go to ortho school." You're like, "What about minor tooth movement, Six Month Smiles, powerprox, Invisalign, whatever, and it's a closed society. Is that a fair assessment or not? Am I reading this wrong, or do you agree that that's how it is.
Geoffrey Hall: I think you're actually probably right on in your assessment. I think they're even more so than how you've described it.
Howard Farran: You describe it.
Geoffrey Hall: It's exactly that. I find it quite bizarre that a dentist can put in an implant right in the sinus of an upper 6 but cannot put a bracket on a tooth with composite resin. It defies any logic.
Howard Farran: One involves bleeding, suturing, scaling, bone grafting, surgery, anesthetic. The other one involves glue and rubber bands.
Geoffrey Hall: Yes, and not necessarily rubber bands, just glue that they use every day.
Howard Farran: It's a weird deal, and what upsets me about it, where it becomes personal, coming from Kansas where my whole pedigree is from Parsons, these small towns, is these dental schools don't teach these kids ortho, and then half of them go back to rural communities where there's no orthodontist.
Geoffrey Hall: Precisely, and that's not doing a service to any patient.
Howard Farran: Those rural tax payers picked up the bill of all these public dental schools. Then they send them back doctors that aren't educated to ... You need to be a full, well-rounded doctor in a small town.
Geoffrey Hall: That's exactly right. To be honest, even in bigger towns today, you need to be more well-rounded, even if you're not going to do it you need to be able to diagnosis it. You need to be able to treatment plan with the other specialists. The more knowledge you have, the better dentist you're going to be.
Howard Farran: Absolutely. All of my friends, myself included that learned how to do ortho, when you learn how to do ortho, you learn more about occlusion and TMJ because when you're listening to these TMJ people who have never done an ortho case, you're just listening to them like, "Dude have you not done one ortho case because everything you just said, if you just did one ortho case, you wouldn't believe any of this stuff." It was Carl Misch who said, "I became an great implantologist because first I became an expert in removable dentures." I got into implants because when these guys were doing overdentures, they were saying the titanium was too weak and was snapping, and I was looking at the denture like, "Well the denture was so bad, and you were so bad on the bite. You put an F denture on these implants, and then when they snap you said it was the implants. He said, "If you don't know how to build a denture correctly, you don't know how to build an implant overdenture correctly."
Geoffrey Hall: That's exactly right. Orthodontics is fundamental. I think they biggest problem that we've had is that there was a small percentage of difficult patients. We're throwing the baby out with the bathwater. These orthodontist are saying, "Well it's all to do with diagnosis", but 90% of patients that come in are quite straightforward patients. That can be treated by just about anybody. The problem I think we have in orthodontics is that we've worked on the basis of swings and roundabouts. We charge the same fee whether it's a difficult or an easy case. The orthodontist is making their money out of the easy cases. They actually don't do that well with the difficult cases. They need to be more highly trained in those difficult cases because that's what they should be getting referred.
Howard Farran: That's what all specialist are. I'll pull out the easy teeth, the gum disease, and the oral surgeon will pull out the impacted wisdom tooth. I'll do the straight canal. He can do the re-treat. That's what he's [inaudible 00:06:24] specialty. I'll tell you another on Dentaltown ...
Geoffrey Hall: He should be charging a premium for that.
Howard Farran: We put up 350 online courses on Dentaltown, and there's none on ortho because the orthodontists that tell me, they tell me, "Howard, if I put up a course teaching ortho to general dentists, I would be an outcast at my local [study lab 00:06:48]. I'm not going to live my life that way. I'm not going to take ..." You will never speak at an ortho meeting, nobody will like you, and I always knew back when I started Dentaltown in '98, if I was ever going to get an ortho curriculum, I'd have to look outside of the United States. I'd have to look for a Canadian, an Australian, a British person. I'm hoping you'd deliver that some day. You know in the internet there's not one single online curriculum to teach orthodontics from A to Z.
Geoffrey Hall: Really? We are looking into that at the moment. Funny you say that about being an outcast because I would classify myself as an outcast here in Australia for exactly the same reasons. No different in Australia how I'm perceived because I'm teaching orthodontics to general dentists. They don't like it. They're threatened.
Howard Farran: Do you feel evil?
Geoffrey Hall: No. I come to the philosophy, people are talking about me, I must be doing something right.
Howard Farran: Absolutely. Why do general dentists need to learn orthodontics?
Geoffrey Hall: If America is anything like Australia, which I'm sure it is. I think we're 10 years behind America in just about everything. I think there's a couple reason. Firstly, the economic times are such there are more dentists that are graduating. The times are much tougher, so they need to have orthodontic practice from a financial point of view. Also, most patients today are coming in for cosmetic work. They don't come in to say, "Please give me an endo in an upper right 6." They want their teeth straight and white. You've got to be able to offer them what they want if you want to stay in business.
The third part, which I find quite amusing is, I think most of us got into dentistry because we're a little bit more intelligent than the average person. Yet, when we get to dental school, they just teach you to hold a burr and to drill and to stop thinking about what you're doing. It becomes very mechanical. Orthodontics you have to do a little bit of thinking, and it's actually fun again to start to think. A lot of people, if they're anything like myself, you get a little bored with general dentistry after a few years, and you need to find other avenues. The people who I've trained in orthodontics say orthodontics, it's been the best thing they've ever done.
Howard Farran: I listened to a lecture by a neuroanatomist out of Italy, and he said that the body of the literature shows that there's no difference if they study 100 ants, 100 dolphins, 100 chimpanzees, 100 humans, all the brains are the same across species, that they can't find anything that says this brain's smarter or this brain's less. What you become good is if you're interested in something. Here's someone who's an expert violist, well hell she played violin 4 hours a day from age 5 to 25. I don't want to do that. It doesn't mean she's a musical genius, and I'm an idiot. I just don't want to play the violin.
What I like most about ortho and Invisalign, and people who join the AEC is that if you hate endo, you can't afford to do endo because if you do root canals and hate it the whole time for the money, if you do things you don't like to do for money, it will always come back and bite you in depression, substance abuse, throwing instruments, selling your practice. So many dentists think [inaudible 00:10:17] they didn't like placing implants or they didn't like [inaudible 00:10:19], they didn't like blood or guts, but they loved cosmetics. They loved ortho. They loved minor [tubing 00:10:26]. What you got to do is, is you got to go play every day, and be [inaudible 00:10:29].
My buddy Joyce up the street who's the first female dentist president of the American Academy of Cosmetic Dentistry, my god, she doesn't need another dollar for anything in the world. She's got more money than anyone, and she just loves it. She just goes there every day doing these big cosmetic makeovers on women who cry when they get it done. It's just crazy, but she loves it. She'll do it until she's 103.
