Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356
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358 FirstBite Dental with Agim Hymer : Dentistry Uncensored with Howard Farran

358 FirstBite Dental with Agim Hymer : Dentistry Uncensored with Howard Farran

4/9/2016 7:18:58 AM   |   Comments: 0   |   Views: 650

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VIDEO - DUwHF #358 - Agim Hymer
            



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AUDIO - DUwHF #358 - Agim Hymer
            



Dr. Hymer travels the world lecturing in many aspects of dentistry. He is a senior lecturer for Progressive Orthodontics.”My aim is that dentists and the public are fully informed in what is available in the world of dentistry.”

 

Education

984-1988: Melbourne University, president of Dental Students Society in 1986

 

Professional Info:

1990-1992: Member of the Medical Board for the Mildura Private Hospital

1993-1996: Worked in private practice in Malvern and Brunswick

1995-2003: Member of the Medical Board for the Vaucluse Hospital

1997-Present: Owned and worked in my own practice, employing two hygienist, therapist and an associate dentist

 

www.firstbite.com.au 

www.progressiveseminars.com 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
            

Howard:

            
            

Hey, it's a huge honor for me today to be hooking up in Singapore with my drinking buddy from Sydney, Australia. Last time I was visiting my brother in Sydney I was with two of my sons. It was Greg and Zach. We went out to a restaurant and you were there.

            

 

            
            

Agim:

            
            

That's correct.

            

 

            
            

Howard:

            
            

My God, you were the life of the party. You are, let me tell you. I think the biggest memory was them hanging out with you that night. They really did have a blast.

            

 

            
            

Agim:

            
            

I tried to look after them.

            

 

            
            

Howard:

            
            

You did and they had fun. You're quite the fellow. We're about the same age. You graduated in 1988 from Melbourne, University. I graduated in 87. You were president of the dental student society in 86. You've done so many things. You have a practice in Melbourne today, right?

            

 

            
            

Agim:

            
            

That's correct.

            

 

            
            

Howard:

            
            

That's where you practice now. You're married, you got three children, two girls, a boy. Your goal is to educate the public about dentistry and on clients empowered to work with their dentist to achieve the healthiest smiles they want. You've been lecturing for Progressive orthodontics for how long? About a decade?

            

 

            
            

Agim:

            
            

Nine, ten years.

            

 

            
            

Howard:

            
            

Yeah, a decade. Progressive orthodontics has been the worldwide leader in [comparance 00:01:25] of orthodontic continuing education since 1984. Over this time it has developed a training philosophy that is practical, easy, reproducible, and effective in allowing students to quickly make a return on their investment while also giving care to the highest standards in the world. The philosophy also incorporates lifetime education with the free lifetime retake policy and unparalleled access to instructors outside of class hours. These philosophies have helped develop a loyal worldwide following with over 5000 members of the POS family, that's Progressive Orthodontic Systems.

            

 

            
            

 

            
            

In 2008, Progressive dentistry was formed to take the same philosophies to other areas outside of orthodontics. What started out as one course taught by one of our top orthodontics instructors has rapidly expanded into a career with a wide variety of offerings and all the exciting topics of dentistry. Currently all classes are taught at a state of the art teaching center or headquarters in Aliso Viejo, California?

            

 

            
            

Agim:

            
            

That's the head office.

            

 

            
            

Howard:

            
            

That's the head office. They have also brought many courses, international ones. I know from my buddy Alan Miller, the founder of AMD lasers, that's Alan Miller design lasers, you're also teaching his AMD lasers, right? Picasso?

            

 

            
            

Agim:

            
            

That's correct. I do that for Dentsply in Australia because they do it. Then in Singapore I'm doing a lecture tomorrow night on the AMD lasers for all the Singaporeans.

            

 

            
            

Howard:

            
            

We were messaging each other today that we were both in Singapore at the same time, so I talked him into coming by the hotel and doing a podcast. You're talking to thousands of dentists. Let's start with two things. Is orthodontics something a general practitioner should add? If they're doing fillings and crowns, do you think they should get into orthodontics?

            

 

            
            

Agim:

            
            

I don't think you can do dentistry without knowing orthodontics. I think it's a total same that no university in the entire world teaches orthodontics properly to general dentists for whatever reasons.

            

 

            
            

Howard:

            
            

It's because they didn't pay enough money. They're only graduating with $350,000 here, so a third of a million dollars. How could they have incorporated all of them?

            

 

            
            

Agim:

            
            

Everything is orthodontics. You're doing porcelain veneers, you're doing periodontics, you're doing implants. Everything is learning orthodontics. I think one of the reasons is orthodontists are a bit scared that dentists will take over the market, but I know, like I'm lecturing today to fifty Singaporeans in the class. We're doing the advanced class. Them learning the advanced system doesn't mean they'll do it. They'll just know what not to do. They'll learn to diagnose, they'll learn what's within their capabilities, and they'll learn to refer what's not.

            

 

            
            

 

            
            

There will be a chunk of dentists who are so excited they'll go and do everything that we're teaching them. I don't think the orthodontic world should be scared of general dentists doing orthodontics. I think it opens up the market for everybody. Everything we do in dentistry is orthodontics. Just everything, case after case. We're doing an update in April this year. We called it multidisciplinary where it's periodontics, it's implants, it's prosthodontics, and how to combine orthodontics in all of those. It just makes us better general dentists.

            

 

            
            

Howard:

            
            

I agree, and I don't think in 2016 you can call yourself a cosmetic dentist without unraveling these teeth before you do veneers. I remember back when I got out of school in 87 when you went to a lecture of a famous cosmetic dentist, it would be massively crowded teeth, and they'd have to file them all down with a drill. Oftentimes you'd have them do a root canal on a couple of the teeth because to get them straight you had to do endo. Now standard of care is unraveling those teeth before you would do something like that.

            

 

            
            

Agim:

            
            

Exactly. Doing it within your capabilities and what you're happy to do, or refer. You still refer, no different to endodontics. You do the endos you're happy to do or refer the ones you're not. Periodontics, do the perio you're happy to do or refer to a periodontist. We teach that you can do anything. Anything's possible, especially with [Scalado 00:06:02] anchorage now and orthodontic pins. To be  controversial, I think a lot of the maxillary surgery isn't needed anymore. Mandibular advancement yes because of the retruded mandible. A lot of these gingival display, we're teaching dentists how to just put some pins in the jaw, give them some paracetamol, and go home. We can correct gingival display nowadays without maxillary surgery.

            

 

            
            

Howard:

            
            

Okay, explain how you do that.

            

 

            
            

Agim:

            
            

It's very easy. It's the orthodontics. What do you do? One, you got to diagnose the case. You've got to diagnose what is the problem. Is the problem that it's delayed passive eruption? If that's the problem, then it's a cosmetic gingivectomy. The other problem is is it maxillary excess? It's the diagnosis that's the difficult part. If it's maxillary excess, then you can put a couple of little pins into their bone and you can just lift that maxilla up knowing the orthodontics behind it.

            

 

            
            

 

            
            

It's very easy, and it's still an 18 month case. It's a very easy case, whereas a lot of the orthodontic world is still doing orthognathic surgery, which is like a car accident. I don't know why a lot of people still doing that. That's very basic orthodontics behind it. Or it could be they've got a short lip, so there's a surgical procedure for that, or it could be that they need some Botox to stop their top lip moving up. Once you decide what the problem is, a general dentist can deal with all of that nowadays and deal with it simply.

