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AUDIO - HSP #269 - Ron Kaminer
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VIDEO - HSP #268 - Ron Kaminer
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Dr. Ron Kaminer got an early start with lasers. Check out his latest projects in this fast paced interview.
Dr. Ron Kaminer graduated from the New York State School of Dental Medicine at Buffalo. He subsequently completed a two-year postgraduate residency in Advanced Dentistry at Northshore Hospital on Long Island.
Dr. Kaminer is a noted author, lecturer, and teacher on topics such as laser dentistry, minimally invasive dentistry, and high-tech dentistry. He maintains a teaching appointment at Peninsula Hospital in Queens, where he trains post graduate residents in advanced pediatric and cosmetic education. He earned the mastership award from the World Clinical Laser Institute and has been featured in New York Newsday, The Orlando Sentinel, and MSN Money for his proficiency in laser dentistry. Dr. Kaminer is also "famous" in Hollywood. You'll see his name in the credits of the Steve Martin movie Novocain.
Dr. Kaminer brings to his practices a comprehensive level of care and knowledge of the most cutting edge dental technology. For many dental product manufacturers, he tests and reports on technology not yet available in the marketplace.
Dr. Kaminer lives in Hewlett with his wife and three children.
http://nylaserdentistry.com
Howard: I'm live with the Greater New York meeting and I was just talking to a friend of minute, Alan Miller of Alan Miller Design Lasers and he said when he launched his laser you're the smartest guy he could find to teach lasers. Congratulations on being that guy when there's two million dentists on earth. Why did he pick you to teach lasers? What's your background on it?
Ron: I'm been practicing 25 years. Day one started using dental lasers. I've taught for every laser manufacturer. According to him I've trained more hard tissue and soft tissue laser on earth than anybody around. It might be a little bit of an exaggeration but I'm probably up there, one of the top three guys who train more laser owners than anybody on hard and soft tissue lasers. I know a little bit about lasers.
Howard: Did you start off in soft and move to hard or hard to soft or ...?
Ron: Here's a great story.
Howard: Tell us your very beginning. Where'd you get out of school?
Ron: I went to dental school in Buffalo. When I was in school at Buffalo, sophomore year ...
Howard: Please tell me you're not a Buffalo Bills fan.
Ron: I'm not a Bills fan.
Howard: Otherwise your heart may be going out on you right now. We may need to call a cardiologist.
Ron: When I was in dental school at Buffalo, sophomore technique crown and bridge was a critical class. If you flunked crown and bridge you had to repeat a whole year. There was an instructor. Him and I didn't get along. Obviously in that respect, the student loses. I flunked sophomore technique crown and bridge by 3 points out of 400. He made sure to grade my last three practicals and I flunked. I got A's and B's in everything else. I petitioned the school. They wanted me to repeat the entire sophomore year. I petitioned the school and they said, "All right. Just repeat some of the technique. You can move on didactically." That left me with a ton of free time because the schedules didn't totally mesh.
A instructor in the oral surgery department who recently passed away, Chuck [Lebos 00:01:57] said to me, "Ron, why don't you come do some laser research when you have all this time?" I said, "Laser research? I don't know anything about lasers." "I'll teach you." Fast forward two years later. That's why I did dental school in five years but fast forward two years later. I was the university's representative at the ADA meeting back then in Hawaii showing my laser research. I presented at a medical meeting, the Academy of Laser Surgery in Medicine my medical research in front of 300 physicians, my first lecture in my career, and got out to private practice and had to have a laser.
The guy that flunked me in crown and bridge basically changed my course of my career because I had lasers day one. Became acute [inaudible 00:02:35] leader way back when with a variety of manufacturers because of my lasers and he wrote my destiny.
Howard: That is so cool. Turn lemons into lemonade. What was your first laser?
Ron: The first one in my office was a Luxar carbon dioxide laser, soft tissue laser. That was my training originally. Very quickly a number of years later, I walked past the Biolase booth at the Academy of Cosmetic Dentistry meeting. Starting playing with a hard tissue laser. Maybe they had sold 40 or 50 in the country. As they were closing the booth, after I had visited back about 10 times. The booth was being taken down kind of like around the time now and the rep said to me ... He knew me by name already ... He said, "Ron, you going to buy this thing or what?" I finally said, "All right. Let's do it."
