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Howard:
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Hey, today is a really, really special treat for me, so I know you're going to love it. I'm with Dr. Biju?
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Biju:
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Biju.
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Howard:
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Biju Krishnar.
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Biju:
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Nan. Krishnan. Biju Krishnan.
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Howard:
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Biju Krishnan.
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Biju:
|
That's it! You go it.
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Howard:
|
Krishna is a god.
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Biju:
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Yes.
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Howard:
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A Hindu god.
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Biju:
|
Hindu god.
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Howard:
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You kind of are an ortho, a short-term ortho god, so maybe you should change your name to Dr. Biju Krishna.
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Biju:
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Maybe. That's something to think about.
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Howard:
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Dr. Krishna, amazing. Born in India but at age 2 moved to Scotland.
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Biju:
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That's right.
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Howard:
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Then lived in Scotland until you were 45?
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Biju:
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Yeah, I suppose so. Yes.
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Howard:
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Then you moved where we're at today, which is Singapore.
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Biju:
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Yes! Welcome to my new home town which is Singapore. I was going to say sunny Singapore but it's not particularly sunny today.
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Howard:
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I find it very cool that you've moved twice because the research I see from the economist is that less than 1% of earthlings live in a country they weren't born in. 99% of people live in the same country they were born in, and you actually left India, went to Scotland for 45 years.
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Biju:
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Sure.
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Howard:
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Now you're in your third country. I'd love to see the stats on what percent are living in a third country. I bet it's one-tenth of one percent.
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Biju:
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I have no idea, but certainly the first move wasn't my choice.
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Howard:
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Yeah, mom and dad did that.
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Biju:
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The second move certainly was my choice. Do you know what? I just wish I'd a lot earlier, maybe 5, 10 years ago. I'd love to have had the opportunity. I see my children now, my children have lived in the UK and now in the Singapore. Especially in Singapore where there's such a melting pot of different cultures and communities and people, they get a really wide view of the world that they never would have got living-
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Howard:
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In Singapore?
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Biju:
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In Singapore it's amazing. It's a real melting pot.
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Howard:
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You think it's more melting pot than Scotland?
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Biju:
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Scotland is Scottish. You know?
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Howard:
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Okay, so Scotland is not like London.
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Biju:
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Not so, no.
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Howard:
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Don't you think London's awfully melted?
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Biju:
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London is very much like that, yes.
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Howard:
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Yeah.
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Biju:
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Singapore is pretty much like London in that sense. Probably about the same size as well. You have, of course, your race Southeast Asian cultures, so it's completely different to that western attitude and outlook, so they've got a great experience. Seeing that, a lot of the people that they're associating with are Australians, Americans, Europeans, Chinese, Japanese, so they get a great range of different views and cultures and attitudes. That can only be good I think.
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Howard:
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I think Scotland has got one of the greatest cultures of all time. That was the birthplace of Adam Smith-
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Biju:
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Indeed. The first economist.
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Howard:
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The first economist. He wrote his book The Wealth of Nations in 1776-
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Biju:
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That's right.
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Howard:
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Which is so weird because he was a 32 year old Scott
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Biju:
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Oh, right.
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Howard:
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The same year, 1776, another 32 year old Scot, Thomas Jefferson, wrote basically the Declaration of Independence, free people, and the American experience was really the first time free people collided with free markets-
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Biju:
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Right. That is interesting. Yeah.
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Howard:
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... and that was a game changer. All throughout history sometimes there's been free people, sometimes with democracy, I mean, there's democracy going back to Plato's republic, the Roman empire. You really didn't have free people and free markets until 2, 32 year old Scots ... My favorite Scottish joke is that's how wire was invented, when two Scots were fitting over a penny.
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Biju:
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Yeah, probably some truth in that actually.
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Howard:
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Dr Krishnan is internationally renowned as the creator of one of the world’s most popular adult cosmetic orthodontic system, Cfast, which stands for Cosmetically Focused Adult Straight Teeth. He is qualified from Dundee University, Scotland, and his practice has been highly commended as best specialist practice in Scotland, and voted best private practice in east Scotland. Dr Krishnan was also recognized as one of Scotland's outstanding dentists. Biju lectures extensively, nationally and internationally, primarily on cosmetic focused orthodontics, in which he has pioneered revolutionary new concepts using the Cfast adult braces systems which he personally developed.
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Cfast was successfully launched in the USA and the UK in 2011, and is now one of the world’s largest providers of cosmetic orthodontics, with a presence in Europe, Scandinavia, Southeast Asia, and Australia. Dr. Krishnan has published in many journals internationally and recently authored the first book on cosmetic orthodontics. He is on the board of the British Academy of Restorative Dentistry and the Editorial Board of Aesthetic Dentistry Today. Today we're talking cosmetic orthodontics. My question is, what made you start a new one considering there's fixed braces and wires-
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Biju:
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True.
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Howard:
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That goes all the way back to the Egyptians. There's a lot of clear aligners; there's Invisalign, Clear Choice. No, Clear Choice was ... Clear Connect. Clear Connect. What made you want to start another ... Is that the genre you put it in?
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Biju:
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Yeah. That's a good question.
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Howard:
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Clear aligners?
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Biju:
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We're not really aligners. Let me give you a little bit of background. I think as with all inventions there's a necessity, is the mother of all invention. I'm a general practitioner and for many years now I've been very interested in minimally invasive cosmetic dentistry. The idea of just picking up the drill and starting cutting, didn't fit well with me. The idea was to try and move the teeth into a better position, prior to them doing some restorative work. I've got a lot of patients that used to come to me for veneers, they wanted a quick result.