Geoffrey Hall: That's how it should be. Whatever you do in life, you've got to enjoy. I'll be honest, I did not enjoy dentistry as a dentist, but I love orthodontics.
Howard Farran: I want to give you a very good ... I'm the owner of Orthotown too. I have Dentaltown and Orthotown. I'm [inaudible 00:11:13] to go on Orthotown, I'm not an orthodontists. [inaudible 00:11:17] company that only sell ortho products. I'm not allowed to go on either. One thing they tell me that I agree with, they say, when you're learning how to do Invisalign or Six Month Smiles, or powerprox, or whatever, if you don't know how to do complex ortho, then when you're doing these simple ortho cases, a lot of times, you don't even know what you don't know. I guess the question is this, this is the specific question. Can a general dentist do Six Month Smiles, powerprox, the short term ortho courses in Invisalign without understanding how to do full, complexed orthodontics?
Geoffrey Hall: Absolutely. What they have to understand, though, is what are the complexed cases. They don't have to understand how to do the complexed cases, they just have to be mindful of what is a complexed case. That's very easy to teach them, that even more so ...
Howard Farran: Can you teach them right now, talking to them in their car? 95% or my podcasters are just listening to us. It's only 5% are watching on video.
Geoffrey Hall: I could teach them. Yes, I could teach them during a podcast.
Howard Farran: Do you want to do that, or do you want to build an online CE course for Dentaltown sometime?
Geoffrey Hall: I think something visual is better.
Howard Farran: I do too.
Geoffrey Hall: I would prefer to do it online. The online course.
Howard Farran: Most people only listen to this on iTunes because they saw my face one time, and they said that I do not have face for YouTube or television. They said, "You only have a face for radio or a podcast." Can you talk about ... What I'm thinking is she's driving to work right now, how hard is it to figure out the [hard 00:13:05] because she's thinking, "I don't want to get into this if I'm going to screw up a big case." Can you kind of go over talking to her in her ears about, how hard is it to stay out of trouble? That's the question. How hard is it to stay out of trouble?
Geoffrey Hall: I think there are two points to it. I'll [inaudible 00:13:21]. I can train them to stay out of trouble. That's not an issue. I think the problem with all that is I think there has to be a system in place where they can actually send the case and somebody just says yes or no to that case via a secure portal. They can actually get treatment assessments done, so they're 100% confident that they will be out of trouble. For example, if you're viewers want to know what would be a difficult case, for example. If you're talking, it's what patients can't accept. Patients can't accept an anterior open bite when they're finished. They can't chew. Patients can't accept a reverse cross bite being a class 3 patient. The 2 main categories of patients that I would be telling them not to treat are patients who have got minimal overbites and patients who are class 3 patients.
Howard Farran: Explain what a class 1, 2, and 3 patient is. There are 7,000 people listening, and someone might not remember that.
Geoffrey Hall: A class 1 is basically a patient who has an ideal overbite overjet, and basically teeth fit together like a jigsaw puzzle. To have an ideal overbite overjet which is a 3 mm overbite, 1 mm overjet, you've got to have what we call a class 1 canine relationship, and a class 1 molar. A class 1 canine relationship is where the tip of the upper canine sits between the groove of the lower canine and the lower first premolar. A class 1 molar relationship is where the tip of the mesiobuccal cusp sits on the buccal groove of the lower first molar.
A class 2 patient would then have more overjet. In other words, the class 2 patient, the upper arch is forwards of that ideal class 1 position. The mesial buccal cusp of the upper first molar would sit forwards to the buccal groove of the lower molar, and the upper canine, which normally sit between the lower canine and the lower first premolar would sit forward of that position. That would be a class 2. By definition, they must be left with overjet. The amount of overjet they would be left with is very easy to figure out because all you need to do is measure in millimeters the canine relationship. If the canine relationship is a 3 mm class 2 on both sides, they have to be left with 3 mm of overjet as the teeth are straight.
The worst scenario is the patient who is a class 3 where the lower arch is forwards of that class 1 position because then they're going to end up with anterior crossbite or a reverse overjet, and patients won't tolerate that.
Howard Farran: Interesting. Do Australians ... are they familiar with Jay Leno? Would Jay Leno be the most famous class 3?
Geoffrey Hall: Yes. We know Jay Leno, yes.
Howard Farran: Would that be most famous class 3 that comes to your mind? It's when you have a big lower jaw that protrudes.
Geoffrey Hall: Yes. Yeah, he would probably be the one that would come straight to my mind.
Howard Farran: Who would be the most famous class 2 overjet where you don't have a chin, when you smile your liver shows?
Geoffrey Hall: That's a very good question. I actually haven't thought of that one. I haven't thought of that. There will be plenty of them.
Howard Farran: You were also showing me, is it your system, the precision digital indirect bonding system? Is that yours?
Geoffrey Hall: Yes it is.
Howard Farran: What I thought was amazing about that is, you were having the lab set all the brackets in a tray indirectly, and then you were cementing them all at one time. What is that system? What do you call that system?
Geoffrey Hall: We call that ...
Howard Farran: Smilefast.
Geoffrey Hall: That's our Smilefast system, yes.
Howard Farran: Explain what ... You're website is smilefast.com. Do Americans have to after the dot com put dot AU, or if they go to smilefast.com does it go to yours?
Geoffrey Hall: I think they've got to put dot com dot AU, but that will be changed soon.
Howard Farran: If you go to smilefast.com.au, the dot AU is for Australia, they're going to go to your website. How long has that website been there? How long has Smilefast ... Tell us the Smilefast story.
Geoffrey Hall: You mentioned other techniques such as 6 Month braces, 6 Month Smiles, etc. The whole idea of short term orthodontics has been around for a fair few years. I think Invisalign has really driven this cosmetic orthodontic market.
Howard Farran: Invisalign was invented by a man in Pakistan, right?
Geoffrey Hall: He's American. He was American but from Pakistan origin, yes.
Howard Farran: Now he lives in Dallas. It's kind of like a Steve Jobs story where they went public and then they got rid of him, right?
Geoffrey Hall: That's exactly right. His name was Zia Chishti.
Howard Farran: Zia what?
Geoffrey Hall: Zia Chishti.
Howard Farran: Zia Chishti. I want to podcast that guy. Do you know him well?
Geoffrey Hall: I do know him, yes.
Howard Farran: Tell him I want to podcast him. It was like Steve Jobs. He built this big Invisalign, had the patents, and they got rid of him.
Geoffrey Hall: They got rid of him.
Howard Farran: Now the patents are about extinct, expired, and he started a new company. What's his new company?