Back then there was no training. The reps didn't even know much about it. I started developing techniques and courses and went to Biolase and said, "Hey, you can't sell these things without a training course." We started training dentists out of a facility that we built in New York, a training facility. I did that for Biolase for a great number of years, then for Fotona. Now AMD is launching their hard tissue in the States and we're going to start training. We're going to have three centers across the country. One in New York, one in Chicago, one in Colton, California. We're going to start training our hard tissue laser ones as well.
Howard: Where are those training facilities, are they dental offices?
Ron: They are dental offices that have a separate facility whether it be a dedicated area with plasma TVs connected to computers, areas not in the clinical space. My office for instance, we have a finished 2500-square foot basement facility that has TVs wired up to the operatory with sound so I can totally be doing work on a patient, have someone down there who is with me communicate questions and things like that. They can watch the procedure eating a New York bagel downstairs while I'm doing the procedure.
Howard: Where are your three centers going to be?
Ron: One in New York. One in ...
Howard: Is that New York? Is that your office?
Ron: That's my office.
Howard: How many does that hold?
Ron: It'll hold 35 people.
Howard: How many operatories?
Ron: My operatory has 6 operatories in the facility.
Howard: What's the other one?
Ron: The one proposed is going to be in Chicago. I haven't seen it recently but when I've been there in the past, held about 20 people, also a separate operatory office.
Howard: Who owns that office?
Ron: Frank Feng is the dentist who potentially is going to be teaching and James Jesse in Southern California in Colton.
Howard: Oh my God.
Ron: Do you know James?
Howard: Yeah. He's an instructor at Loma Linda.
Ron: He is absolutely. Jim and I taught hard tissue lasers together for 15 years. He'd come to New York.
Howard: I took his classes 20 years ago.
Ron: There you go.
Howard: He's an amazing guy. There's also a facility ... Implants Direct has a facility in Vegas.
Ron: Correct. We're going to look for other opportunities I think as well. It depends, I think, on volume and how many people we're going to train.
Howard: Can you leave a message to James Jesse that I want to podcast him?
Ron: Done. I'll text him when we're done.
Howard: He's so damn cool. I love that guy.
Ron: Jim's a great guy.
Howard: He's going to be one of your instructors?
Ron: He definitely will.
Howard: Who are all your instructors going to be?
Ron: Right now we're putting together our body of instructors. We're going to seek out a good number of people who we know have taught in the past. Lasers are about training. A dentist who is happy needs to be trained well. Jim's a phenomenal educator. As you say, Jim and I taught for many, many years. We're really going to go after some experienced guys who've been in the industry for a while.
Howard: You used to work for Biolase for a long time.
Ron: I wouldn't say work for them but I was one of their key guys way back when.
Howard: I guess the most uncomfortable question I could ask you since this is dentistry uncensored [inaudible 00:06:01], what's the difference between this and Biolase because this Light Touch is an erbium YAG for about 50 grand.
Ron: Correct.
Howard: What's a Biolase cost?
Ron: The Biolase, it probably runs between 70 to 85 thousand dollars. They're similar family of wavelengths. Biolase is a patented wavelength but they're very, very close. They're both erbium family wavelengths. They both cut hard tissue and soft tissue really, really, really well. There's nothing bad to say about Biolase. Al Miller is brilliant when it comes to bringing quality into the market at lower costs. This unit is much smaller, more compact. It carries the same power, is able to do exactly the same things for really almost half the cost. It's going to be a fun ride.
Howard: Will it be half the cost? This is 50 and you said the other one is 70 to 85?
Ron: Two thirds of the cost.
Howard: A third less.
Ron: The other ...Let's say you want to call it the other hard tissue on the market is Solea which is a CO2 hard tissue but still a hard tissue laser is up 119 thousand dollars. When people are looking for lasers they're going to look at Solea, Biolase and Fotona.