            

 

            
            

Howard:

            
            

You're hitting the big 5-0 this year, right?

            

 

            
            

Agim:

            
            

That's right.

            

 

            
            

Howard:

            
            

When we got out of school, there really wasn't clear liners. It was all brackets and bands. Do you see the market really shifting away from brackets and bands to clear liners, like Invisalign or Clear Connect or all these different brands? Where's your stance on that?

            

 

            
            

Agim:

            
            

Me personally, I'm more of a purist. I like the braces because it definitely does a nicer job. In saying that, I'm not silly because Invisalign and Clear Connect, the market wants it. We now practice, we offer all those things too. We look at the case, we show the patient. We don't rely on the company Invisalign to tell us what to do because we know the orthodontics behind it. We can diagnose the case and say to the patient, "This is what you'll get from Invisalign. This is what you'll get from braces, what we can achieve. This will be the difference between the two. Which would you like?" Then the patient decides which way they want to go. If someone came in for Invisalign, I would say probably 30% of those will go to braces because we could diagnose what each system will do. Then the ones who still want Invisalign, we do the Invisalign. We don't have problems with it at all.

            

 

            
            

Howard:

            
            

What's the cost of difference of fixed braces versus Invisalign?

            

 

            
            

Agim:

            
            

The fixed braces is cheaper.

            

 

            
            

Howard:

            
            

By what kind of factor?

            

 

            
            

Agim:

            
            

I can only go by Australia. Let's say a simple fixed braces case in Australia would be around about say the 6000 kind of mark for a simple level alignment, where as Invisalign for a simple case could be six and a half, six eight.

            

 

            
            

Howard:

            
            

What would the lab fees be on Invisalign versus fixed?

            

 

            
            

Agim:

            
            

That's the problem because Invisalign would be $3500 whereas braces would cost the dentist about $180. The profit in the braces is much higher.

            

 

            
            

Howard:

            
            

That is not nearly as big of an issue in a very rich country like Australia or Canada or New Zealand or Germany or Scandinavia. When you get to a poorer country like Vietnam or Cambodia or Malaysia or Indonesia, that lab fee, just the lab fee alone is more than they can get for the whole braces. Would you agree or disagree?

            

 

            
            

Agim:

            
            

100%. Progressives, we teach in Vietnam, Progressive has become part of one of the university courses for the general dentist in Indonesia now. They're going to be learning orthodontics like no other university teachers.

            

 

            
            

Howard:

            
            

In Jakarta?

            

 

            
            

Agim:

            
            

No, it's in Medan I believe. We teach in Nepal. Nepal charges 800 US for an orthodontic case. We go there and we teach them how to do it. Progressive sells their own brackets, but it doesn't mean you have to use it because we teach orthodontics. They go and get their brackets from Pakistan or China for $80. We teach them how to use them and the problems they'll have with that prescription and those whys, et cetera. If you know the problems of the bracket, then you can deal with it. It's just Progressive's bracket saves you a lot of those problems. We can teach you the ortho behind any system. It doesn't matter. $800, the Nepalese is still making profit.

            

 

            
            

Howard:

            
            

I want to ask you another old-timer's question now that you're hitting the big 5-0. I got to get these questions out before you croak dead on me.

            

 

            
            

Agim:

            
            

I am not.

            

 

            
            

Howard:

            
            

Has the x-rays going from 2D pano, 2D ceph to 3D, has that been a game changer in your orthodontic career, or not really?

            

 

            
            

Agim:

            
            

I think at the moment, we're seeing a lot of things, I've got a 3D machine in my clinic. They can be a bit scary where before you thought you had bone, et cetera, if you're taking a 3D x-ray, you realize there probably wasn't any bone there in the beginning. That's I think going to be a problem especially with some brackets that you know are expansion brackets. They go, "Oh, we don't extract anything." I extract very few cases, because I just don't like extractions for ortho, but you got to do some. These cases that are just expanding everything, I think 3D x-rays, if you talk it beforehand, you probably realized that you don't have the bone there in the beginning.

            

 

            
            

 

            
            

I think as it progresses, we may not want to look at those x-rays as much as we probably will in the future. I think it's going to be scary once we start looking at them a lot more. It's great for impacted canines. It's fantastic for knowing where the inferior alveolar canal is, it's great for that, especially when you're adding all the surgery to your own orthodontics.

            

 

            
            

Howard:

            
            

Do you think another thing that's appealing to orthodontic is the fact that if you're in a country where the insurance companies dominate the fees, they tend to dominate the fees on x-rays, fillings, exams. Usually ortho is cosmetic and not really controlled by the insurance. Is the fact that you can set your own orthodontic fees, is that a big part of why you like ortho?

            

 

            
            

Agim:

            
            

Orthodontics is the only field in Australia now where we can set our own fee.

            

 

            
            

Howard:

            
            

It's the only one?

            

 

            
            

Agim:

            
            

It's the only one. Implants, there's competition now. We actually reduced our fee and we market more and we're doing more of them. Fillings, we can't increase our fees because people around us, they're with health funds or corporates or something, they're dictated so we can't increase our fees. Whereas I agree, orthodontics at the moment is the only thing that we can do what we want to do. The other beautiful thing is the orthodontists don't want general dentist to do orthodontics so they scare a lot of the gentle dentists off, which I think it's absolutely fantastic. If a lot of dentists are scared off from orthodontics, that keeps the fees up too. We have to thank the orthodontists for scaring everybody off a bit. It maintains the fees.

            

 

            
            

Howard:

            
            

Singapore is part of the only, it's one of the only countries I ever been to where they all claim they have a shortage of dentists and they need more dentists.

            

 

            
            

Agim:

            
            

It's changing, though. it's changing a lot. It's changing everywhere.

            

 

            
            

Howard:

            
            

I'm trying to get all the American dentists to come to Singapore so I have less competition, especially the dentists in Phoenix should really move to Singapore.

            

 

            
            

Agim:

            
            

The dentists here, they'll see patients at 10 o'clock on a Friday night. They've got no qualms of going to work at any time. There work very hard in Singapore.

            

 

            
            

Howard:

            
            

I don't want to say this because it sounds so racist, but it actually is racist. Asian people just have some of the highest, hardest work ethics anywhere you go around the world.

            

 

            
            

Agim:

            
            

100%.

            

 

            
            

Howard:

            
            

You go to China and nobody thinks twice about working sunup to sundown seven days a week forever. These dentists I talk to in Singapore, they'll work until 9 o'clock at night and they just think that's normal.

            

 

            
            

Agim:

            
            

That's right.

            

 

            
            

Howard:

            
            

Do you think the Asian dentists have a higher work ethic than say Australia where you're from?

            

 

            
            

Agim:

            
            

100%. They'll work any day any time. They'll see you whenever. They do work a lot harder. I know in the class some dentists finish the class and go to work at 5 o'clock just to keep seeing patients. I suppose that's why Progressive is becoming quite big within Asia now because they're earning more, they're becoming wealthier countries. Now orthodontics is becoming something that they want to do. It's something they can now afford. the same as the cakes and the Western diets and they're putting on weight.

            

 

            
            

Howard:

            
            

I've heard it the most from Asian dentists are saying that their dental work is their life. Their life is their dental and their dental office is their life. They just love it, that's all they do. They absolutely love it. Australia now has two publicly traded dental chains. What is it called, the [footsy 00:16:31], your stock market?