Geoffrey Hall: He started a new company about 10 years ago, which I think was called Clear Smiles, if I'm not mistaken, but Invisalign closed him down. Now there's another company out there called ClearCorrect, which I don't know whether Zia has an interest in there or not, but knowing Zia he probably does behind the scenes. Invisalign has not been able to close ClearCorrect down as it turns out.
Howard Farran: It doesn't matter because don't all those patents expire real soon.
Geoffrey Hall: There's a useful note in that. The main patent expires in about 2 years, but they've got so many other patents with regards to attachments, etc., I don't think anybody really knows which patents are still going to keep going on or not. The original will expire in a year or 2.
Howard Farran: What is Smilefast? Is that like a short term ortho, Invisalign, ClearCorrect? What is that?
Geoffrey Hall: It's more of a short term ortho. I think what you've got to realize how, I'm coming from now a little bit with an orthodontic hat on, from an orthodontist's point of view because what I want is one, I want to train doctors with sound orthodontic principles. All of these other systems have been done with general dentistry, not a bit about orthodontics, but they're not really sound by mechanical systems. They've been taught something by somebody who's been taught something.
I've brought Smilefast in, which is coming from an orthodontist. What's really unique about is, I think one of the things an orthodontist will tell you is the most difficult thing to do in orthodontics is position brackets correctly. That's the hard part to do in orthodontics.
Howard Farran: Why is that the hard part when the assistant does it every time? Come on Geoffrey, you know nobody cements a bracket. The assistant does that.
Geoffrey Hall: In Australia, that's one thing we have to do, but I know in America that's a whole different thing.
Howard Farran: I'll never forget a Friday I wanted to return something to my orthodontist. The whole place was packed. They're like, "Shh, don't say anything. Last night he went to the cabin." They're not even in there on Fridays, but anyway, continue.
Geoffrey Hall: I'm not going to say that's the right way to do it. When I was training in Philadelphia it was actually very interesting because I was trained by Ron Roth and a guy called Norman Setwin. This were some of the real ... The guy who invented the bracket, the Siamese twin bracket, a guy called Barney Swain. These were the gurus, and I was the first Australian ever to train in Philadelphia, so they took me out for dinner, these 5 orthodontists, and they said, to me ... They were having this discussion between themselves, and they said, "Has there ever been a case where you haven't had to re-bracket a tooth to get the perfect result?" These 5 orthodontists who probably would have been the best 5 orthodontists the world's ever seen said there's never been a case. That's all I do in my practice all day every day to get perfection is to re-bracket teeth.
Then I thought, we're now in the digital world, and the hardest thing to try and teach a general dentist without a lot of experience is how to put brackets on. That's where we set up this digital indirect bonding system. Now we can place the brackets entirely in just about the perfect position within reason because there are some teeth that are so rotated you just can't get the brackets on perfectly anyway. Within reason, we can get the brackets on perfectly. Then that gets transferred to this indirect bonding tray. The chair-side time for a doctor to get your brackets on perfectly, which is the key to aligning teeth, is about 2 minutes for the doctor's chair-side time.
Through this digital technique that we've got, it's now like an Invisalign clincher. You can show the patient, you can do the measurements. You've got a whole visual representation of what it's anticipated to look like. No other system has, and I think that's really ...
Howard Farran: Let's slow down and talk specifics. What do they need to do? They need to take a pano and ceph, and study models, and then they mail that to you physically, a pano, ceph, and study models?
Geoffrey Hall: Basically yes.
Howard Farran: Does your company trace the ceph?
Geoffrey Hall: We'll just go back a stage. We actually have an online portal. They don't have to mail any x-rays, they just load all the case on our online portal: the photos, they can light up the x-rays, any comments they want. They only thing they need to send to us is the impressions, and that's all they need to send.
Howard Farran: Are you going to eventually have the oral scanner? I know that ... Didn't Invisalign buy an oral scanner?
Geoffrey Hall: They bought the OrthoCAD scanner. Any scanner, if they've got a scanner that can get STL files, which is just about every scanner. The Kia Stream's got one now, Three Shapes got one. They can load those files straight onto the portal.
Howard Farran: This is all based out of Melbourne, Australia?
Geoffrey Hall: Yeah.
Howard Farran: Then you would get it. You got the scan. They can mail you hard models or they can send you an STL file, and then they upload. What do you need a pano and a ceph?
Geoffrey Hall: Yeah.
Howard Farran: And photos?
Geoffrey Hall: Definitely photos?
Howard Farran: Definitely photos, and then you guys pour out the model, go on.
Geoffrey Hall: We pour out the model. If they give us a model we produce the STL file, then we do the scanning if they don't have scanner. Then we provide the digital setup with the bracket placement. We send it to the doctor with a 3D viewer, so they can manipulate it all. Then they can see what they can modify. As soon as they press the approve button, the indirect bonding trays are made with the brackets in that exact position.
Howard Farran: Then you get the patient back and go through the exact bonding stage of how you band these brackets on.
Geoffrey Hall: This is really difficult. This is why dentists can't do it. You've got to inch the teeth. You've got to then put some bond on the teeth. Then you put some composite on the back of the brackets during the transfer tray, and then you've got hold that transfer tray in for 2 minutes.
Howard Farran: Do you have to put any resin on those indirect brackets.
Geoffrey Hall: Yes. You put a flowable composite resin on.
Howard Farran: Just the flowable [gut 00:25:36], but not bonding agent. No resin?
Geoffrey Hall: You do put a bonding agent on about 20 minutes prior, just solo, whatever it be, just to wick that old composite to allow the new composite to bond.
Howard Farran: What resin cement system do you recommend bonding with?
Geoffrey Hall: In our practice we use a Kerr product called Maxicem.
Howard Farran: Kerr products [Max Sam 00:26:01]?
Geoffrey Hall: Maxicem. It's a ...
Howard Farran: Spell it.
Geoffrey Hall: It's a jewel cured flowable composite that you use for looting in [weights 00:26:12].
Howard Farran: Nice. Spell that. Max what? M-A-X.
Geoffrey Hall: Maxicem, M-A-X-I-C-E-M.
Howard Farran: Kerr, which is owned by Sybron, which is owned by Danaher, right?
Geoffrey Hall: Yep.
Howard Farran: That would be filing genus species. How long does that take to set that on there?
Geoffrey Hall: Well, because it's jewel-cured it will set in about 5 minutes as a chemical cure, but we also use the light to get it to set very quickly. In five minutes it's all set. You take the trays off, and the brackets are now bonded on to the teeth.
Howard Farran: Then you're going to start with what wire? How many wire systems is this going to be?
Geoffrey Hall: We try to keep this very simple because we're doing simple orthodontic alignment, so it's usually 3 wires, an 0-1-4 Ni-Ti, and 0-1-6 Ni-Ti.
Howard Farran: 0-1-4 Ni-Ti, and then the second wire would be an 0-1-16?