Howard: Talk specifically, what is really the difference between a carbon dioxide, a CO2 hard laser and an erbium?
Ron: It's all in the wavelength. They're all vaporizing water within the tissue itself. It's all in the wavelength. Talk to the Solea guys, they'll say theirs is more efficient and quicker. They all cut hard tissue really, really well. If you closed your eyes and I gave you each laser and you looked at what you had afterwards, you'll see a nice preparation probably with all of them. They're all extremely, extremely efficient.
What Al did for the diode market AMD when diodes were selling for 10, 12 thousand bucks, he brought the Picasso in and sold it for 5. He went from what I call zero to hero in five years. The number one selling soft tissue laser in the world in five years. He's poised to do the same with this. Dentists are still always price conscious but give them something of value at the right cost, teach them how to use it, get the best trainers out there, support it with the right manufacturer and it's supposed to be a winner. That's the direction that he's really heading into.
Howard: Talk to [my homies 00:08:08] out there. The number one thing we hear from patients is ... Half the questions are money, money, money. How much is it? Will my insurance pay? Will Care Credit finance it? Can I make payments? Half the issues is money. After money, I see it switches to pain. Do I have to get a shot? Do you have nitrous oxide? Can you put me to sleep? Then it probably moves ... What is it going to look like? Now which teeth is it?
Sometimes we hear from lasers that you don't need a shot. Then other dentists say, "Naw, they're full of it. That's marketing." Tell the truth. If someone bought a Picasso or Lite Touch erbium YAG hard tissue laser, what fillings could it do really without a shot?
Ron: One of the things I think that many manufacturers have built on and years ago was, no shot, no pain dentistry. The reality is you can do a lot without anesthetic but to say that I'm not giving injection ever again with any of these products is absolutely false. Having done 20,000 teeth over the years probably with lasers, I would say I can do my pediatric dentistry 90 to 95% no injections. That's routinely regardless of depth.
Howard: Pediatric dentistry what?
Ron: 90 to 95 no injections. Deciduous teeth.
Howard: That's [crosstalk 00:09:27] surface too?
Ron: Any surface you want regardless of depth. Sometimes even we can encroach and get into the pulp and they still don't feel it. I would say adult teeth it's closer to 60 or 65%. Still you can do ...
Howard: 60 to 65% occlusal ...
Ron: No anesthetic. Occlusal, class II, class III, MO, class V. If they weren't sensitive before in a class V, then you can probably get the class V done with the laser without an injection. Can you promise that all the time? Absolutely not. It depends on your patient. Go into your geriatric patient, smaller [pulps 00:09:58], things like that, you'll do 80% of the work without anesthetic. 100%? Absolutely not. Because this is an all-tissue laser, you go soft tissue side, it's still going to generate heat even though there's air, water and laser energy coming out of the tip, you have to anesthetize or use one of the compounded super topicals that are out there to do what you have to do. That's true with all of these lasers.
Howard: Look at my homie. Who should get that? Who does this fit? Which practice does this fit best?
Ron: I think first of all for pediatric dentists it's a no brainer. Over the years I've taught many pediatric dentists and they've built their practice on laser technology. For the GP doing a variety of procedures, who's doing routine operative, some surgery, it's a no brainer. Today we had a number of periodontists go out and buy the laser. They want to find a minimally invasive way to do a maximally invasive procedure. Lasers allow them to do that. It fits them as well.
You can make a case for almost anybody but an orthodontist to buy this type of laser in their practice and they'll be happy with the results that they get.
Howard: Pediatric dentists or your children would be the most freaked out by a shot. If mom doesn't like you, dad doesn't like you but you do with their kids, they're all coming to you. Mom will throw the whole family under a bus if little Jimmy and Janey like you. You think this is a no brainer for [pedo 00:11:27]?
Ron: It's a no brainer for pedo. They will build a practice. I have kids that specifically come to me for using the laser. "Are you going to use the laser today, doc?" The only limitation really is removal of metals. Amalgam still presents a limitation. It'll remove composite and [glassona 00:11:43] very, very quickly but amalgam if you have to remove existing amalgam you have to go back to shot and drill because it's not meant to remove metal.