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I never found it great to just pick up the drill and start cutting, so we looked at different systems that allowed us to move the teeth. Going back even one step, we used to refer a lot of those patients to the orthodontist, to try and get those teeth in a better position. The question I'd always have for my orthodontic colleagues was, "This patient is unhappy about a mild crowding of the upper lateral incisor, can you correct that?" The orthodontist said, "Yeah, sure I can correct that." I said, "Great, how long is that going to take?" "18 months."
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I said, "Really? For a lateral incisor?" They said, "Yeah. Well, you know, they've got problems at the back, they've got class 2." All these other issues. I'm thinking, "Well, you know, the patient's 45, they're not really interested in that. They've survived, and chances are they're going to survive a little bit longer with that cross bite. Can you not just fix that lateral?" "Yeah, yeah, but we've got to treat all these other stuff."
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I'm thinking, there's got to be a more pragmatic approach, because quite frankly, if you don't do that and move that tooth, all that's left for me is to cut that tooth. I quite frankly don't want to do that. As you well know, about 10, 12 years ago, aligners came onto the market, and that's great because it really empowered general practitioners to do orthodontics. The problem again that I had when I did aligners was, it really was orthodontics, in the true sense of the word. I'm a general practitioner, I have no real interest in orthodontics, I have an interest in cosmetic dentistry, so it was quite a roundabout way for me to provide good cosmetic dentistry.
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Other systems then came on the market, that started to introduce the concept of a fixed appliance brackets and wires, but again, the problem I had with those systems, they were all of those really developed by orthodontists for use by general practitioners to do cosmetic dentistry. The orthodontic component always got in the way. I was ending up with problems with the bite, and I was doing certainly that I felt I just didn't need to do for the vast majority of patients coming to see me.
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Really the idea was then to set up, or to develop a system that really met my needs in terms of, I just want to focus on the front six teeth, that's what the majority of patients come in for. Let's just develop systems that can do that. If I had a blank sheet of paper and an ideal wish list, what would this system look like? That's what I think we've done with Cfast. Over the last 5 or 6 years it's changed a lot. I think we've been the one system that constantly been innovative and looked at modern technology and tried to introduce some of the advances that we have in technology into our system. You look at what we have now and I think we're so far ahead of pretty much everyone else out there. Certainly in terms of cosmetic orthodontics.
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It's not to be confused with comprehensive orthodontics, this is not a replacement for comprehensive orthodontics, that's a completely different animal. What we are trying to do here is give people a cosmetic smile, a nice smile, really using an affixed appliance as an adjunct to other restorative treatment. Most patients when they come to see me [inaudible 00:08:58] a nicer smile the first thing we'll think about doing is aligning the teeth, getting the teeth into a better position.
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The next thing we'll do is do a bit of tooth whitening. Then if we need to do a bit of adjustment, you know, a lot patients present with incisor edge wear, we can do some bonding or we can do some veneers, but by this time it's minimally invasive. That's really a potted history of where we are today.
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Howard:
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How does a dentist do this case? By the way, I understand. I feel your pain with the orthodontist. It seems like if your only tool is a hammer, everything looks like a nail. If you ever send anybody to an orthodontist, I was surprised you said 18 months, because in Phoenix, you send anyone to an orthodontist it's minimum 24 months. It's 24 to 30 months, it's $6000, they need to put one-third down.
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It's just like, okay. The other thing is not only is it one size fits all, I look at so many of those cases, how many of those bicuspid extraction cases where they just needed 3 or 4 millimeters if you would have took out the [inaudible 00:10:05], and put in [inaudible 00:10:08]. It just seems like there could have been ... You can't really go to a market with one car.
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Biju:
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Sure. I'm not putting down what orthodontists do.
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Howard:
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Correct.
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Biju:
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What they do, it's a hugely specialized skill and there's a reason they train so hard and so long after their degree to do what they do. This is not really an alternative to orthodontics, this is an alternative to invasive crown or bridge work. Think of it like that.
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Howard:
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Right. How does it work then?
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Biju:
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In the majority of cases that we see are treated with a affixed labial appliance. It pretty much looks like an orthodontic appliance, but the brackets are positioned such that all the movement is kept to the anterior region, and we really minimize any movement in the bicuspid area.
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Howard:
|
These are brackets with a wire, it's not a retainer?
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Biju:
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Brackets with a wire. It's not an aligner.
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Howard:
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It's not an aligner.
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Biju:
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No.
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Howard:
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By the way, what's the big aligner out of the United Kingdom?
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Biju:
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I expect the big aligner everywhere is Invisalign.
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Howard:
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No, there's another, what's the other one out of ...
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Biju:
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We have Smile True and we Clean Align, I think we have-
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Howard:
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Tiff, Tiff.
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Biju:
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Oh, okay. Tiff is a pioneer when it comes to cosmetic orthodontics. Tiff and his colleagues worked with Inman Aligner.
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Howard:
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Inman Aligner.
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Biju:
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Yeah. [crosstalk 00:11:33]
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Howard:
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That's a retainer.
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Biju:
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That's a removable appliance, yes.
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Howard:
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This is not a removable appliance?
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Biju:
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It's not a removable appliance.
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Howard:
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So it's really not an aligner, or it's not a ... What is the genre? You're calling it an aligner? Clear-
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Biju:
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It's a fixed brace.
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Howard:
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It's a fixed brace. I think of Invisalign, and Clear Connect and Inman Aligner as ... What do you [inaudible 00:11:57]?
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Biju:
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Clear Connect and Invisalign, those are aligners. Those are sequential clear trays that move the teeth incrementally. Inman is very different. Inman is a removable appliance that again, really just focuses on the front, mainly the incisors. It pushes those teeth into a nicer self position. It's a little bit restricted in terms of what you can do, you can do much more with a affixed appliance than you can with a removable appliance. Some patients can find it a little bit bulky, because it covers the palette, so it affects the speech. When it comes to moving teeth, really a fixed appliance is the goal standard. We incorporate all the advantages of a fixed appliance, but as much as possible, we try and remove the orthodontic element from it.