Geoffrey Hall: Yes, and then the third wire would be an 0-1-8 Ni-Ti.
Howard Farran: 0-1-8. You're saying always with round.
Geoffrey Hall: Basically. It's very rare that we would be using rectangular wire unless there are specific reasons to.
Howard Farran: For my viewers, in America, the 10,000 orthodontists probably do 90% of all the ortho. These guys listening to you, I want you to explain what is the difference between Ni-Ti and stainless steel, and then secondly I want you to explain the difference between using a round wire and a rectangular wire.
Geoffrey Hall: Firstly, in the old days, if you go back to the told days of orthodontics, and you remember the old orthodontists would show you these wires with all these big loops in the wires and everything else, and no different too when you were at dental school when you made one of those URA's, those removable appliances to push an upper right lateral out of cross bite. What you would do is, you would actually add more coil into it, into the stainless steel wire. The reason you had more coil in it is to increase the flexibility of the wire.
In the old days, you couldn't get these thick stainless steel wires engaged into brackets. The whole way how orthodontics works, you put your brackets on, and whatever wire you put in there, the teeth are going to move to the shape of that wire. The brackets are just a handle on the tooth, and the teeth are going to move to the shape of that wire. In the old days we had stainless steel wire, which was too stiff. You had to be a really good orthodontist to be able to bend wires with all these loops to give it the flexibility to engage onto these brackets.
In the 1970's, Ni-Ti came along because of the space program, and you guys use Ni-Ti all the time now in endodontics. Ni-Ti is what we call a shape activated wire. It always wants to return back to its original shape. Here we are, we get it out of the box, it's a flat shape. It's a straight, round, flat shape. If we engage that into a bracket, that tooth would now want to move into its flat shape. It's just made orthodontics so easy that the key to is putting the brackets on the correct position, so the wire would then drive the teeth into the correct shape. That's Ni-Ti wire. They come in sizes so you do it in a very gentle, progressive force.
The nice thing that Ni-Ti is, we all remember from dental school days that orthodontic movement is a slow, continuous force, is the best way to move teeth. Now with Ni-Ti, whether you deflect the Ni-Ti wire by .5 mm or you have to deflect it to get into a canine by 5 mm, it's actually the same force level. You're getting the same consistent force. If you did that with a stainless steel wire, the force would triple in force, which then means the forces are too high, and you get what we call undermining absorption, and the teeth don't move, and you get more unwanted side effects. Ni-Ti has revolutionized orthodontics, as I can understand its revolutionized endodontic treatment as well.
The question that you have with round and rectangular wires, rectangular wires ... When you gauge a bracket to get torque, and by torque what mean is actually moves the root of the tooth. 90% of cases don't require root movement. Invisalign is very effective in moving roots of teeth because they're all pushing on crowns of teeth. Rectangular wire is very overdone in orthodontics. We get told as an orthodontist, you've got to put rectangular wire in, you've got to put rectangular wire in. In fact, when you talk to some of the best people around, they will tell you that the more times you put rectangular wire in, the more the case gets out of control because you end up with torque in different places, and the occlusion gets mucked up.
There are only specific situations where you do need torque control. For example, if you've got a wrecked incisor which is so pushed in palettely, then the root is still paletable. 90% of cases that we treat, they look fantastic just with round wire. We do teach people when to use rectangular wire, but it's not as often as what people would think.
Howard Farran: One of the reasons back in the day, when I got of school, 30 years ago, you know why back in the day a lot of the general dentists started doing some orthodontics is because 30 years ago if you sent any case to an orthodontist, 9 times out of 10 the diagnosis was pull the first 4 bicuspids, and then do the ortho. What it seemed like to everybody is that they would pull those 4 bicuspids, they would put in the round wire, level in the line and everything, and it'd look almost done in 6 months. Then they'd spend the next year and half trying to close back the 5 mm spaces where they had done these extractions.
What drove me nuts about it is, they would pull 4 bicuspids, and I would think, "They had MOD amalgams on their bicuspids. They had crowns on their first molar. If you just would have came to me and said make 5 mm space, I could have redone those old amalagams with composites with open contacts. I could have slenderized a little in between the teeth. I could have taken out those big, fat, bulbous crowns and put on crowns that were smaller. I could have made you your 5 mm of space while redoing a bunch of old amalgams and crowns and crap that needed to be redone anyway." It just seemed like everything was just one cookie-cutter approach. Pull 4 bi's.
If someone comes to you in 2015 and says, never, ever pull 4 bi's, now you're talking to an extremist. The truth is always 50 shades of gray. There is absolutely times when you need to pull 4 first bicuspids. There does need to be much moderation with all humans in all industries. Everybody seems to be yes, no, left, right, up, and down, when life is 50 shades of gray. I always thought it was amazing that general dentists are easily set to do these cases because if you got a bunch of crowding, and you got a bunch of MOD amalgams, and a bunch of crowns, you can take everything out of that arch, and then build it back up with matrix's that leave open margins and gaps, and then you put in just a simple round wire, and in 6 months they've gone from amalgam, crooked, ugly teeth to straight, pretty, and white.
Geoffrey Hall: Exactly.
Howard Farran: Fast.
Geoffrey Hall: In all honesty, the cases that we do, in 3 months, we've proven is just out of this world.
Howard Farran: My job is to guesstimate what these guys, or these cynics are calling you. I know the first question they're asking is, "How do I know that you're guy is going to put the bracket on better than my guy? Who's putting on your brackets? For all we know, they're no better at it than my assistant or me."
Geoffrey Hall: The good thing about this is that the ... when they brackets are put on, we have our arch wire in the brackets, and it shows you what the teeth are going to look like at the very end. You can determine ... The bracket that's in the position, that's what going to happen at the very end of the treatment. That's the key. It's driven by what is at the end of the treatment. You don't know when you put the brackets on to start off with how good they are until the teeth start to line up. What we're doing is seeing how the teeth are going to line up, and that determines the bracket positioning.
Howard Farran: Do you prefer to go by Geoff or Geoffrey?
Geoffrey Hall: Geoff's fine.
Howard Farran: Geoff, how sure are you? I think you guys can put them on better because your on a model on a bench, and I'm in some kids mouth. How sure are you, Geoff, that you're bracketing system is going to put the brackets on more accurate than if the dentist did it free-handed, or the orthodontist?
Geoffrey Hall: I hate to sound arrogant and say 100%, so I'm going to say 99.9.
Howard Farran: Really? You've been doing this for how many years?
Geoffrey Hall: We've been using the digital system for the last 3 years.
Howard Farran: Do any orthodontists use this system, or is this only general dentists?