            

 

            
            

Agim:

            
            

No, the ASX.

            

 

            
            

Howard:

            
            

The ASX has two publicly traded, one's 1300SMILES and one's Pacific Smiles?

            

 

            
            

Agim:

            
            

Yeah, and then there's Dental Corporation.

            

 

            
            

Howard:

            
            

There's three publicly traded?

            

 

            
            

Agim:

            
            

I believe. One of them just got bought by one of the big health funds.

            

 

            
            

Howard:

            
            

The United States has zero publicly traded corporate dentistries. The biggest one, Heartland, has 1500 offices, but there's none publicly traded. There used to be twenty years ago. Orthodontic Centers of America had about a dozen on NASDAQ and they're all been delisted. Tell us what's it like in Australia to have three publicly traded corporate dental chains. That was something that wasn't existing when you got out of school.

            

 

            
            

Agim:

            
            

No, not at all.

            

 

            
            

Howard:

            
            

That's changed. Is that a good thing, bad thing, neutral thing? Tell us about that.

            

 

            
            

Agim:

            
            

I suppose it's a good thing if you're running that company. If you're not running that company, then it's not a good thing. The big thing that's just come out in Australia just in the past week is one of the big health fund owns a lot of practices.

            

 

            
            

Howard:

            
            

Dental practices. What's the name of that health fund?

            

 

            
            

Agim:

            
            

Bupa.

            

 

            
            

Howard:

            
            

Spell that for me.

            

 

            
            

Agim:

            
            

B-U-P-A.

            

 

            
            

Howard:

            
            

Is that the ...

            

 

            
            

Agim:

            
            

I believe it's Dental Partners is the company they bought.

            

 

            
            

Howard:

            
            

Dental Partners the company they bought.

            

 

            
            

Agim:

            
            

Yeah. What happened though is all these health funds used to use private dentists who would join the health fund and charge health fund fees. The health fund would send their patients to them. The health fund was using that as a marketing tool to get more and more people into the health fund. Everyone was telling the dentists don't join the health funds because you're just making them stronger and stronger. These dentists were going, "Oh, no, it's a really good system. We'll help the health funds." What the health fund Bupa did is they just went out and bought dental partners, and I might be wrong, but they own something like 180 practices overnight.

            

 

            
            

Howard:

            
            

[inaudible 00:18:43] sells dental insurance?

            

 

            
            

Agim:

            
            

They sell dental insurance and health insurance. Overnight they now own their own 180 practices. Let's say that's the number. These are the dentists who were preferred providers. What's happening now is if the health fund owns a practice near you, they don't want you anymore because they've got their own practice. They're beginning to delist these practices or beginning to tell these dentists that you're not our preferred provider anymore. These practices, 80% of their patients would be health fund patients.

            

 

            
            

 

            
            

These dentists are now in the past week going to the Australian Dental Association saying, "You must help us. This is unethical." I've been voicing it for a long time. I can't speak for the Australian Dental Association because that's up to them. They've been saying for a long time as well that you shouldn't have done it. We told you not to join them. We told you that they're interested in their own pocket. They're only interested in their [e-berts 00:19:46], their 20% they can just take out of the dental practice. Now that they own their own practices, why should they use you? If you're a health fund provider who owns the practices, I'd be doing the same thing as what they do.

            

 

            
            

 

            
            

These dentists are going, "Oh, but the health fund is telling the patients leave us." For years, because I'm not a health fund provider, I had to learn how to market in that environment where my patients kept being told to leave and go to a health fund provider because it's cheaper. I had to incorporate ortho and perio and endo. I had to teach my learn. We had to train our staff to offer service, which is something you talk about all the time, like a good restaurant. We had to be like a very good restaurant so everyone felt welcomed.

            

 

            
            

 

            
            

For years we've learned to market within our environment. We send 70,000 newsletters to all our environment so people only know our practice. Last year we did 4000 school students, so they only know our practice. Marketing is becoming bigger and bigger and you have to keep thinking about it in this harder environment. These dentists who are now losing their patients, it's like, join our world now, but you got to start from scratch because the health funds will just take them away from you. You shouldn't have done it in the first place. You made them big, and now they're bigger.

            

 

            
            

Howard:

            
            

Do you want me to tell you how this is going to play out?

            

 

            
            

Agim:

            
            

How?

            

 

            
            

Howard:

            
            

One of the most fun things about being 53 years old, when you lived half a century, you don't see many things for the first time. It's always, oh, I saw that a long time ago. Let's roll back to when I was 24. One of the biggest insurance companies in America was Cigna. They had the same great idea. Why am I having my patients go to these private dental offices and then billing me? We're going to set up our own dental offices. They started rolling out all these corporate Cigna dental offices where they were going to sell the insurance and provide the dentistry. When they started providing the dentistry, they were like, these clinics were running massive losses and they couldn't figure out why they're running losses.

            

 

            
            

 

            
            

It took them about a decade to get out of all those offices and close them all down because they thought, we are not going to provide the dentistry because the dentists are too willing to do this at a loss at their own office. If we do it the way all of our dentists think the dentistry should be done based on our fees and premiums, we're losing money. They said, "Let's just concentrate on selling the dentistry and let these dentists provide these services at a loss."

            

 

            
            

Agim:

            
            

Yeah, that happened in England too I think with Boots pharmacies. They went out and bought all these different practices. They just sold the whole lot. What I'm hoping is that these accountants running the practice, the problem is is that they're going to start getting dentists on wages. It will be like the NHS or they'll just be doing rubbish. Practices like ours that are one stop shops with the ortho, the perio, I do a lot of TMD work. I still refer to people because you must refer. There's other people with more skills than me in certain fields. At least the patient feels like they're being controlled.

            

 

            
            

 

            
            

It's a bit like women go to hairdressers and pay an absolute fortune for a haircut, but they could actually go to a chain hairdresser and pay 20 bucks. I want the people who don't want to go to the $20 haircut place. I want the ones who want the proper haircut and the proper coloring. Come to us and we'll look after you. That's the marketing that we put into it. I think dental practices that spend time on becoming a bit more boutique will survive this. It's harder for us, but we will survive this. Hopefully the big funds run by accountants realize hey, a lot of these dentists on wages, they can't afford to go to any course and learn anything. Why should they? They'll just watch TV and know all the TV shows instead.

            

 

            
            

Howard:

            
            

I don't think two bald men should be talking about hairdressers. I am going to follow on that deal. What hairdressers and dentists have in common is the hairdresser is touching the patient. It's all surgery. When you go to a physician, not even 20% are surgeons. 80% are just reading reports and writing prescriptions. Study after study after study shows at least half of any market that people are extremely particular on who is going to touch them. Who's going to lean them back, open their mouth, touch their body.

            

 

            
            

 

            
            

Dentists, we work with our hands. We're all surgeons. Half of every market at the end of the day is some woman's going to be extremely concerned like I'll let him touch me and do work on my tooth, but I went to that person and I'm never going back. I don't care if I have the insurance there, I don't care what say. I did not like that person. You were talking about you mailed out 70,000 pieces of mail?

            

 

            
            

Agim:

            
            

We do that every ten weeks.

            

 

            
            

Howard:

            
            

You mail out 70,000?

            

 

            
            

Agim:

            
            

To homes, mail delivery in the letterbox?

            

 

            
            

Howard:

            
            

70,000 every ten weeks? Talk about that. 70,000 every ten weeks. There's fifty two weeks a year, so five times a year.