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Howard:
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Walk them through a case, what it would be like?
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Biju:
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When a case comes in, first of all, the patient is assessed. We have a triage system in place, so we ask the dentist to take some photographs, and send it to one of the orthodontists or one of the mentors that they have. We have a one to one mentoring support system in place, which is really important, which we'll talk about later. It's one of the reasons I'm here in Singapore in fact.
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They take the photographs, they submit it to the lab of one of the orthodontists or one of the mentors. That case is then assessed for suitability. If the case is suitable, then they either take a 3D scan of the mouth, or they take some PVS impressions, send it to the lab. The lab then constructs the appliance, it's all made digitally, and send it back to the dentist. It's an indirect carrier system, so the dentist doesn't have to worry about where the brackets go, it's all pre-positioned for them. We use an indirect bonding system, like a gum shield, it goes on the teeth, the dentist just cures the brackets in place and peels the carrier away, so the brackets are perfectly positioned.
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Howard:
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That's a nice, fast way to do it.
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Biju:
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It is great, and one of the biggest advantages-
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Howard:
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I know a lot of orthodontists that are ... Derrick Mahoney is one who does that.
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Biju:
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Yeah.
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Howard:
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He's cut his banding time down to fraction.
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Biju:
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I've done a bit of work with Derrick. Derrick helps us with some of the Cfast courses.
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Howard:
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Derrick Mahoney does?
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Biju:
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Yeah, in fact Derrick actually wrote the forward to my book.
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Howard:
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Really?
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Biju:
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Yeah. I know you know Derrick very well because the last time I was in Sydney, I think you came up in conversation a few times.
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Howard:
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Yeah, last time we were there ... My brother moved to Sydney, Australia.
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Biju:
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That's right. That's right. He mentioned that.
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Howard:
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I've lectured there probably every 3 or 4 years for 25 years.
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Biju:
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Yeah, yeah. Derrick mentioned that so I know you know Derrick quite well.
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Howard:
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I missed my move to Australia, because they always say you can only move there until 50.
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Biju:
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Oh right.
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Howard:
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When I first learned that I was about 43, and every time I ever went to Australia and would always think, "This is the only place I ever go all the time that when I go back to Phoenix, I always say why did I come back to Phoenix?" Then my brother had the brains to move there permanently, but when he moved there permanently I was already 51.
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Biju:
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It's a big move. Australia's a big move, isn't it?
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Howard:
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You know what, I swear, it's just a greater civilization.
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Biju:
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Yeah. I love Australia, and I certainly love Sydney.
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Howard:
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Oh my god, I mean, suburbian life in Phoenix is so boring. I could walk out my street, fall asleep for 3 days, and no one would know it. My brother, you walk out his front door and it's a restaurant, then a bar, then a bookshop, then a ... It's just so exciting and you don't need car.
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Biju:
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Sure.
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Howard:
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My brother doesn't have a car.
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Biju:
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Right, okay. It's a bit like Singapore then. As you'll no doubt find out today, when we'll show you a bit of the town.
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Howard:
|
You moved here from Scotland to set up the Cfast in Singapore.
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Biju:
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Really to set up Cfast in southeast Asia.
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Howard:
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When you say Southeast Asia, what does that include?
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Biju:
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We're talking about Singapore, Malaysia, Philippine, Thailand, Hong Kong. We're not quite registered in mainland China yet, and we're looking at very soon Taiwan, Korea, these sort of places.
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Howard:
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Wow, you have big expansion plans.
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Biju:
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Absolutely.
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Howard:
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How's it taking off?
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Biju:
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It's been amazing in Singapore so far. Last year was a crazy year for us, we shifted the whole family, we had the whole idea of settling into the house, I'm working general practice still, getting kids into school, setting up our offices, and then in between all that we trained over a hundred dentists here in Singapore.
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Howard:
|
How old are you kids?
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Biju:
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We've got quite a range. From 17 through to 17, and then 4.
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Howard:
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Are they excited? Or are they mad at dad?
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Biju:
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They love it. I think initially with kids, they don't like change too much, but now they're here I think they love it.
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Howard:
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Well, it's definitely different weather than Scotland.
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Biju:
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Definitely.
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Howard:
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They've got to love the equator over [inaudible 00:16:44]. You know, I find beauty so arbitrarily, so I mean, I think of straighter teeth as easier to brush and clean and all that stuff, but there's a lot of people who say that you really can't tie it to less gum disease, less decay. There are some research people who say that it's just all cosmetic, but I think is funny in cosmetic is, when you go to the United States, which is half the population is European Caucasian, they're sticking botox and dermafillers trying to puff out their lips. Then you come to Asia where they draw a line from the nose to the chin, and if that upper lip sticks out in front of that ... What do they call that line? Then they want that lip back.
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Biju:
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Sure.
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Howard:
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It's funny because they'll spend a lot of money moving that lip back, and in the United States they're all pumping up everything try to move it forward.
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Biju:
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That's true.
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Howard:
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I've got to ask you, where is a beautiful lip? Is it on the line? Is it in front of the line? Is it behind the line, from the nose to the chin?
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Biju:
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It really depends on you as a patient, how you view it.
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Howard:
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Yeah. It's because it-
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Biju:
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It's so subjective.
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Howard:
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It is.
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Biju:
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You can't really impose your view of beauty on someone else. I don't try to do that, what we try to do is we try and find out where the patient is.
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Howard:
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Do you know what I'm talking about [inaudible 00:18:03]?
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Biju:
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Sure. Absolutely. The aesthetic line.