Howard: Then a lot of people say, well, it's slower than a drill. Other people say, well, yeah, but you don't have to wait for the anesthetic to soak on. When you used to sit down and give a shot, then let it soak in, now you just sit down, pick up the laser and start going. For total time, what does the total time look like prepping with light touch, erbium YAG laser versus numbing up, then using a high speed?
Ron: My line always was in my lectures was, if you're going to anesthetize and have a case that I'm not, typically my patient will be almost walking out of the chair before your mandibular block took effect and really hits. Your preparation is very, very quick. Your time is in the restoration really not in the preparation. It'll cut if you want. It's fast as a high speed.
You bring up an important point. What if a patient wants laser technology but you have to numb him up? If I crank the power of a laser I'll cut as fast or faster than that of a high speed. We cut at low powers because it leads us very often to not to need to use local anesthetic. It's still cutting quickly but in that situation if I were to race a 557 and a laser, the 557 would win. If I take the entire treatment, no anesthetic versus the block, well we're going right at it. Right at the beginning it's very, very rapid.
Now take into account, what if the patient has multiple filings in multiple quadrants and I can do an MO on 3, a DO on 31 and an occlusal on 14 and a distal on 20 all in the same appointment if I don't have to anesthetize or an occlusal on T and a DO on K all on the same appointment. Now you're much more productive. It leads you to productivity as well instead of breaking up the appointments.
Howard: I want to ask you something very controversial. This is dentistry uncensored. We still have 5,000 pediatric dentists doing sealants all day every day while a lot of other people build up a body of research saying that 40% of these sealants have failed in a year, 80% have failed in two years. There's a lot of people who believe that you should only do preventative [resin 00:13:53] restorations which is a occlusal composite. True or false?
Ron: Did you know I lecture on sealants and caries detection? Did you know that?
Howard: No, I didn't but I [crosstalk 00:14:01] you're the smartest guy in your [crosstalk 00:14:03].
Ron: Here's the trend. Today I think that's always been a concern obviously. There are a number of manufacturers that make clear sealant materials that will allow caries detection devices to fluoresce through the sealant. For instance, Air Techniques and Acteon have caries detection devices that use fluorescent technology. That you image the tooth, it will show up on a screen and tell you if there's caries in a groove or not.
If you can take an image of the tooth and it tells you there's no caries in the groove and put a sealant over it and then fluoresce through that sealant in four months, six months, a year or two years later, what value does that bring to your practice? Or if you can fluoresce initially and it is a little bit of caries in the distal part of the occlusal groove and you just go ahead and do a minimally invasive restoration with a hard tissue laser with no anesthetic and seal the rest and can fluoresce through that six, nine and twelve months later, what value does that bring to the table?
It's all about education and the technology today. I think that's where we're going. Voco's got a clear sealant material that is transparent. You can fluoresce right through the sealant, called Control Seal.
Howard: Slow down. Voco has a sealant. What's the name of it?
Ron: Control Seal.
Howard: Control Seal. What do you mean fluoresce through?
Ron: Acteon's got a caries detection device that uses fluorescent technology. It's like an intraoral camera but it has different LEDs in the head that allow you to take a digital image of the tooth and that image appears up on a screen. If there's no decay there, the image will look like a green tooth with a bunch of grooves inside. If there is decay, well then what happens, you will see in the grooves of the tooth, you will see different colors.
Acteon has developed a proprietary scale that correlates with those colors. Blue would mean early enamel decay. Red deep enamel decay. Orange would be deep dentinal decay and yellow early dentinal decay. Not exactly in millimeters but it gives you an idea where the tooth is. What if ...?
Howard: You scan this and it goes on to a separate monitor?
Ron: It goes right onto your monitor. You could keep that ...
Howard: It's called Acteon?
Ron: This is Air Tech's device called Spectra. Spectra by Air Techniques.
Howard: Have they done an online CE course for this?