            

 

            
            

Agim:

            
            

We do it, yeah. It's just part of our marketing because if we do the letter drops, if we do the school talks in those same areas ...

            

 

            
            

Howard:

            
            

What are the school talks? You just do that during dental health month, like February?

            

 

            
            

Agim:

            
            

No, no, no, we've got a whole list of schools we'll always go to. All year long we're always going to as many schools as we possibly can. Our nurses do it, my wife is an ex-schoolteacher so she does some them. She writes the programs. The thing is ...

            

 

            
            

Howard:

            
            

Put your wife to work, good job. Good job, that should be part of your seminar. How to put your wife to work.

            

 

            
            

Agim:

            
            

She's very good. Dentists think I'm just going to go to schools or I'm just going to write this letter and put it in letterbox drops. No, you've got to trial the letter. It takes a long time to get a letter that actually works. You just can't put any letter into the letterbox.

            

 

            
            

Howard:

            
            

Do these letters have an economic incentive like a coupon, like bring this in and get $50 off tooth whitening?

            

 

            
            

Agim:

            
            

No, we found that doesn't work. For our market, we've offered a cheaper whitening, the two for one whitening, we've offered all these whitening and cheaper deals.

            

 

            
            

Howard:

            
            

It's not working?

            

 

            
            

Agim:

            
            

We don't get one person coming in ever. We just do an educational kind of letter. It's a nice marketing kind of letter. I always write a really good article, like the latest article, the letter was about that gingival display where you smile and people show gum. If you go to a lot of the orthodontic world, they'll do orthognathic surgery and brachial maxilla like a car accident, whereas I'll just put a couple of pins in and fix it and you're back at work two days time after the pins. Of course the ortho will continue. It's those kinds of things, learning what's out there and then giving it to the market. That's very big for us.

            

 

            
            

Howard:

            
            

Every ten weeks, five times a year, how many pages is a newsletter?

            

 

            
            

Agim:

            
            

One, back in front.

            

 

            
            

Howard:

            
            

Back and front. Is it like folded up?

            

 

            
            

Agim:

            
            

It has to be properly folded and you've got to find a company that will put it in the letterbox, not amongst all of the supermarket stuff, not with the newspaper.

            

 

            
            

Howard:

            
            

You're not mailing it?

            

 

            
            

Agim:

            
            

No, no.

            

 

            
            

Howard:

            
            

You're having someone put it on the doorstep?

            

 

            
            

Agim:

            
            

In with the mail. It's got to go in the mailbox.

            

 

            
            

Howard:

            
            

It's got to go in the mailbox, but not by the mailman?

            

 

            
            

Agim:

            
            

No, the mailman's too expensive now.

            

 

            
            

Howard:

            
            

In the United States that's illegal.

            

 

            
            

Agim:

            
            

Is it?

            

 

            
            

Howard:

            
            

Only the government has the, you know the government, leave it to the government. Only the government can stick something in the mailbox.

            

 

            
            

Agim:

            
            

Yeah, we can do it.

            

 

            
            

Howard:

            
            

In United States you can rubber band it around the doorknob or stick it in the front door screen.

            

 

            
            

Agim:

            
            

Right. Doing that 70,000 times is pretty difficult then. We're lucky.

            

 

            
            

Howard:

            
            

Is that your main marketing?

            

 

            
            

Agim:

            
            

No, no. We do everything. You got to do social media now.

            

 

            
            

Howard:

            
            

Talk about that. What are you doing on social media?

            

 

            
            

Agim:

            
            

We have a Facebook page and we're trying to build that up. My daughter does Instagram because I actually don't have a clue how it works, all this hashtag, hashtag stuff. She'll always find new things to put on Instagram as well. We do a lot of internal marketing. Google, we're number one on Google. We've got a huge website. Our website had the most information on it, and we got beaten by Wikipedia. That's the website I created many years ago.

            

 

            
            

Howard:

            
            

What is your website?

            

 

            
            

Agim:

            
            

Firstbite.com.au.

            

 

            
            

Howard:

            
            

First bite?

            

 

            
            

Agim:

            
            

Dot com dot au.

            

 

            
            

Howard:

            
            

F-I-R-S-T-B-I-T-E dot com ...

            

 

            
            

Agim:

            
            

Dot au.

            

 

            
            

Howard:

            
            

Dot au.

            

 

            
            

Agim:

            
            

With your listeners, don't go and steal stuff. Other people, they steal it and put it on the website.

            

 

            
            

Howard:

            
            

If you went to just firstbite.com, it would probably still go to you? Firstbite.com?

            

 

            
            

Agim:

            
            

Yeah. It's still our practice website. That makes us number one on Google.

            

 

            
            

Howard:

            
            

For searching what, dentists in Melbourne?

            

 

            
            

Agim:

            
            

More if you search dentists in our locality, we'll come up. Because I do a lot of things, like I do a lot of TMD work, I'll come up with TMD. The orthodontics will come up.

            

 

            
            

Howard:

            
            

You're in Melbourne, Australia which is the home of probably one of the largest dental companies in all of Australia and New Zealand, SDI. What does that stand for?

            

 

            
            

Agim:

            
            

Southern Dental Industries.

            

 

            
            

Howard:

            
            

Southern Dental Industries, which I believe is the largest amalgam manufacturer in the world, isn't it?

            

 

            
            

Agim:

            
            

Yeah, they'd be one of the last, wouldn't they?

            

 

            
            

Howard:

            
            

Definitely I think it's the largest. I wanted to ask, you're in Melbourne. How many dentists are in Australia? Maybe 12,000?

            

 

            
            

Agim:

            
            

Yeah, there's about four and a half thousand in Victoria.

            

 

            
            

Howard:

            
            

Okay, you're all practicing around the largest amalgam manufacturer in the world, SDI. Are you guys are using amalgam?

            

 

            
            

Agim:

            
            

No, I don't. I haven't for a long time. I know you still like it because I listen to all your audio podcasts. I don't purely because of the color of it. We don't use it. I haven't for a long time. I don't have a major issue with composites if they're done properly. Do they last as long as amalgams? Probably not. My clientele just wouldn't, they don't like amalgams in their mouth.

            

 

            
            

Howard:

            
            

I agree with everything you just said. To be clear on my stance is that there's two million dentists around the world, let me tell you about how, I've seen this happen more times than I can ever want to count. You go into the dental office and the little poor girl comes in in a country where the average person make three dollars a day and she points to a brown spot. The dental chair is a chair like we're sitting in. The dentist is by himself, has a bucket. He starts drilling on the tooth and he's drilling and drilling and drilling. Then he gets out the kit and he paints on the acid then the woman takes a couple waters, swishes, spits in a bucket. Then he puts on the resin. Then he'll cure that and then she'll rinse and spit. Then he'll squeeze on the composite and then he'll shine it.

            

 

            
            

 

            
            

I'm standing behind in country after country thinking this is just crazy. When they hear rich fancy doctors from Australia and New Zealand and Canada say I don't ever use amalgam, they don't realize who's listening. I believe that almost one million dentists on earth do not have the high-speed suction, the vacuum, the isolation. They need to be placing posterior amalgams. The technique that they're using to place these posterior composites, it's absurd. It's comical.

            

 

            
            

Agim:

            
            

Yeah, they're not going to work.