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Howard:
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The aesthetic line. Explain that because the United States in only 6% Asian, and so only half of those would be women, and only maybe a fraction of them would have the lip. A lot of these guys you're talking to are not really familiar, so review that again.
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Biju:
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If you look at that, if you take a lip from the tip of the nose to the chin, basically the lips should just touch that line. Anything forward of that line is seen to be unaesthetic, and I think too far behind that line is unaesthetic. It's an interesting point that you've brought up because this has been a learning curve for me when it comes to treating teeth in Asia. In the west when somebody says, "I want straight teeth." What they mean is, my teeth are a little bit crowded, I want them aligned so that they're nice and evenly spread out.
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Here in Asia when somebody says, "I want straight teeth." Quite often what they're saying is I want my teeth less proclined. I want them back, so they're not sticking out. That caught me out a bit in the early days because sometimes teeth can be very straight but they're proclined, that's not a look that people like here.
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Howard:
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How do you bring the teeth back?
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Biju:
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You can't with cosmetic orthodontics, that requires orthodontics.
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Howard:
|
Is that bicuspid extraction?
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Biju:
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Or surgery but yeah, so here you get a lot of what we call bimax. Proclination protrusion, and some of those cases probably have to be treated with extraction.
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Howard:
|
I know, and I was lecturing the other day and this little girl was telling me how she wanted to save up and she wanted to do that, and I'm just looking at this little girl, I was like, "You're adorable, you're cute!" Why the hell is this demon in your head-
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Biju:
|
We have a lot of those conversations.
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Howard:
|
Yeah! It's like, my god, you couldn't be more cute and adorable.
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Biju:
|
Those are always my biggest challenges, the patients that start good. Those are the one with the high expectations you're just never going to me. Those are the ones you just don't treat. I don't treat them anyway.
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Howard:
|
I interrupted you, so walk these guys through a case.
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Biju:
|
Again, so a patient comes in, you take an impression, you take it to the lab, the lab will send you back the appliance. Just a little aside here, Cfast is not just about affixed labial appliance. We also have lingual appliance, and we also do aligners, because some cases, there's a bit of flexibility in terms of the clinical case. Some clinical cases require an aligner, some require other ways of treating the dental condition, so we don't restrict yourselves to one specific appliance, but the main appliance that we use is a affixed labial appliance.
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The dentist then puts the appliance on, very straight forward, it's an indirect bonding technique, and then the wire is attached. One thing we have with Cfast which as far as I know, no other system has, it's patented self liagating bracket, which means there's no modules, no ligatures. You just pop open the bracket, the little door. Put the wire in, and close.
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Howard:
|
No rubber bands.
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Biju:
|
So simple. No rubber bands, it doesn't stain, and also one of the big things moving to Asian, if you tell somebody in this country, "Don't eat curries because it will stain our bands," they come back with, "Well, what do I eat?" It's very restrictive to have those rubber bands in place. We don't have that any more, and these brackets are, when we talked earlier about using real technology, some of the advances? These brackets are all 3D printed, so they're super small, very low profile, extremely aesthetic.
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Howard:
|
Are you making your own bracket and wire?
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Biju:
|
Yes, these are all supplied by our partners in the US. These are super brackets, I mean, if I was wearing it now you'd have difficulty telling I was wearing it.
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Howard:
|
Why is lingual still a minority? What percent of your cases in Cfast are done lingual?
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Biju:
|
Me? About 5 to 10. You're right.
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Howard:
|
For you personally, or for the company?
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Biju:
|
Yes. No, I think for the company it's probably about 5%.
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Howard:
|
If everyone's doing all the Invisalign and Clear Connect and all this stuff to avoid braces, and you can just put them on the inside, why is that just not [inaudible 00:22:17]?
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Biju:
|
[inaudible 00:22:17] we advertise lingual braces a lot, and we have people come in for lingual braces. I think dentists have a retisense in providing lingual because it is more complicated than a labial appliance. It's a bit more demanding in terms of just physically fitting appliance and adjusting it. It's also more expensive in terms of lab fees.
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What happens when a patient comes to see me, they come to see because they want a lingual appliance. They don't want to wear a lingual appliance that is viable at all. When I show them how aesthetic the labial appliance is, and the fact that they can probably finish their treatment in about 4 to 5 months, and it's going to cost them significantly less than the lingual appliance, most patients, even though they came in for a lingual, are happy to go with labial. These labial appliances are super, super cosmetic. Most patients say, "Well yeah, I'm saving a few thousand dollars, I can live with the labial for a few months."
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Howard:
|
You know, on our iPhone, the Dental Town app started the online CE. We put up 350 courses, and they've been viewed half a million times.
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Biju:
|
Yeah, I'd believe that.
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Howard:
|
Have you ever thought about making an online-
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Biju:
|
We have an online course. In fact, we have what we call the Cfast University, which is very much online. Everything that we teach, not just in terms of orthodontists, but a lot of the adjunct courses as well in terms of things like composite bonding, minimal prep veneers-
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Howard:
|
That's on the website Cfast.com?
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Biju:
|
We have a Cfast University, it's a separate website. If you go to Cfastresults.com, that's the main website-
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Howard:
|
The Cfast is for Cosmetically Focused Adult Straight Teeth.
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Biju:
|
Yeah.