Geoffrey Hall: There are some other systems an orthodontist swear by in America, which are purely designed for orthodontists. I think most orthodontists will tell you, the more arrogant ones will tell you. What's interesting is the position of the brackets, you'll have people tell you, for example, you put the bracket in the middle of the tooth, okay? Let's say people have been taught, they say they've been taught at uni, and there are case after case where you put the bracket in that middle of the tooth, but the tooth isn't still straight, and you don't know why. We can show you why with the digital setup. If we put it in the middle of the tooth, the tooth's not straight.
Howard Farran: Is this being CAD/CAM digitally designed or humans sitting on a bench putting these one?
Geoffrey Hall: CAD/CAM.
Howard Farran: It's all CAD/CAM?
Geoffrey Hall: All CAD/CAM.
Howard Farran: There's no way a human eye can do better than a computer CAD/CAM. The next thing they're asking is, what does this cost?
Geoffrey Hall: The whole system, I should go back a stage because one of the other thing about this Smilefast system that we do, which i think is even more important than everything else, is the support because it's all via the web. What doctors do is every visit, they put their photos on there, and I tell them what they should be doing next time. We have discussion about it. It's the best way to learn. We have a running commentary of every case that they're doing. They get a really great learning curve. With the education, the course that we teach, and the digital indirect bonding, but we have an on-going support system. That's all included in the case. It would be about equivalent of about $800 U.S. dollar per case. That includes the brackets, the arch wires, just about everything you need for that case. The elastics, the ligatures, etc., the digital indirect bonding with the 3D viewer like Invislign, and it also includes the on-going support from us.
Howard Farran: There's a 25-year-old woman that is driving her car right now, and she's saying, "Geoffrey, I'm confused. Should I learn first a fixed ortho like yours or a removable? What should I learn first? Should I be taking an Invisalign course or a removable tray course first or should I learn fixed?" You're talking fixed orthodontics.
Geoffrey Hall: I'm talking fixed orthodontics here.
Howard Farran: Explain to her the pros and cons of learning fixed, removable, and where should she start? Say she even wanted to learn both, which one would be first?
Geoffrey Hall: The fixed would be first. The reason being is the fixed is the most predictable, the most cost effective way to proceed, and what the fixed will do is teach the practitioner diagnosis, which cases to treat, which not to. One of my criticisms with Invisalign, in fact I was the first practitioner outside of America to do Invisalign, so I've been doing it since 1999. Invisalign believes that every case can be treated with Invisalign, which is not true. I think from an education point of view, they should do fixed first, but I think everybody should have Invisalign in their practice because they are patients there who just refuse to have anything else done because it is a very cosmetic appliance. Also, the fact is Invisalign, drives a lot of patients to the practice. They have to be, I think today, an Invisalign accredited provider. They have to do Invisalign, there's no doubt about it, but I would be doing the fixed first. I think they would get a much better concept of saying, "What cases should I do with Invisalign or not?" They'll get a much better knowledge to understand that.
Howard Farran: I think the worst part ... I'll give you a historical example, so you kids who are 25, I'll give you an example of what was going on 30 years ago before they were even born. In endodontics, everybody says in endodontics it's not what you put in the tooth, it's what you take out. It's the cleaning and the shaping is the success of endo. No one really cares what you are treated with. Then Thermofil comes out. Tulsa Dental Products, Ben Johnson, general dentist who practiced limited endodontics came out with this gutta-percha on a stick, and it made it so easy that general dentists quit cleaning and shaping, and as soon as they could get a file to the end, they'd warm up that gutta-percha on stick and shove it down there. Then when they would fail everybody would say it was the Thermofil, and blah, blah, blah.
I think the same thing is happening with short-term ortho is that these dentists, they get a little bit of training and start doing ortho cases, and I am old school, I believe you should know how to do fixed ortho first. You should learn how to do complete ortho, and all of these guys out there on the circuit teaching short-term ortho can't even do ... haven't even gone through a curriculum of any type of formal education on ... Yeah, you want to do fixed first.
I want to say something else that some dentists, sometimes I'll be sitting in a bar and these dentist will say, "Oh, I believe you 100%." Other dentists tell me, "I don't agree with this at all." I want to ask you. The reason I like fixed is because when I do removable, my patient is holding all the cards of the success. If they don't wear their removable then I look bad. When I see a patient, if she's a girl, and she's gone through the trouble to do her hair and put on makeup, and she's got mascara, and she's making herself uncomfortable by wearing 2, 3, 4-inch pumps on her feet, and you just look at her and say, "Wow! I spent 3 minutes getting ready. I stepped in the shower, showered, shaved flossed, peed, got out, threw on a uniform. I was out of there in 5 minutes. She's obviously spending a half an hour to an hour. She's obviously miserable walking around in these heels." I believe she'll wear it, and she always does last 20 years because she's committed to pain and suffering to look better,
God darn, when you see a 12-year-old boy laying there, and he's got a booger hanging out of his nose. He's wearing the same shirt 3 days in a row. His hair is matted up, and his mom is saying, "We want Invisalign or [inaudible 00:42:27]." I'm like, "Look at Billy. He don't care. If he can take them out, he ain't going to wear them." Every case I've ever had that failed was some boy that took looking pretty about less serious than I do. That's when you got to do fixed. You got to sit there and say, "I don't trust Billy to cooperate." The only thing Billy's going to be compliant on is his non-compliance. That's the only thing he'll be compliant on is his non-compliance. I want fixed. I want to make Billy not have to do anything in this case of work. Do you agree with that or not?
Geoffrey Hall: That's what I said to you just before, you said "Why fixed orthodontics?" I said, "It's predictable." I think that's the word. It's predictable. All of the removable appliance therapy, you get some good cases, you get some disasters. It's not predictable. That's why the fixed. The other part to is what you were saying before, I think is so correct. You've got to learn correct principles. The only thing dentistry ... The story that you talked about in endodontics, cleaning the canal first. Orthodontics has principles. I can teach 90% of orthodontic principles in 2 days. When people understand the principles, the rest of it is easy.
Howard Farran: Why don't you put that on Dentaltown?
Geoffrey Hall: I can do that.
Howard Farran: We've got 205,000 members. 205,000 members. You'd be a household name in a year in 206 countries.
Geoffrey Hall: We can do that.
Howard Farran: Back in our day, we used to fly around. I can't even count how many 15 hour plane flights I've had: New York City, Sydney, Melbourne, Auckland, Nepal, Hong Kong. Now, you can lecture ... that's what I love the most about podcasts. Usually I would have to drive to the airport, fly 4 hours, spend the night in some hotel, get up, talk all day to 300 people, and then fly all the way back to Phoenix. Now I can sit here at my desk and talk to 7,000 dentists in 206 countries every single time. That is just amazing. I think that dentists have a lot of anxiety, and they can sit here, and they're like, "I don't know, I'm stressed. I'm not going to make a decision. I'm paralyzed. I don't know if I should do Invisalign, fixed. I don't know, I don't know."