            

 

            
            

Howard:

            
            

Nothing went right. What I like about amalgam is that if you don't have high speed suction, if you don't have a rubber dam, if you don't have a dental assistant and you're not going to get isolation and there's going to be fluids, wet, water, blood, whatever, amalgam is so forgiving. I just cringe when these dentists hear dentists from rich countries bad mouthing amalgam. I think in a world, but you're right. I should quit being an old crotchety fart and just get off the bandwagon because the last straw of death for mercury was mercury in a filling, it's an insoluble salt, it's not a health issue.

            

 

            
            

 

            
            

If you think it is, if you think placing a silver filling in soluble salt with silver, zinc, copper, mercury [inaudible 00:33:08] is a health issue, I just don't see what you're talking about. When you cremate humans with all those silver fillings in their mouth, that accounts for 6% of the environmental mercury in the atmosphere. When I saw the cremation data I said, "That was the final nail in the coffin." In atmospheric cremated mercury, ethyl, methyl mercury vapor in the air, 6%, 50% comes from coal. 6% comes from cremating humans. It's dead.

            

 

            
            

Agim:

            
            

Yeah. Third World countries still cremate. First world countries are beginning to do it more.

            

 

            
            

Howard:

            
            

Oh, yeah. Everyone's cremating. It's the lowest cost way. In America it's $300 to get cremated, but probably 6 to 10,000 to get a casket, a burial, a plot, all that kind of stuff. I noticed SDI is massively converting to composites. They're completely changing their portfolio.

            

 

            
            

Agim:

            
            

Yeah, they make a lot of things. Look, here's another topic that you brought up. You had some guy, and I agree 100% with what he was saying is that he was saying that you've got to, and with your amalgams as well, you've actually got to market to people who can't afford dentistry. We do everything and we give someone the options of you can do a root canal or you can pull out the tooth. Which would you like? We don't push the point, just whatever they want. You had someone talking about they do $350 crown, et cetera. Very hard to do that kind of quality. The cost of lab work, we've got a CEREC so it's probably a bit easier.

            

 

            
            

 

            
            

I agree that you've got to market to whoever comes in the door. I think that's another way to avoid recessions in dentistry and to fight everyone, just don't find a niche of going to find only wealthy people. Find solutions for people who struggle to find money as well. Find materials that work for those people also, but don't just close your practice to the lower socioeconomic. Open it up to the upper. You're seeing everybody, middle class, upper class, lower class. Find ways of dealing with everybody as a whole. That's what I found worked well especially after the global financial crisis is deal with everybody. Don't just deal with one person. Find materials that work for that person.

            

 

            
            

Howard:

            
            

By the way, how come you didn't send me a thank you card for that global financial crisis, since it started in America? I figured all my Australian dentist friends send me a thank you card. Thank you, thank you America. We really enjoyed that financial melt down. Okay, to be fair, you're in Australia. You're talking about mailing 70,000 flyers every ten weeks. Tomorrow you're lecturing in Singapore, that's illegal. What will you be telling ...

            

 

            
            

Agim:

            
            

What's illegal?

            

 

            
            

Howard:

            
            

Direct mail, advertising. In Singapore, Hong Kong, China, if they did direct mail, if they put a billboard out, if they did direct mail they'd lose their license. How do you build, talk about your internal marketing. Pretend you're lecturing in Singapore now. How do you build your practice if you are not allowed, if the Ministry of Health says you cannot do direct mail, you cannot do a Yellow Pages, you can't do advertising. How would you build it internally?

            

 

            
            

Agim:

            
            

You just got to have a look at it. What do we do? The biggest thing is referrals-based. We always send a thank you letter to every single patient that refers to us. You can always send a newsletter to those patients. We send a newsletter every ...

            

 

            
            

Howard:

            
            

In Singapore can they send a newsletter?

            

 

            
            

Agim:

            
            

To your own patients.

            

 

            
            

Howard:

            
            

To your existing? I don't know.

            

 

            
            

Agim:

            
            

I don't know either that one.

            

 

            
            

Howard:

            
            

That would be a great question to ask your class tomorrow.

            

 

            
            

Agim:

            
            

Yeah. They could do the school talks, couldn't they, as an educational thing.

            

 

            
            

Howard:

            
            

We do that.

            

 

            
            

Agim:

            
            

Yeah, just put a letter in there saying hi, First Bite Dental gave a talk to your school today. They could do things like that with no marketing whatsoever. It's just a school talk.

            

 

            
            

Howard:

            
            

Where did that name came from, First Bite? What does that mean?

            

 

            
            

Agim:

            
            

My wife thought of it, just First Bite.

            

 

            
            

Howard:

            
            

First Bite?

            

 

            
            

Agim:

            
            

First Bite, that's right.

            

 

            
            

Howard:

            
            

That is an interesting name.

            

 

            
            

Agim:

            
            

Yeah, my wife's pretty good. She helps me a lot in the practice. She's my sounding ground.

            

 

            
            

Howard:

            
            

Right on.

            

 

            
            

Agim:

            
            

Yeah, for a lot of things, yeah. You've really just got to be smart about it, don't you? You've got to think of how can you do it.

            

 

            
            

Howard:

            
            

Yeah. Let's switch gears completely to our common buddy and everyone's best friend, Alan Miller of AMD lasers, Alan Miller Design lasers. What I love about him is I'm from Kansas and he's from Indiana. Those boys know how to, wire was formed when two men from Indiana were fighting over a penny. When I got out of school, lasers were 50, 70, $50,000. They went up to $85,000. He got that laser down to $3500. You're a big fan of his Picasso laser.

            

 

            
            

Agim:

            
            

I've been using the Picasso ever since, as soon as it came in Australia I think I was one of the first to buy one.

            

 

            
            

Howard:

            
            

How long ago was that?

            

 

            
            

Agim:

            
            

That was a well ago. Eight, nine years ago or 10 years ago when it first came. Yeah, the other ...

            

 

            
            

Howard:

            
            

Alan Miller told me that Picasso was born in Indiana. I don't know if that's true though.

            

 

            
            

Agim:

            
            

Yeah, I don't know. I don't know.

            

 

            
            

Howard:

            
            

What year do you think it was that you got yours?

            

 

            
            

Agim:

            
            

It would have been eight or nine years ago that I got my first AMD laser. The lasers as you said, they're all 15 or 16, $17,000. Then all of a sudden this laser came out. I remember Rod [Curfey 00:39:16] from the States. His biggest saying was a diode is a diode is a diode. You can spend 20,000 on a diode and it doesn't matter because it's still just a diode. When the AMD came out and it's a diode, it does exactly the same as the more expensive diodes. Why would you spend more? I bought the AMD laser and now we've got three of them because we've got three surgeries. We've just opened up two more rooms. We're doing that. We'll get another AMD.

            

 

            
            

 

            
            

Since then I've just all of a sudden used it nonstop for a lot of things. Exposing canines, you just cut the little flap and you can put your bracket on straight away. You're doing your CEREC, you can just do your gingival troughing and it's nice and clean and it's moist. For composites too, how did dentist put composites when it's bleeding under there? They should use amalgams then if they can't control the bleeding, because you can't bond glue to mud. You can't bond glue to blood. They should be using amalgam or get a laser and clean it up a little bit and make sure it's dry and then do your composites properly. That's how it should be done.

            

 

            
            

 

            
            

Or gingival composites, you should use your laser because exactly what you said, you can't have seepage, you can't have bleeding. How many times does your slow speed nick the gingiva? Then they go, "Quickly I'll put glass ionomer in there. I'll hold my breath. I'll squeeze it dry. THen hopefully it doesn't bleed before I can get my curing light on there." Use your laser first and charge for it and tell your patient. Patients are happy to pay for it. They actually are. They actually want proper dentistry. They want something that's going to last.