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Howard:
|
If you go to Cfastresults.com, that's where you have the-
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|
Biju:
|
In the Cfastresults.com there's two parts to that website. The first part is the-
|
|
Howard:
|
Just pull it up right here.
|
|
Biju:
|
It's a public facing website and on this part of the system as well, you can log in and you can see, it says here, "I’m a dentist," that allows you log into the professional sight. This logs into the dentist part of the website. On there they can access all the modules, the downloads, everything basically. It's like the whole course online.
|
|
Howard:
|
If someone goes to Cfastresults.com, how many hours of instruction are there?
|
|
Biju:
|
On the Cfastresults.com, that's really a support website. We have on there the whole course basically, so you're talking, oh god, many hours worth of downloads, how-to-videos. Actually, the whole course is on there as well. Separate to this, we actually have a separate system called Cfast University which has a whole bunch of other stuff on there.
|
|
Howard:
|
Like what?
|
|
Biju:
|
It has the whole course online. If you're familiar with things like fixed appliances or done other short term ortho systems, then-
|
|
Howard:
|
I think I'm having a hard time with word appliance, because in my walnut brain, in the United States, born in Kansas, an appliance is something made in a lab.
|
|
Biju:
|
Right, okay.
|
|
Howard:
|
If your brackets and wires-
|
|
Biju:
|
Brackets and wires, what do you call that?
|
|
Howard:
|
Fixed-
|
|
Biju:
|
Affixed brace.
|
|
Howard:
|
Yeah, we just call it fixed.
|
|
Biju:
|
Fixed, okay, it's a fixed. so if you've got a fixed-
|
|
Howard:
|
Fixed brackets and wire.
|
|
Biju:
|
Yeah, fixed brackets and wires. If you're familiar with doing that, if you've experience in doing that, then we have an online conversion course. It walks you through the system, it's in five separate modules, total about 8 to 10 hours worth of downloads there. That allows you to go through the system and become accredited to use it. Over and above that we have a lot of other lectures that come in and support that.
|
|
Howard:
|
Where's your lab that makes the-
|
|
Biju:
|
We have several labs, we have one in US, in Texas.
|
|
Howard:
|
That was Skip Pruits.
|
|
Biju:
|
Yeah, Skip Truitt.
|
|
Howard:
|
The Skip Truitt that did all the ortho, or is it his son?
|
|
Biju:
|
Yeah, no Skip Truitt is the guy that's very famous for the ortho. I think has trained over 50,000 dentists in ortho I think, over 30 years.
|
|
Howard:
|
So it's his lab?
|
|
Biju:
|
Yeah.
|
|
Howard:
|
Now how old is he? Is he still out there lecturing?
|
|
Biju:
|
Yeah, we just met him a few weeks ago, so he must be in his, if I get this wrong he'll kill me, I think late 60s, probably 70s by now but still making very good for it.
|
|
Howard:
|
My god. In Dallas?
|
|
Biju:
|
In Dallas.
|
|
Howard:
|
Oh my ... You know, I think I studied from him in like '87.
|
|
Biju:
|
Yeah. Yeah.
|
|
Howard:
|
How old do you think he is?
|
|
Biju:
|
He must be in his late 60s, early 70s. He's still going really strong.
|
|
Howard:
|
There's no way he can be in his late 60s. He has to be in his 70s.
|
|
Biju:
|
He must be in his 70. I'm just airing on the side of caution, just to be safe.
|
|
Howard:
|
You just don't want to get in trouble! Skip is still out there lecturing?
|
|
Biju:
|
I think as we speak he's just on his way to Malaysia, so he's not far from here. He's in KL, Kuala Lumpur now.
|
|
Howard:
|
Is he in another orthodontic ... Is it just lecturing for his won?
|
|
Biju:
|
Yeah, so Skip really talks about proper comprehensive orthodontists. We're talking more orthopedic type orthodontics. He talks a lot about non-extraction and developing the arches.
|
|
Howard:
|
You're using his lab?
|
|
Biju:
|
We use his lab-
|
|
Howard:
|
What's his lab called?
|
|
Biju:
|
It's call Triple O.
|
|
Howard:
|
It's called what?
|
|
Biju:
|
It's called Triple O.
|
|
Howard:
|
Triple O?
|
|
Biju:
|
Yeah.
|
|
Howard:
|
T-R-I-P-L-E
|
|
Biju:
|
O.
|
|
Howard:
|
Just O.
|
|
Biju:
|
Triple O, yeah.
|
|
Howard:
|
TripleO.com?
|
|
Biju:
|
It must be TripelO.com, yeah.
|
|
Howard:
|
Or TripleOlab.com
|
|
Biju:
|
I'm not sure, I think it's TripleO.com.
|
|
Howard:
|
Where are your other labs? Singapore you have one?
|
|
Biju:
|
We have a lab in Singapore, we have a lab in Birmingham in UK. That's also one of the Tripe O labs.
|
|
Howard:
|
That's Skip Truitt's lab?
|
|
Biju:
|
Yeah, in England. Well, it's one of Skip's business partners who also actually has a stake in our Cfast business as well.
|
|
Howard:
|
Really? Does Skip have a stake in that?
|
|
Biju:
|
In the US lab, yes.
|
|
Howard:
|
Not in Cfast though?
|
|
Biju:
|
Not in Cfast, no.
|
|
Howard:
|
The Triple O lab guy has a stake in it.
|
|
Biju:
|
Yes, absolutely.
|
|
Howard:
|
Where are all the Triple O labs?
|
|
Biju:
|
There's one in US and there's one in-
|
|
Howard:
|
Dallas and Birmingham?
|
|
Biju:
|
In Birmingham in England, yes. We also have a lab here in Singapore and another lab in Australia.
|
|
Howard:
|
Where in Australia?
|
|
Biju:
|
But these are specific Cfast labs. The one in Australia is in Sydney.
|
|
Howard:
|
Is that with Derrick?
|
|
Biju:
|
No.
|
|
Howard:
|
That's where Derrick is.
|
|
Biju:
|
Derrick's based in Sydney, yes.
|
|
Howard:
|
One of the reasons I'm such a huge fun of Derrick Mahoney is he is the epitome of what everybody's been telling orthodontists for 20 years. He helps all the local general dentists with any of their ortho cases.