Ron: They've done some webinars. Online CEO, I don't know.
Howard: Do you think you could get them to send me an hour long ...
Ron: Absolutely.
Howard: [inaudible 00:16:26] course?
Ron: Acteon's got a product too called SoproLife that does something similar. It doesn't have the scale but it also fluoresces onto the tooth. I could save that image in my imaging software.
Howard: There's my e-mail howard@dentaltown [crosstalk 00:16:38] sell.
Ron: Got it. I will do that.
Howard: I wish you'd do that because I think all dentists agree that it's mostly about the kids. Everybody would rather get an A in pediatric dentistry than in geriatric dentistry. I mean why fix up grandpa when he's going die next Thursday. I'm really concerned about sealants and sealants failing and I would love to learn more [crosstalk 00:16:59].
Ron: This is the way this technology is going. Acteon's product does the same thing without the scale. It's about getting that image, being able to see what you've got preop, imaging through a sealant postop and being able to follow that image six, nine, twelve months later. Not to harp on this but one little more point, let's say you say to me, "Ron, you know what? Forty percent or sixty percent of those sealants have decay but it's early decay. What if I could take a remineralization cream like MI Paste from GC or Reminpro from Voco with a brush, just paint it in those grooves, put a sealant over it and see nine months later if I could remineralize those grooves from the inside out?
Howard: I know, that's cool. I love both of those [inaudible 00:17:43].
Ron: It's possible. That's where we're going with the growing teeth. That's what this type of technology can really get to. It's wild.
Howard: Whose the dentist product champions on those? Who could we talk to?
Ron: Talk to me.
Howard: Why don't you build an online CE course?
Ron: I could definitely do it.
Howard: Could you do that?
Ron: I have a [KOL 00:18:01] for all these manufacturers and I could definitely do that for you.
Howard: I wish you would do that. There's 5,000 pediatric dentists in Dentaltown and it is the most active part of our community. Dentaltown has on the app, if you look right here, we have 202,000 members and that was a minute ago, two minutes ago. They're talking around the clock but we go to categories. We have a category called lasers.
Ron: I'm a big contributor.
Howard: Yeah. The Pediatric Dentistry Board is one of the most active boards we have on dentistry. I would love to have an online CE course.
Ron: You could definitely do that. The technology about tooth growth and what's happening and re-mineralization protocols, we have a phenomenal technique in treating white spots and getting white spots to look normal using a technique that we've come up with. A lot of fun things that we can do in that space.
Howard: Well, thanks for letting me go by and snag you in your booth. Congratulations on you guys squeezing the cost out of this things, getting a product that's usually 75 to 85 to 150 thousand down to 50. That's Alan Miller's legacy is just squeezing cost down. That's so cool of a story that you got into this because of troubles in crown and bridge. Thank you all so much for what you do and I would love to come back and get a course to really explain these sealants.
Do you agree that most traditional sealants as we do them now are just failing and not working?
Ron: Absolutely because there's just been no way to monitor. We can use dyes, we could do stuff, they're just too inaccurate. These devices really can hone things down and really can make a sealant a much more predictable final result.
Howard: If it was your daughter? How old are your kids?
Ron: I got 23, 21 and 19.
Howard: My oldest is 26, so maybe a granddaughter. Your granddaughter when she gets her six-year permanent molars, is it going to be a sealant or a preventative resin restoration?
Ron: It'll be visualization with a caries detection device and it will be a sealant for sure.
Howard: Really?
Ron: For sure.
Howard: See mine is three years away. My little Taylor is only three but I would say when it's six, I will actually clean out the grooves and do a [inaudible 00:20:26] res and restoration but you're saying we don't have to do that.
Ron: With those devices today you just ... If you start using one and you will see how accurate they are and how specific they are, I think you'd be blown away.
Howard: Well that would be pretty damn cool. If you put on a online CE course on Dentaltown and change my view for your little niece.
Ron: Absolutely. Done.
Howard: All right buddy.
Ron: Howard, thank you. It was a pleasure.
Howard: All right. Thank you so much for coming by.
Ron: You've got it.