            

 

            
            

 

            
            

Dentists assume the patient doesn't want it and they'll be upset. If you just tell them what's happening, most people are pretty decent out there. Lasers are good. We all use my lasers a lot. Since then I like talking, so I got asked by Dentsply to lecture on them. I was doing it on the side anyway myself just teaching people how to use lasers. We're in Singapore doing a laser lecture for AMD tomorrow night. I think there's about 60 dentists coming, so it's going to be a big talk.

            

 

            
            

Howard:

            
            

Dentsply sells you the AMD laser.

            

 

            
            

Agim:

            
            

In Australia.

            

 

            
            

Howard:

            
            

You mentioned that you have CEREC, which is owned by Sirona.

            

 

            
            

Agim:

            
            

That's right.

            

 

            
            

Howard:

            
            

Those two companies got married this year. Now it's Dentsply Sirona.

            

 

            
            

Agim:

            
            

That's right.

            

 

            
            

Howard:

            
            

Talk about CEREC. You own a CEREC machine.

            

 

            
            

Agim:

            
            

I love my CEREC machine.

            

 

            
            

Howard:

            
            

How long have you had that?

            

 

            
            

Agim:

            
            

Probably, what, since the GFC.

            

 

            
            

Howard:

            
            

The GFC?

            

 

            
            

Agim:

            
            

The global financial crisis.

            

 

            
            

Howard:

            
            

Which was what, September 15, 2008?

            

 

            
            

Agim:

            
            

Yeah, something like that then. Probably six, seven years.

            

 

            
            

Howard:

            
            

You bought it after the melt down?

            

 

            
            

Agim:

            
            

The government, I was going to buy it and then the government in Australia, the economy went down. They offered a huge tax incentive to buy stuff. I bought it with the tax incentive.

            

 

            
            

Howard:

            
            

In 2008 or 2009?

            

 

            
            

Agim:

            
            

Something like that. I think it's fantastic. I absolutely love it. It's a huge marketing tool. We do proper diagnosis. I see a lot of people from country Victoria. They'll come in, one visit, two or three crowns, go back to their country place. It's huge like that.

            

 

            
            

Howard:

            
            

I missed that. You're in Melbourne but you said they'll come in from, oh, Melbourne is in ...

            

 

            
            

Agim:

            
            

We're in the city. Melbourne is a capital city, a city.

            

 

            
            

Howard:

            
            

Of Victoria?

            

 

            
            

Agim:

            
            

That's right.

            

 

            
            

Howard:

            
            

You're saying people come in from the rural far away?

            

 

            
            

Agim:

            
            

From the rural area. That's it.

            

 

            
            

Howard:

            
            

They want same-day dentistry?

            

 

            
            

Agim:

            
            

They want same day dentistry. It's all done in one visit. I think the porcelains are pretty good now that they've got, it's a lot of nice porcelains you can put on the machine.

            

 

            
            

Howard:

            
            

When you say you love it, after you prep, are you scanning, designing, milling, staining, glazing, or does your assistant do all that?

            

 

            
            

Agim:

            
            

Yeah, I do everything. I do everything. In Australia our nurses can't do what your nurses can do in America.

            

 

            
            

Howard:

            
            

Punch the doctor, slap them, kick them?

            

 

            
            

Agim:

            
            

That's right. You nurses can do a lot of your ortho. Our nurses can't do it here. The dentist has to do everything. That's where it's handy having a few rooms so I can have nurses who can do the changeovers and I can walk from room to room to room. We probably have to work a little bit harder to do the orthodontics. Now in Australia I do a lot of that stuff. It doesn't bother me. My hands are pretty quick. I can do things pretty quickly. I've been doing it for a while now.

            

 

            
            

Howard:

            
            

What kind of block are you using in the CEREC?

            

 

            
            

Agim:

            
            

We now that Dentsply CELTRA Duo block. It's a new block.

            

 

            
            

Howard:

            
            

The Dentsply what?

            

 

            
            

Agim:

            
            

CELTRA Duo.

            

 

            
            

Howard:

            
            

Spell that.

            

 

            
            

Agim:

            
            

S-E-L-T-R-A Duo, D-U-O.

            

 

            
            

Howard:

            
            

Who talked you into that? Did Mike [detolla 00:44:26] talk you into that or who?

            

 

            
            

Agim:

            
            

No, the Dentsply rep showed it to me and then I did my own research. They produced it in combination with Vida. Vida's actually got exactly the same block.

            

 

            
            

Howard:

            
            

Is that Vida out of Germany?

            

 

            
            

Agim:

            
            

Yes, I believe so. They produced this block together and Vita is selling it as their own block. Dentsply is selling it as their own block, but it's actually the same block.

            

 

            
            

Howard:

            
            

Dentsply has their block is outsourced from Vita?

            

 

            
            

Agim:

            
            

I don't know how they manufacture it. I don't know.

            

 

            
            

Howard:

            
            

That's what you think, you think it's a Vida block?

            

 

            
            

Agim:

            
            

I think they developed it together. They definitely developed it together.

            

 

            
            

Howard:

            
            

Does Dentsply Sirona, do they own Vida?

            

 

            
            

Agim:

            
            

No, I think it's their own company.

            

 

            
            

Howard:

            
            

You like that block the most?

            

 

            
            

Agim:

            
            

It's very nice. It's much stronger than the old Vida block.

            

 

            
            

Howard:

            
            

Are you cementing it, or are you resin bonding it?

            

 

            
            

Agim:

            
            

Resin bonding, yeah.

            

 

            
            

Howard:

            
            

What are you bonding it with?

            

 

            
            

Agim:

            
            

NX3.

            

 

            
            

Howard:

            
            

NX3. You opened up another can of worms when you were talking about the Picasso laser. Sometimes there will be bleeding and the dentist will want to put glass ionomer there. You said glass ionomer. In the United States they hardly, you look at the percentage of glass ionomer a typical Australian dentist or dentist will use. It's several times higher than the average American. Why do you think that is, and do you think that's changing?

            

 

            
            

Agim:

            
            

I personally don't use glass ionomer. I think it depends who you listen to and who you like to listen to. You can achieve the same result with different materials. I'm more a [Bertalotty 00:46:13] kind of follower. I've always been more a Bertalotty kind of guy.

            

 

            
            

Howard:

            
            

Raymond Bertalotty, my buddy.

            

 

            
            

Agim:

            
            

I've always done what he said and it works perfectly. Everything he says is true. We actually don't do many root canals in the practice. We're a very busy practice.

            

 

            
            

Howard:

            
            

Go over what's Raymond ...

            

 

            
            

Agim:

            
            

Raymond is just, you don't use glass ionomer, you just bond the tooth. You do your primer bond and put your flowable in there and put your composite on top.

            

 

            
            

Howard:

            
            

[crosstalk 00:46:42] What primer, what composite, what flowable?

            

 

            
            

Agim:

            
            

You've stumped me there. The same company that makes NX3, I've just gone blank on that.

            

 

            
            

Howard:

            
            

[Bisco 00:46:57]?

            

 

            
            

Agim:

            
            

No.

            

 

            
            

Howard:

            
            

Danville?

            

 

            
            

Agim:

            
            

No, we don't use Danville's product. It's the one that Gordon Christiansen recommends at times too.