|
|
Biju:
|
Sure, that's right.
|
|
Howard:
|
What it turns out to do, they'll do about 5% of their cases, but then Derrick will get the 95% of all the referrals.
|
|
Biju:
|
Sure.
|
|
Howard:
|
Everywhere else, because Derrick sees the end vision in mind, which is the patient, and he thinks in abundance. Most orthodontists around the world think in total fear and scarcity, and if you ask them a question they're not going to help you at all.
|
|
Biju:
|
Yeah. It's very refreshing speaking to Derrick. He understands the bigger picture.
|
|
Howard:
|
What does he have, 4 offices in Sydney and a half dozen ...
|
|
Biju:
|
Yeah, I mean Derrick is hugely, hugely successful.
|
|
Howard:
|
How many orthodontists in each of those?
|
|
Biju:
|
He has an internship program, so I think part of his course, he allows the people on that course to come in and work with his practice, so it's real hands-on.
|
|
Howard:
|
I've never seen anything like it.
|
|
Biju:
|
It's amazing. He really is an amazing guy. Yeah, very impressive.
|
|
Howard:
|
Incredibly impressive.
|
|
Biju:
|
Very impressive. He does a lot more in the US, he's coming more and more and talking in the US, so if any of your listeners get a chance to go one of Derrick's courses, it's strongly recommended.
|
|
Howard:
|
It's just tough because from LA to Sydney is a 15 hour flight.
|
|
Biju:
|
Yeah, but I think he runs courses in the US, or will be very soon.
|
|
Howard:
|
Yeah, in LA. Once you get to LA, it's another 5 hours to New York.
|
|
Biju:
|
Yeah, yeah, I know. I've been there, I've done that, I know what that feels like.
|
|
Howard:
|
Oh my god. You get off the plane from Australia and you don't even ... I remember the first time I went there was before cellphones, and I walked out the plane and I went the cell phone to call my ex to get a ride home, and I couldn't even remember my number. I'm just saying, "Oh my, I can't even remember my," your brains just fried. You feel Cfast is a unique enough selling proposition to carve its own space in this market?
|
|
Biju:
|
Well, it has done.
|
|
Howard:
|
It's exploded in the UK.
|
|
Biju:
|
It's exploded in the UK, Australia, and here. In the year since I've been here, we've trained over a hundred dentists and it's just growing every month and month.
|
|
Howard:
|
What do you think it really had that Invisalign didn't have? Or why-
|
|
Biju:
|
I'll tell you what, it's because it's not orthodontics. You know, general practitioners get it, because it really is quite simple. We're dealing with the things that patients come in for requests, "I want nice smile, I want straight front teeth." It just deals with that, it doesn't deal with any of the complexities of orthodontics. It's a simple system so dentists, they just get it. It's nothing overly complicated.
|
|
|
The reason I think it's really exploded is because we provide very good one to one support. It's that kind of support Derrick Mahoney gives. The reason I've sold my practice in the UK and moved out to Asian was because I know that I need to be here. I need to be on hand, I need to just be able to speak to those dentists, look them in the eye and say, "Hey, you got any problems? Speak to me, I'm here to help." We do that everywhere we've been.
|
|
Howard:
|
You set up a Cfast lab in Singapore?
|
|
Biju:
|
Yeah.
|
|
Howard:
|
There wasn't a Triple O lab in Singapore?
|
|
Biju:
|
Yeah, well, we do it in conjunction with a lab that was already here.
|
|
Howard:
|
Now are you going to set up a dental office for you?
|
|
Biju:
|
No. I work in practice here but I'm too busy really with Cfast to set up my own practice here.
|
|
Howard:
|
You're working with someone else?
|
|
Biju:
|
I work with someone else.
|
|
Howard:
|
Was it hard to get a license? A UK dentist to get a license in Singapore?
|
|
Biju:
|
As a UK dentist the degree's transferable.
|
|
Howard:
|
Because Singapore was a British colony?
|
|
Biju:
|
I think yes.
|
|
Howard:
|
Hong Kong?
|
|
Biju:
|
Hong Kong as well.
|
|
Howard:
|
Australia?
|
|
Biju:
|
Australia.
|
|
Howard:
|
The United States? India? You've only lived in countries that were-
|
|
Biju:
|
If you're talking history then, I think there has been no empire bigger than the British empire ever, in the history of empires.
|
|
Howard:
|
Right? It was 68 countries.
|
|
Biju:
|
That's right. Most of the globe was British at one point.
|
|
Howard:
|
It was very easy to get license in Singapore?
|
|
Biju:
|
Yeah. We have to come over here, and there's 2 years we would do a conditional registration period where I have to work closely with one of the other dentists to make a sure I understand the local nuances in providing dentistry, and that's fine. After that you can get your full registration.
|
|
Howard:
|
What do the local dentists think about a new guy coming down. Do they look it as fierce and scary like, "Hey, we don't want any outsiders coming into our field." Was there open arms? What was that like?
|
|
Biju:
|
I think I've been really luck, all the guys that I've meet have been hugely welcoming. We come here with an idea to teach and to educate and look at other possibilities that are available out there and so far [inaudible 00:33:39] has been hugely positive. We've trained a lot of people, we helped a lot of people develop their cosmetics dentistry skills. Singapore there's plenty of patients, there's no shortage of work.
|
|
Howard:
|
You're practicing 2 very [inaudible 00:33:56] the United Kingdom, its scholars very insurance driven with NIH and the government, the NHS. The government is very involved in that all and Singapore is-
|
|
Biju:
|
Almost completely opposite.
|
|
Howard:
|
I remember explaining to dentists in China about dental insurance and they're like, "Why would your government or your boss?" You're the one drinking doctor pepper and you don't brush and you don't floss. The Chinese dentists were looking at me like, "Why would someone else ... ."