They're in the comfort of their home, in their la-z-boy. If they have Apple TV they can just throw it up on their big screen, go to Dentaltown online CE, watch you for an hour. Then if they got to the bathroom, whatever, they can just pause it, go to the bathroom, some one calls, whatever. Go through it on their own time, and then if they go through it on their own time, they'll think, "Yeah, okay, I'm going to give that a try." Is it any different dealing with a lab in Melbourne as it was if I'm in Phoenix dealing with a lab in LA or New York? What's the turnaround time?
Geoffrey Hall: The turnaround time would probably be about 10 to 12 business days.
Howard Farran: 10 to 12 business days. It's $800 all upfront for that one deal?
Geoffrey Hall: It's approximately $800 US dollars.
Howard Farran: What should the dentist be charging for this case then?
Geoffrey Hall: That's a good question. The way we look at this is ... We would probably be charging ... What we recommend in our course is to charge about 25% less than what orthodontists are charging for upper and lower treatment for 2 years with clear braces because one of the things we do at Smilefast is we want to take away the barriers of treatment. One of the barriers sometimes is appearance. We always use clear or porcelain brackets.
Howard Farran: 25% less, and the orthodontists would be a 2 year treatment. Is the average orthodontists 2 years?
Geoffrey Hall: Yes.
Howard Farran: How long would this ... You're calling Smilefast, I mean it's got to be faster. How long would you say the average case is?
Geoffrey Hall: The average case I reckon is about 7 months.
Howard Farran: 7 months? 25% less, and they'll get it done in a year and 5 months less.
Geoffrey Hall: Yeah.
Howard Farran: I want to add on thing. We're talking about money. I know I repeat myself on my podcast, but the lesson is not getting learned.
Geoffrey Hall: It's a very profitable procedure for the dentist.
Howard Farran: I want to say something. I want to give you an analogy because I don't believe in financing orthodontics. I believe that the first person that realized that made hundreds of millions of dollars. His name was Lazzara out of New Orleans. A catholic boy. He started Orthodontics Centers of America, and his genius insight that still no one [inaudible 00:47:19] this day, that put to orthodontists, and they say the typical ortho in the United States, with a class 1 ortho, study model [inaudible 00:47:28]. It's going to be about 6000. Then orthodontist is going to say, "To do this, I'm going to need a third down. I'm going to need 1500. The balance is 4500, and I'm going to finance that over the 2 years, and this is your monthly payment." Lazzara just said, "Whoa, whoa, whoa, whoa. You're brackets were 100 bucks. Your pano and your ceph were a dollar. Why do you need a third down?" The orthodontist said, "I did all the brain. I did all the diagnosis."
I said, okay, let's say that you need it down. Why are you financing it out because it's the same thing, hair, nails, teeth, getting a mani-pedi? What if you went into the mani-pedi, and probably 90% of them around the world, any place I got a mani-pedi, from Brazil to cruise ship, they're always Vietnamese. You go in there, what would you do if the Vietnamese girl said, "You need a mani-pedi every other week for 2 years. That's going to cost $1000, and I need $400 down. Then we're going to have to approve you for financing, and finance them out." You'd say, "Whoa, whoa, whoa, who, you're not going to have any cost until I come in to get the mani-pedi. Why am I paying finance interest on something you didn't incur?"
A dental office, 35% goes to the doctor, 25% to the staff, 5% to the facility, 6 to 8% supplies, 10% lab bill. You're not incurring any cost. It's not like General Motors who has to buy 30,000 parts in cash, put them, assemble a car, and when they sell you a car say, "Hey Geoff, I need 30,000 bucks, I bought a lot of shit to make that car." That's not what we're doing. We're selling a service. Orthodontics Centers of America came out and said, "Hey, 0% financing. 0% interest. Nobody's denied. No credit check. 249 a month for 24 months. Everyone's approved." All these mom's said, "Oh my God, my orthodontist wanted a $1500 economic barrier to entry. I don't have $1500. My girl looks goofy. She doesn't like her smile." They ran to Orthodontics Centers of America because there was no down payment, everybody's credit's approved. The guy was a flipping genius.
It spun out of control and went under, all this. What was the take away from Orthodontics Centers of America? Less than 1% of the people never came back because number 1, they're strapped up with braces. You just can't go home and live to be 80 years old with all that stuff on your teeth. Wires come off, all that stuff like that. So many millions of Americans were so satisfied because they didn't need a down payment. You could go in your community and say ... every orthodontist in your community's saying, "Oh yeah, we need $1500 down, and you go to have good credit, and we're going to finance the rest."
You could just tomorrow say, "Orthodontics in my office. We'll finance it at 0% interest. At 0% down. No credit check will be run. Everybody's approved. 249 a month for 24 months", or the short term ortho you're saying what, 25% less as a general dentist. That would be how much? 6000 bucks times .75 would equal $4500. Divide that by 24 equals 187. You could be out in the newspapers tomorrow say, "Hey! Geoff's Orthodontics in the middle of Ho-Honk downtown rural America, you know Kansas town dental office. We'll finance your ortho at 0% interest. 0% down. No credit check necessary. We'll do your braces for $187 a month for 24 months." All the mom's are just going to run to your office.
If you don't believe they're going to run to your office, then ask me this, why was Orthodontics Centers of America the only company, dental services organization that ever in the history of America made it to the New York Stock Exchange and had a billion dollar evaluation? You're saying you don't believe me, or that I'm not right. Go Google it, man. It's already proved us, alright. Nobody learned a lesson from Orthodontics Centers of America. This billion dollar company came and went, and 120,000 general dentists, 10,000 orthodontists, 20,000 of the other 8 specialties never ever discuss what that was all about. It was like a flipping hurricane that flew across America for 5, 6 years, and it's like as soon as it was gone, everyone was like, "Wow, what the hell was that?" They don't talk about the lesson learned.
The lesson learned is, you can't finance a service because you don't incur the cost of the service until you incur it. The mani-pedi shop doesn't have to pay their rent, equipment bill, computer, insurance on your appointment today verses your mani-pedi 2 years from now. It's completely bat-shit crazy. It's cultural.
Geoffrey Hall: We actually had a company in Australia that does exactly what your talking about. They outsource it. You outsource it, and they guarantee the money. It'd be an interesting something to give to America. That's what we use in our practice. We have exactly that situation.
Howard Farran: You mean it's a financing company?
Geoffrey Hall: Yes. 0 deposit, 0%, no credit checks at all.