            

 

            
            

Howard:

            
            

3 AM?

            

 

            
            

Agim:

            
            

No.

            

 

            
            

Howard:

            
            

[Cur 00:47:11]?

            

 

            
            

Agim:

            
            

Cur, that's it.

            

 

            
            

Howard:

            
            

Raymond Bertalotty is a big Cur user.

            

 

            
            

Agim:

            
            

No, no, no. We just used our own bond system and use NX3. They're not Bertalotty products. It's exactly the same principles.

            

 

            
            

Howard:

            
            

Australia is home to some big gurus of glass ionomer like Graham [Millisich 00:47:32]. New Zealand has ...

            

 

            
            

Agim:

            
            

Jeff Knight.

            

 

            
            

Howard:

            
            

No, Jeffrey Knight in Australia and Graham Millisich is in New Zealand.

            

 

            
            

Agim:

            
            

That's why we use more glass ionomer is because they talk ...

            

 

            
            

Howard:

            
            

Because of those two men?

            

 

            
            

Agim:

            
            

I lecture a lot in New Zealand. You go to New Zealand and they're all talking glass ionomer and they're a bit shocked when I say I don't use the stuff and I do more dentistry than you do and I don't have a lot of root canals coming into my practice from deep fillings. Really either system works. They both actually work, it's just which one are you comfortable with. That's the way I see it. Use either. It doesn't matter what one you use, you can't have blood and saliva coming out of your matrix band. You go to New Zealand and the Australian lectures are very big there. They're going to use more glass ionomers because that's the lectures they get. Whereas if Bertalotty went there more, they'd probably not use it as much.

            

 

            
            

Howard:

            
            

You know, it's funny you say that because as you get older and older and older and travel further and further and further, when a dentist starts telling you what they think, I'm pretty good at knowing who influenced them.

            

 

            
            

Agim:

            
            

Yeah, that's right.

            

 

            
            

Howard:

            
            

As you get older and older and older, people are more parakeets and you go, oh, you're a Graham Millisich fan.

            

 

            
            

Agim:

            
            

Whereas if you use a bit of both, then you're Gordon Christiansen. He uses a bit of both. You can follow who someone listens to.

            

 

            
            

Howard:

            
            

Yeah. It is tough when you're talking to two million dentists covering all these different continents and countries. Just that infrastructure difference. Just having access to an offertory and high speed suction and everything that's in your offertory, half of the dentists in the world don't even have access to that. That really is a game changer on what technology. Are you into implants?

            

 

            
            

Agim:

            
            

Yeah, yeah.

            

 

            
            

Howard:

            
            

Are you placing them?

            

 

            
            

Agim:

            
            

Yeah, doing everything with the implants.

            

 

            
            

Howard:

            
            

Talk about that.

            

 

            
            

Agim:

            
            

What do you want to know? I think my statistics are very, very good now with implants because when you first start off they're very tricky. I think implants are trickier than orthodontics because you could have the best x-rays, the best 3D imaging. You can have anything. When you go in there, the bone may be like butter or it may just flick off on you. I think implants are very hard to do. What I've learned as I've done more and more of them is just pick my cases more. I'm not as gung ho anymore. I just pick them where I can see they've got nice bone and you don't have to do much grafting or you do it all before and let it heal and then put the implant in there afterwards.

            

 

            
            

 

            
            

I think implants, everybody should do them. I think the cost will come down further with implants because the novelty will wear off. I don't think we should be offering lifetime guarantees on implants, especially as the costs come down. I'd say implants in the future are going to be a tsunami of problems with implantitis. I think the new dentists should start learning how to deal with all our implant problems that are going to occur in the future. Implants for me, I love them, I think they're fantastic. I'm just becoming a lot pickier in what I do and don't do. I still don't have problems creating a bridge if a bridge is better in some cases than trying to graft something and find bone that may not be there.

            

 

            
            

Howard:

            
            

You know, that's a high sign of intelligence is when you're not an extremist. So many humans, especially in youth, everything is binomial. Left, right, up, down, black, the young dentists just say, "I don't do bridges." You look at some of the nightmare scenarios. There's just a tooth on each side and it's like, you could have just done a three unit bridge. Their extremist crazy fundamentalist mentality, they just couldn't do it. Even though every other indicator was saying no go, no go. You don't have enough bone. You have to do a sinus lift. You're going to have to walk from here to Kathmandu. They're just like, "I can't file down two teeth." It's like, if you can't file down two teeth, how come you don't blink at filing down a sinus? How come you can stick half a cow up into the sinus and that's not a problem, but shaving out the enamel of a bicuspid and a molar is somehow against your dental religion, you know what I mean?

            

 

            
            

Agim:

            
            

I see bridges I did 25 years ago that are still there. I don't have 25 years of data on my implants yet. I think a lot of the bridges are still actually really good that was done a long time ago. I think what we'll find is it'll sway back a little bit. You know how things ebb and flow. I think it'll sway back to where maybe people might start doing bridges a little bit more again. Maybe doing that root canal again if you've got enough ferrule, you call it ferrule in America? If you've got enough ferrule, you might go back and start doing root canals again.

            

 

            
            

Howard:

            
            

My buddy Gregory explained to me a ferrule, do you remember where the word ferrule comes from?

            

 

            
            

Agim:

            
            

No. Is it an engineering term?

            

 

            
            

Howard:

            
            

It was a barrel term, when you had a barrel you had all these planks of wood. To keep all the barrel together you'd have a little three inch ferrule band of metal around the barrel. That's what held all the boards together. If you just had a ferrule, it came from a barrel. Barrel making is ferrule. If you do have three millimeters of tooth structure all the way around, it basically works. If you don't have that three millimeter ferrule and you do your post and your buildups and adhesive dentistry and all that stuff, a lot of times it's just not going to work, especially in the anterior where forces are not straight up and down.

            

 

            
            

Agim:

            
            

Yeah, exactly. Create ferrule or don't do it. Do something else. Here's another topic for you, because I lecture a lot on TMD. That's probably my pet topic out of everything. It's just one that's just fascinated me a long time. I'm noticing a lot of people, when I do TMD I realize that I can only do what I can with the dentistry part that I can do with TMD. Then I've got a team with me, oral medicine, oral surgeons, physiotherapies, my therapists, neurologists, EMTs. I've gathered the team around me for TMD because I realized that none of us have the actual answer. We have to work together.

            

 

            
            

 

            
            

Another thing I'm noticing is people more and more are saying, "I'm a TMD expert." As soon as I hear that word I think don't go to that person because no one can be an expert on such a complicated topic. You actually need a team of people who work together. No one can be an expert on TMD. I've even got a Chinese medicine person I send some patients to. He deals with TMD. Who knows what he does, but he gets good results for some people. TMD is I think is another huge topic.

            

 

            
            

Howard:

            
            

That's another huge factor of success is just being humble, the fact that obviously in 2016 nobody understands what's completely going on. If you absolutely think in 2016 you know all the answers, you know what you know. That's a little sliver. You know what you don't know, that's maybe a sliver twice as big. You don't know what you don't know. That's 98% of the whole pie. To be humble and to try things on a very complex subject like that, temporomandibular disorders, migraines, headaches. I'm sure 100 years from now it will look completely different.