|
|
Biju:
|
[crosstalk 00:34:28] your problems that you created.
|
|
Howard:
|
Tell me what are your thoughts. What does that make you think of the NHS system? Like in America, 95% of dentists just say, "Well, if the insurance is going to pay that's the end." Now, you're in Asia where they don't even know what dental insurance is.
|
|
Biju:
|
I was fortunate in the UK, I had two practices. One practice was very much NHS based. The second was more of a specialist cosmetic restorative practice, which is purely private. I got to see a bit of both while I was in the UK. Very much what's happening in NHS dentistry because it's so cheap for the patients. Patients totally undervalue the skills of the dentist or the quality of the work that they're getting. Dentistry in the UK on the whole is hugely undervalued by the patients and the profession is undervalued as a whole by the patients and also by the government.
|
|
|
Right now, there's a whole bunch of problems that is kicking off there because of that. What's happening now certainly with UK dentistry, there's a lot of stuff that, especially when you come to the cosmetic itself isn't available on the NHS.
|
|
|
When it comes those more cosmetic type treatments, patients are starting to understand the really value of good dentistry. At the basic level when it comes to prevention and simple fillings and stuff, really dentistry as a whole is hugely undervalued because it's so cheap. How can something that's that cheap be of value? A lot of dentists feel that they're not valued, their profession isn't valued, the skills aren't valued both by the patients and the government. That's the sad state of affairs.
|
|
Howard:
|
Would you say that the dental economy in Singapore and Hong Kong is healthier than in London because it doesn't have this government interference with insurance?
|
|
Biju:
|
Having the government subsidy in one sense is a wonderful thing because you will always be treated. The concept for NHS dentistry was, if you need the cosmetic of NHS medical or dental treatment is that if you need help you will get it. It's free at the point of delivery. That's a wonderful thing to aspire to but it's a road for the political, a road of the government at the moment in the UK.
|
|
|
Here, of course, because it's so expensive when you compare to other things, people look after their teeth. They try not o get into situation where they need dentistry. Saying that, the interesting thing I've found is that tooth decay is less here but [inaudible 00:37:22] is worse. You talked earlier about what strengthening teeth for orthodontic, does that work? Yeah, really works. I can show you lots of slides [inaudible 00:37:32]
|
|
Howard:
|
There are some things, I don't know if people are afraid to talk about because it's race related. I read once back in the days in the '80s that basically the Asian tooth has a very constrictive cervical back. Because of that constrictive cervical back minerals like calcium and phosphorous precipitate out and form tartar, calculus [cimzia 00:37:54] and that's making it for gum disease. The opposite of that if the African tooth, they're the most [inaudible 00:38:00] tooth. If you talk to any pediatric or dentist he will say, "Yeah, keeping gum so crown on the little baby African tooth." There's no under cuts, it's hard to keep.
|
|
|
The Caucasian or what you used to teach the [Caucasoid 00:38:13] was in the middle. Do you think the constrictive cervical has any thing to do with it or do you think it's something else?
|
|
Biju:
|
I can't tell you the [critical 00:38:25] thing because I cannot tell you what I see totally every day. What I see I s that people in Asian are much more susceptible to gum disease and periodontist than their counter parts in the west. Now I can't tell you-
|
|
Howard:
|
Their smoking is [inaudible 00:38:42]
|
|
Biju:
|
There's that as well.
|
|
Howard:
|
When I was in Malaysia, you almost see anybody without a cigarette in the hand.
|
|
Biju:
|
Sure, but a lot of patients don't smoke at all but still have ... Relatively I'm not saying they've poorer oral hygiene. They're of average oral hygiene but they've a lot barrier that wouldn't necessary associate with that level of hygiene.
|
|
Howard:
|
You're seeing less decay in Singapore than Scotland.
|
|
Biju:
|
Yeah, Scotland we've rampant decay.
|
|
Howard:
|
Why does Scotland have rampant decay?
|
|
Biju:
|
I think it's a case of poor education, messages not getting through. It's just not reaching significantly over the years.
|
|
Howard:
|
I found you said something very profound where-
|
|
Biju:
|
I think again dentistry is so cheap, it's not of value-
|
|
Howard:
|
When dentistry is cheap-
|
|
Biju:
|
Yeah, when anything is cheap and free you don't value if. You'll always get it fixed, it's not a problem.
|
|
Howard:
|
The same thing with the exploding cost to health care, [inaudible 00:39:38] thing line seven, eight hundred million dollars might be just duplicate balling. No one even looks at their bill because Medicare, they wouldn't even have a 5% compliment. I always had to myself if United States had 5% [inaudible 00:39:54] on everything across the board. They talk about fifty thousand need [inaudible 00:39:57]. Say it was 10% , say you've 50,000 and your portion was 5, 000 or a 5%, $2500. Do you know how many people will say, "No, I'm going to exercise? I'm going to lose 50 pounds."
|
|
Biju:
|
That's interesting because certainly I've noticed in Asia, not just Singapore but throughout Asia health is much more important, especially as you get older. I see many more people here in the evenings walk around, you see a lot older generation doing [touch 00:40:27] exercises, that kind of thing. People here can't really afford to get [inaudible 00:40:32] in a big way so you try not to. Prevention there is important and health is a big thing, it's a big business here. A lot of companies are set up to make sure that you don't fall ill. You look at nutrition, you look at diet, you look exercise. A lot of things that we do, in some way we do we get [inaudible 00:40:53] but we don't do it. Here people do it because they sort of have to. You can't really afford to get severe illness.
|
|
Howard:
|
Every engineer would say that everything has a trade off. What you said earlier was that when a government subsides anything it's more of it. If you don't subsides it and you tax you will get lost of it. You're saying that you subsides dental insurance, that's a good thing but the trade off could be that your personal behavior changes because the government got if for free.