Howard Farran: For ortho though ... A root canal is one appointment, but ortho is 24 appointments. They're very, very different breeds. You're our listener, do you think you might put a curriculum on this? How would they learn because number 1, you're in Melbourne, Australia. You ever lecture in the United States, or would all my homeys have to get on Qantas and fly 15 hours to Sydney?
Geoffrey Hall: I have lectured in the states before, and I lectured a lot in Asia as well. I think we should really look at doing something, even if it's just a simple few hour lecture on how to diagnosis orthodontic cases, and a really good introduction into what's a difficult case, what's a easy case, when to use aligners, when to use a fixed appliance system. At least get your viewers on board ...
Howard Farran: What aligner systems do you like? If someone had to pick an aligner system, which one would you like, which one would you recommend?
Geoffrey Hall: I would still be talking Invisalign.
Howard Farran: Invisalign? What about Tiff, how do you say his name, Tif [Desh 00:53:52] out of England?
Geoffrey Hall: The Inman aligner.
Howard Farran: Inman aligner. How do you say his name?
Geoffrey Hall: Querishi.
Howard Farran: Tif what?
Geoffrey Hall: Querishi.
Howard Farran: Querishi, that's a hard name to ...
Geoffrey Hall: Q-U-E-R-I-S-H-I.
Howard Farran: Q-U-I ...
Geoffrey Hall: Q-U-E
Howard Farran: Q-U-E
Geoffrey Hall: R-I
Howard Farran: R-I
Geoffrey Hall: S-H-I
Howard Farran: S-H-I. He's got rave ... You always hear Invisalign because they got a marketing budget bigger than the federal reserve.
Geoffrey Hall: It's true.
Howard Farran: Tiff, those Inman aligners, he's got a lot of raving fans all around the world. Will you talk about the difference between Invisalign and Tiff's Inman aligners or any other ones you like?
Geoffrey Hall: The problem with the Inman aligner, it's very, very bulky. It's a very bulky product. You can't wear the upper and lower together. It only has minimal movements on anterior tooth. You can't really move anything else above the upper anteriors, and it's only for labial and minimal movement and a little bit of rotation. There's not extrusions at all with the Inman aligner. It's ideally designed as a pre-prosthetic appliance. You'd move the teeth a little bit, and then you would do composite facings or porcelain veneers. Personally I find, in my hands, I found it very cumbersome. We're actually looking at a new aligner product, which I think is very exciting, and it's very hard to explain over a podcast. It's an aligner with Ni-Ti wire in the aligner. It's like Invisalign, but it's using the Ni-Ti wire to move the teeth.
Howard Farran: What company is that?
Geoffrey Hall: It's a company in Spain.
Howard Farran: Spain. Do you know it's www? Do you know the name of it or a URL?
Geoffrey Hall: I can give it to you. It's called Geniova. G-E-N-I-O-V-A.
Howard Farran: G-E-N-I-O-V-A?
Geoffrey Hall: V-A. Yeah. I've been over to Spain. We've been trialing it for the last 2 years. We're going to be probably bring that to the market as another part of Smilefast. In other words, you've got to do something as a pre-prosthetic alignment with very quickly in 3 or 4 months. Something which is removable, this would be fantastic. Then we've got the Smilefast for the more involved movements.
Howard Farran: I just went there. G-E-N-I-O-V-A?
Geoffrey Hall: Right.
Howard Farran: Very interesting. You think that's going to be a hit.
Geoffrey Hall: I'm just doing some more clinical trials at the moment. I've been them ... It's like all those products. When Invislign first started, it wasn't good enough clinically. We had a few difficult cases. I went to Spain a few weeks ago, and revisited it again, and we're now going to start a few more cases. I think if it works, which I can't see why it won't, it will be a very exciting product.
Howard Farran: Interesting. Very interesting. You only got 2 minutes left, what's your close, buddy?
Geoffrey Hall: What's a close? I believe, I think orthodontists need to change their approach to helping general dentists. I think they need to start to realize that orthodontics isn't as difficult as they think it is and stop trying to bluff everybody. I think general dentists need to make sure that whatever course they do, they got to be trained properly with principles, and they have a good technique behind them, and more importantly, good solid support with sound orthodontic principles. If they do that they will never get into problems in any area of dentistry. Orthodontics should be no different to the way they think about any other area of dentistry. Make sure they find the right person to teach them and the right system to use.
Howard Farran: I want to end on a little macro. You said in the very beginning that you were 75% American. You went to Philadelphia. A lot of these people listening have never been to Australia. Is practicing dentistry in Australia, my brother lives in Sydney by the way ... Tell Americans what it's like being a dentist in Australia, and is there any difference than in the United States? Is there any more incidence of decay? Do they eat the same amount of sugar? You guys use community water for a nation. Are there any low-hanging fruit differences between practicing here and Australia?
Geoffrey Hall: I don't think so. We've had fluoridation in our city for the last 30 years, so decay is just about non-existent.
Howard Farran: Did everyone turn communist?
Geoffrey Hall: No, but we have a lot of communist coming to our country. We have an enormous influx of Asian dentists coming in. What was interesting, David Penn, who was lecturing with you there was about to make me about 5 minutes, I might add, David was talking about 2, 3 years ago we had 210 registered dentists from Australia, now we have 953 a year. The competition is getting harder and harder.
Howard Farran: You went from 210 new dentists a year to how many?
Geoffrey Hall: To 950.
Howard Farran: How do you spell David's last name?
Geoffrey Hall: Pen, P-E-N-N.
Howard Farran: P-E-N-N, oh Penn.
Geoffrey Hall: Penn.
Howard Farran: Why was there ... That's basically 210 to 950, that's a 4-fold increase. What year did Australia start a 4-fold increase in dentists?
Geoffrey Hall: About 2 years ago.
Howard Farran: That was because the Australian government started recognizing a lot of dentists from other countries.
Geoffrey Hall: That was part of the reason, and then because of the private universities. They setup all these private universities, and all they want to do is get money to have their students come in.
Howard Farran: We're in the same in the United States. You have all these private schools, A.T. Still, Midwestern, Nova. You have all these private universities opening up. We've had a massive explosion of graduates too because there's no price elasticity in the schools. That's what the schools found out. They get 5000 applications for 50 kids, and they were charging $30,000 a year, so they said, "Let's charge 40,000." They still got 5000 applications. Now some of these schools are up to 100,000 a year, and they still get 5000 applications for 50 to 100 seats. That's what you call price inelasticity. Price has no effect on demand.
If McDonald's doubled the price of a Big Mac from 2 bucks to 10 bucks, they'd quit selling most of their Big Macs. That's called price elasticity where price has a very elastic effect on demand. You'll sell a hell of a lot more $10,000 cars in America than you will $100,000 Lamborghini. The global problem of dentistry right now around the globe, it doesn't matter if your in India, Brazil, Australia, and America, is that one third of the dental students, their dad's a dentist. I have 4 boys. If one of my boys said, I want to go to dental school, and the only dental school that would let him cost $250,000 a year, I wouldn't blink. I'd like, "Hell yeah. I want him to be a dentist."