            

 

            
            

 

            
            

Think of all the things that are so different just in my lifetime. When I was in physics in college, they told us that 99.9999% of the space of an atom was all empty. Now it's all dark matter where all that has the massive density, you know what I mean? It went from 99.999 empty to this massive dark matter and dark energy, you know what I mean? Could they have got it more wrong? Just amazing. I always teased that 100 years from now there's going to be a TV series showing in Australia saying back in 2016 when a human had a toothache, they would take a drill, drill a hole into the tooth, take little wires, pull the guts out, rinse it with bleach, smash pink rubber down into the tooth. They would do that while the human was alive. Everybody's sitting there like, oh my God, oh my God.

            

 

            
            

 

            
            

Then you talk to some people doing root canals today and they think it's just complete godly science of all known knowledge. It's really one of the craziest, most barbaric acts of medicine done on earth today. I'm sure 1000 years it will be in a museum and we'll look like complete idiots. It's an uneducated arrogant mind. Arrogance and know it all is just a sign of, it's horrible. You just have to realize, you have to be humble. You have to be humble that you're just trying to do the best you can with what humans have figured out this far in the game. We probably haven't figured that much out.

            

 

            
            

Agim:

            
            

That's right.

            

 

            
            

Howard:

            
            

I'm sure 1000 years from now this is going to look like the stone ages. My last question to you, it's 57 minutes, I only got you 3 minutes. How many countries have you lectured in?

            

 

            
            

Agim:

            
            

Lots now. Lots of Europe. A fair bit in the states. I was in Washington DC in November. That was really cool doing that. California, New Zealand, lots around Australia. A lot of Asia I've lectured in. I've lectured in China, Singapore, do a lot in Malaysia and Singapore. Nepal I've been to many, many times. We've got the same friend Neil in Nepal.

            

 

            
            

Howard:

            
            

Oh, I love Neil. Are you ever going to climb Everest?

            

 

            
            

Agim:

            
            

No. I don't want to lose a finger or a nose.

            

 

            
            

Howard:

            
            

Have you done any of this, have you done Kilimanjaro?

            

 

            
            

Agim:

            
            

No, I haven't done that. I've done Annapurna, that's the highest I've ever gotten.

            

 

            
            

Howard:

            
            

Where's Annapurna?

            

 

            
            

Agim:

            
            

Annapurna, I couldn't tell you exactly where it is. It's 5500 meters. I did it 20 years ago or 22 ...

            

 

            
            

Howard:

            
            

Is it in Nepal?

            

 

            
            

Agim:

            
            

Yeah, 22 years ago with my wife. Back then there was no roads. We just did it in jeans and we had to buy clothes from the Nepalese the higher we went because we didn't have a clue what we were doing. That was a bit dangerous thinking back on it.

            

 

            
            

Howard:

            
            

I did the tallest in Africa, Kilimanjaro, and I did the tallest in your country, I can't remember the name of the mountain. It's named after a Polish guy. Mount Ozzie Osborne ...

            

 

            
            

Agim:

            
            

Kosciuszko.

            

 

            
            

Howard:

            
            

Kosciuszko. I'll tell you what, when I was up there lecturing in Nepal, I read in a plane to go see Everest. There was this charter company. The three of four of us, we chartered. I just wanted to see, fly over base camp. Oh my God, I'm so glad I did that because the tallest mountains in the United States are 14,000 feet. 14,000 feet is the base camp of these things. Then they go up another 14,000 because they're are 28,000 feet. I was so glad I saw it because if you haven't seen it, you might be dumb enough to think, oh, that sounds fun. When you fly over you're like, oh my God. That's crazy. That is just crazy. I mean, wow. Crazy, crazy. Man, is it beautiful.

            

 

            
            

Agim:

            
            

Yeah, I love Nepal. I love the people there. I feel at home in Nepal. I like it a lot.

            

 

            
            

Howard:

            
            

To the listeners out there, it's a little bitty country that's sandwiched between two great empires of India and China. It's a completely landlocked island. It is the most beautiful, and the people, their clothes are so colorful. The girls are running around in bright purples and yellows and golds.

            

 

            
            

Agim:

            
            

They want the tourists to go back, because that's their only money. Go back, go back. Go back to Nepal.

            

 

            
            

Howard:

            
            

Nepal is your favorite country to lecture in. If you were talking to these Americans and they were going to go on a vacation and make it a tax-free trip, what country would you recommend? Nepal?

            

 

            
            

Agim:

            
            

Nepal is fantastic. It's a different world, isn't it? If you're happy to do that, then definitely Nepal. They're all great countries. Singapore is fantastic. Vietnam and Cambodia, you can just keep going on. That's why I do the lecturing. Being at work is more profitable. I just meet so many more people and I get to travel and the family comes with me a lot of the times. It's just a great way to live.

            

 

            
            

Howard:

            
            

I'll be seeing you a lot more in your home territory, because now my brother live there. Two of my sons love to go in there. Ryan, have you been there? You haven't been there. We'll probably go there this year. Eric, he can't do any traveling with this because he did the marriage kid thing. He's tied down for a couple decades. Hey, it was a huge honor that I texted you and said ,"Hey, we're both in Singapore, come on by." Really, thank you for all you've done for dentistry. Thank you for all you done from everybody. Hey, one last favor, on the Dentaltown app we put on, oh, I got it on airplane mode. We put up, we just passed 211,000 dentists from every single country on earth. We put up, the online CE is now on your android and your iPhone. We put up 350 courses. They've been viewed over half a million times. Any chance we ever could a course on there from you?

            

 

            
            

Agim:

            
            

We could think about what course would you like?

            

 

            
            

Howard:

            
            

You know your buddy Neil, did you see Neil posting the other day on Facebook because when he goes to their study club in Nepal, it's hard to get speakers there. He throws the course on his iPhone. With Apple TV at his study club, he throws it up on the big screen. There's his study club in Nepal on a big screen watching a free course on dental town.

            

 

            
            

Agim:

            
            

That would be fantastic, wouldn't it?

            

 

            
            

Howard:

            
            

We got a dozen courses in every genre. What I like about you is you're just keeping it real. You walk the talk, you're doing this on real people in Australia. Everything you talked about and you lecture you do. It's not theory, it's not hypothetical. You're not selling a shiny toy, you don't make your money selling objects. You walk the talk. It would just be a huge honor to get an online CE course from you.

            

 

            
            

Agim:

            
            

Yeah, I'd be happy.

            

 

            
            

Howard:

            
            

Which you can't talk like in Australia, you got to change your accent to Nepalese or Singaporean.

            

 

            
            

Agim:

            
            

The problem with Australians, we talked through our noses. Really, I've got to hold my nose and talk like this. Then everyone will understand me more.

            

 

            
            

Howard:

            
            

What I think funny is when I first went to Australia, you always associate Australia with Foster's beer. The first time I went to Australia, I had a 15 hour flight, I get in my hotel, I go down to the bar. I think, I'm in Australia, I'm going to have a Foster's beer. They didn't even have Foster's beer.

            

 

            
            

Agim:

            
            

No, we don't drink Foster's.

            

 

            
            

Howard:

            
            

I'm like, what? This is Australia, home of Foster's beer. They're like, no, we don't have Foster's beer. It's a marketing myth in America that all the Australians drink Foster's beer.

            

 

            
            

Agim:

            
            

That's right, 100%. We don't have kangaroos in our backyards either.

            

 

            
            

Howard:

            
            

All right, thank you so much for coming by.

            

 

            
            

Agim:

            
            

You're welcome.

            

 

            

 

Category: Orthodontics
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