|
|
|
I was thought the smoking rate was crazy because they'll buy a seven, eight, nine dollar packet of cigarettes everyday but they only get a hundred thousand dollar [inaudible 00:41:37] in fact Obama or their employer to pay for it and say, "Well, if you paid seven or eight dollars a day, shouldn't like one dollar of that go into a fund?" They say, "Oh yeah, we've been waiting for you." You've been smoking for forty years and you've hundred thousands dollar throw away and you ready to [fully 00:41:58] open.
|
|
Biju:
|
It makes sense but common sense is something that I think-
|
|
Howard:
|
Common sense is not going ... You've that whole university on Cfast.com or-
|
|
Biju:
|
Cfastresults.com. Once you get aggregated with our system, we give you access to all that kind of stuff.
|
|
Howard:
|
What will be the next step for one of my listeners? What of someone want to do [inaudible 00:42:32] Cfast?
|
|
Biju:
|
We've created courses throughout the US and certainly in your show we can put up a link to where they can get more information.
|
|
Howard:
|
You mean like lecture in the United States is Mike [inaudible 00:42:46].
|
|
Biju:
|
I think a lot of your listeners probably know of Dr, Mike [inaudible 00:42:51] so really seasoned lecture. Great guy.
|
|
Howard:
|
His father is a big in sacrament and [inaudible 00:42:59]
|
|
Biju:
|
I think he's second or third generation dentist, got great practice in sacramental. Great dentist and great educator.
|
|
Howard:
|
Mike is your main educator in United States?
|
|
Biju:
|
Yes.
|
|
Howard:
|
What else do they need to know. Anything else you want to add?
|
|
Biju:
|
No, that's it certainly if anyone is interested in looking at it, developing a Cfast practice or introducing Cfast into their practice then [inaudible 00:43:29] we can send a link with lots of information on how to get a course and how to start using the system.
|
|
Howard:
|
All right, so you think there's a fourth country you've used some day?
|
|
Biju:
|
Sorry, say that again.
|
|
Howard:
|
You think there might be a fourth country, you think Singapore is just the third?
|
|
Biju:
|
I'm sure, we're venturing that way.
|
|
Howard:
|
What will be your fourth country?
|
|
Biju:
|
We've done a lot of Asia but I'd love to be able to do something in China.
|
|
Howard:
|
Tell why? You need to live in China or just Cfast in China.
|
|
Biju:
|
Living in China I've to convince my wife. I don't think [inaudible 00:44:03] too far but I'd love to spend some time in China.
|
|
Howard:
|
You have spend much time in China?
|
|
Biju:
|
No, I've only been-
|
|
Howard:
|
I got [inaudible 00:44:09] so far in China one time that the dentist, he kept laughing at me because everyone will stop and just stare at me. Then I finally got to this area and I sat down. I sat down on floor and it was a little kids school and these little chunky Chinese kids [inaudible 00:44:30] he kept coming closer and closer and closer and finally he reached out and he touched my head and he goes [inaudible 00:44:37]. I didn't move, I just smiled at him so everybody knew he was safe. The next think I knew I was like 20 Chinese little kids all wrapped at the top of my head.
|
|
|
One thing you were saying some people say, "I constrict [inaudible 00:44:52] with Asian gum disease." Some people say they have thinner gums. The smoking rate is got to have some factor because I'm looking at the United States they say 1950 half of adults smoke a packet a day. In 2015 it was under 18% so it had gone from 50% to under 20%. I see a lot of studies showing that smoking rates in like Malaysia or Indonesia for adults males 40 can be 80 to 90%, females as higher as 30%. Do you think it's smoking or do you think there something we don't even know?
|
|
Biju:
|
No, it's got to be contributing factor. Smoking definitely is a contributing factor here but from things I see and I see patients who smoke and who don't smoke. There is this underlying [inaudible 00:45:45] gum-
|
|
Howard:
|
You think we know what it is?
|
|
Biju:
|
Actually no.
|
|
Howard:
|
Is there anything combating it?
|
|
Biju:
|
It had to do with my skill to give you that answer. Cfast what I can do on practical level, I do a lot more nerve Cfast especially with neurosense. Just for to relive that crowding, to make easier for them to make their oral hygiene. I can show you ton of slides where we've done that and-
|
|
Howard:
|
It makes common sense.
|
|
Biju:
|
It makes a big difference to the health of the teeth.
|
|
Howard:
|
Another thing that makes common sense is a lot of the mouth washes, whether be the [chlorine dioxide 00:46:18] that is made of water or the alcohol based like the Listerine, chlorine dioxide and [glucagon 00:46:24] is a sticky oil. When you look at the research is they always point back that chlorine dioxide and Glucagon they're still better and they think just because that's stick oil is killing bacteria for a long time after the chlorine dioxide or the alcohol based is gone.
|
|
Biju:
|
Absolutely, do it.
|
|
Howard:
|
Agreed. All right. You're an amazing man buddy.
|
|
Biju:
|
Pleasure is my Howard. I've been listening to your podcast for sometimes. It's great to be finally to be on one.
|
|
Howard:
|
Since you're Scottish I'm going to charge you a penny.
|
|
Biju:
|
A penny. I've got some couple wire here, will that do?
|
|
Howard:
|
We'll smash the wire together, we'll make a penny.
|
|
Biju:
|
Quite right.
|
|
Howard:
|
Okay, thanks for coming.
|
|
Biju:
|
Thanks for coming to Singapore.
|
|
Howard:
|
It's not [inaudible 00:47:11] all right thanks for coming with me all the way to Singapore.
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Biju:
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Pleasure.
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Howard:
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Okay, thank you.
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Biju:
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Thank you.
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