There's no price elasticity on the price of education. That's what you've got to follow. There's going to be a bigger and bigger demand because when private money sets up a dental school, they got all the customers they can get. My word to the wise, when these dental schools are losing money, I'm like, "Why are you losing money if you're charging this much for tuition, and you turn down 95% of your applicants, and your losing money?" Does that make any sense?
Geoffrey Hall: I think ...
Howard Farran: What's a dentist supposed to do? You're talking to 25-year-old kids. What's a dentist supposed to do if the future means there's going to not be one dentist for every 2000, but there's going to be a day when where there's going to a dentist for every 1500, so what are you going to do?
Geoffrey Hall: Firstly, I think the days of a specialist are going to be gone. I don't believe there's that much left in specialists. I think what the dentists have to do is become what I would call a mini-specialist. They've got to be good at 3 or 4 different areas of dentistry.
Howard Farran: What do you think those 3 or 4 should be?
Geoffrey Hall: It has to be something in the cosmetic field because that's where the demand is. Whether they like to do perio, implants, but they have to be in a situation where they can't refer a lot out. They have to be able to enough work, but do it well.
Howard Farran: Cosmetics, perio, implants, what else?
Geoffrey Hall: If I was a general dentist, I would obviously throw orthodontics into the cosmetic area, obviously. I think there will be less and less endodontic treatment done. I don't think ...
Howard Farran: Why do you think there will be less and less endodontic treatment? You mean endodontists or endo in general?
Geoffrey Hall: I think endo in general. I think people are putting in more implants when something fails.
Howard Farran: When a root canal fails, there's going to be a lot more just extractions and implants.
Geoffrey Hall: Yeah.
Howard Farran: Instead of re-treats.
Geoffrey Hall: It's a more long term producing ...
Howard Farran: You're already seeing that endodontists, the endodontists are telling me that you've already seen the death of the apicoectomy. No one's going to do an apicoectomy. They're going to lay a flap and doing something, they're going to pull the tooth. It's killed apicoectomies, and it's really put downward pressure on re-treats.
Geoffrey Hall: I would say that's the 3 main areas. I think the other big area in dentistry that people need to get into today is sleep apnea.
Howard Farran: Sleep apnea. Cosmetics, which includes ortho, perio, implants, sleep apnea, and what was the other one? Cosmetics, perio, implant, orthodontics, sleep apnea, was there another one you said?
Geoffrey Hall: No, I think that was it.
Howard Farran: I think you're wrong. I don't think you should do any of that. I think you should just remember that you can marry more money in a minute than you can earn in a lifetime. You just need to go out there and find some rich, rich woman, and just marry her. That's my final thoughts.
Geoffrey Hall: Howard, if you have a name of someone in Melbourne, I'll take it.
Howard Farran: You mean you won't move to Phoenix to marry a rich, rich woman.
Geoffrey Hall: I would move anywhere in the world to marry a rich woman.
Howard Farran: I want to say one thing. This is my closing words. I have lectured in 50 countries. I have been all around the world. I take my boys to more countries than they can name, and the greatest civilization, society I've ever seen is Sydney, Australia. In fact, it's so great, my only brother moved to Sydney, and god dang, you don't need a car. There's a restaurant on every corner. It's a walkable society, a bicycle ... What's amazing, I don't know why the whole world doesn't get on ... these interstates in America, they're just jammed packed. You're the only civilization that figured out tunnels.
You need to go on the other side of town, and out of nowhere there will just be a tunnel, and you drop down. They built tunnels clear under Sydney, and you pop up the other side. In all our American cities they say, "We don't have a place for this freeway, there ..." Hell, the Australians, I don't know if it's because they're part kangaroo. Do kangaroos live underground? How did you guys figure the obvious that if you can't build a freeway here, then just dig a damn tunnel. Those cab drivers are just ... I say, "How long is it going to take to get there?" "No problem, I'll just in the tunnel and pop up the other side." Is that just amazing or what?
Geoffrey Hall: Australia is great place to live. I have to agree with you.
Howard Farran: Sydney's the only city where every time I do visit my brother, I just like, "I don't want to go back to America." I would kill to trade places with my brother, Paul. You don't need a car. He can walk out of his house and go to any bar or restaurant. It's just so ... and the people love Americans.
Geoffrey Hall: They do. They absolutely love Americans.
Howard Farran: They go out of their way to tell you they like Americans because there's a lot of countries you go to, you want to wear a Canadian jacket with a big maple leaf on the back. There's a lot of countries that do not like Americans. I will tell you that. I got a free dinner in Italy because this guy started yelling at me and my son about American policy and this and that. The owner of the restaurant got up and kicked the old man and then comped us for a free dinner. I'm like, "Wow, that was nice. Anybody can yell at me for a free dinner." It's probably going to be a $250 tab. Australians love Americans. You don't need a car. The weather is perfect. It's just, man. To think it was built all by ex-convicts.
Geoffrey Hall: I think there are still some convicts.
Howard Farran: Is that an inappropriate joke? Is that an inappropriate joke when someone makes a joke about Australia being a prisoners colony?
Geoffrey Hall: No, not at all.
Howard Farran: It's not at all?
Geoffrey Hall: We sent them all to Tasmania, so don't worry. It's alright.
Howard Farran: We're on double overtime. We're 7 minutes over. Geoff, thank you so much. I enjoyed listening to you lecture 3 times in Melbourne and Sydney and Brisbane. I know all these Americans can't go see you lecture live in there. I hope you have a digital learning strategy on Dentaltown. I would love to turn 205,000 dentists onto your message. Thank you for all that you've done for dentistry. Most of all, thank you for being an orthodontist and talking to a little, low-life, general dentist like me today. That was so big of you.
Geoffrey Hall: Thank you, Howard, for talking to me today. It was wonderful. We'll speak soon, and we'll see what we can do about getting a digital online ...
Howard Farran: I usually go visit my brother every year and take 2 or 3 of my sons. Next time I go down there, are you going have coffee?
Geoffrey Hall: That'll be fantastic. Let us know when you're there.
Howard Farran: You're in Melbourne, right?
Geoffrey Hall: Yeah. You should come to Melbourne. Have you been to Melbourne?
Howard Farran: I've been there like ... I've lectured there like every 5 years for the last 25 years.
Geoffrey Hall: I'll either see you in Sydney, or you come to Melbourne.
Howard Farran: Okay, buddy. Thanks for all you do.
Geoffrey Hall: Howard, thanks very much. Thank you.