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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Howard Farran:

It is just a huge honor to be -

Noritoshi Iwata:

Nice to see you today.

Howard Farran:

Nice to see you. I'm sitting here in one of the greatest civilizations that ever lived. I'm with Noritoshi Iwata.

Noritoshi Iwata:

Noritoshi Iwata, right, yes.

Howard Farran:

In Tokyo, Minato-ku, Nippon.

Noritoshi Iwata:

Right.

Howard Farran:

Americans call it Japan, but you guys call it Nippan or Nippon.

Noritoshi Iwata:

Nippon.

Howard Farran:

You call it Nippon?

Noritoshi Iwata:

Yes, we call our self Nippon. In Japanese language called Nippon.

Howard Farran:

Okay, I heard the older people call it Nippan. And the younger people call it Nippon?

Noritoshi Iwata:

It depends.

Howard Farran:

Ni-hong?

Noritoshi Iwata:

Ni-hong or Nippon. It depends.

Howard Farran:

Ni-hong. And America has that, some call it the United States. Some call it America.

Noritoshi Iwata:

Right, right.

Howard Farran:

Some call it U.S.A. The largest city in America in New York City. That's about eighteen million people and that's in five burroughs. Tokyo is twenty million people in twenty-three districts.

Noritoshi Iwata:

Yes, something like that.

Howard Farran:

And we're in the Minato-ku district right now.

Noritoshi Iwata:

Minato-ku (speaking Japanese), center of Tokyo, here it is.

Howard Farran:

And you know, one of the reasons that I like meeting dentists from all over the world on Dentaltown, is because they always say, you need to think outside of the box. I think when people are born, raised, lived and they've never left Oklahoma.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

They think everything in Oklahoma is just the only way it can be.

Noritoshi Iwata:

Right.

Howard Farran:

And then when these dentists start meeting other dentists from Russia and Brazil and Japan, they start realizing. Like in America, it's so common to think that, well whatever Delta Dental does, you have to do. Then you go to Singapore and they don't even have dental insurance.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

Neither does Brazil. I think an interesting thing about Tokyo, Japan is that we were little they told us America was great because people move there from every country in the world.

Noritoshi Iwata:

Right.

Howard Farran:

And we had these immigrants from every corner of the world and that's why we were great. Then you come to Japan, which is just as great, and it's one of the most isolated countries because it was an island.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

It's not like Poland where Russians were traveling through and Germans and Ukrainians and the whole world. You know everyone's always, or the silk trades, all the way from India all the way to Rome and back.

Noritoshi Iwata:

Right.

Howard Farran:

Japan was an island. It didn't have any neighbors.

Noritoshi Iwata:

Yes.

Howard Farran:

And only ten percent of the dentists read English, so you didn't have really any immigration. Yet you built one of the greatest societies. I mean just look out this window.

Noritoshi Iwata:

Yes, that's right.

Howard Farran:

This is probably the cleanest, most organized, safest, nicest countries I've ever seen in my life.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

I don't think I've seen anything that tops this.

Noritoshi Iwata:

Yeah.

Howard Farran:

So it goes to show you that just because it's this way in your country, that doesn't mean that's why your country's great. Japan's great not from immigration, but from a great work ethic and a great culture.

You're the director of international business for imports for the Japanese dental market for Pentron.

Noritoshi Iwata:

Mm-hmm (affirmative). Yes, right.

Howard Farran:

Now when I was little, when I got out of school in eighty-seven, Pentron was called Generic Pentron.

Noritoshi Iwata:

In the past, they're old story.

Howard Farran:

Old story.

Noritoshi Iwata:

They're old story. They changed a lot in twenty years.

Howard Farran:

That was in Connecticut. Then it got bought in 2008 by Danaher.

Noritoshi Iwata:

Yes, that's right.

Howard Farran:

So Generic Pentron got all swallowed up into the KaVo Kerr Groups.

Noritoshi Iwata:

Yes, KaVo Kerr Groups.

Howard Farran:

But Pentron lived on in the Danaher group in Japan.

Noritoshi Iwata:

Yes, she survived here.

Howard Farran:

It survived in Japan? Is Pentron, the name-brand Pentron, really only in Japan now?

Noritoshi Iwata:

In Japan Pentron is our company name. Also the brand name for Pentron products. But in United States it is only the brand name. Kind of the company name Pentron Clinical, but operated by the KaVo Kerr Groups. But we are very happy to import. Still we can import from KaVo Kerr Group for Pentron brand products.

Howard Farran:

And your number one selling product. You've been in dentistry for twenty-three years. You're not a dentist, you've been in the dental business for twenty-three years.

Noritoshi Iwata:

I'm not a dentist. I'm marketing side. Business man, I'm sorry.

Howard Farran:

Yeah. No, don't be sorry. It's funny, when I started Dentaltown a lot of dentists said, well you can't let non-dentists on Dentaltown. I said, that's absurd. If you close down five-hundred dental companies, I'd be trying to fix your tooth with bottled water and a pocket knife. I mean, how? I need about five-hundred dental companies to do the work I do.

I mean, for me to do my root canals, and fillings, and crowns, and x-rays, and CBCTs. Three-hundred RPM night timing. I own Dentist Town, but I didn't use it. I use Dentaltown. So Dentaltown is always welcome, because you need to see what your dentists are saying about your product.

Noritoshi Iwata:

Actually, yes. Because Japanese doctors, dentists they wanted to know how American doctors doing this. How they treat United States patient. So that's also very important for Japanese doctors, dentists, to learn a lot.

That's why, I used to see your Dentaltown. Sometimes it shows the fiber post-treatment questionnaire, something like that. So, I brought back to Japanese doctors, with my translation. It helps also our Japanese doctors.

Howard Farran:

That's a beautiful story. So, fiber, your main product that you sell in Japan, is the fiber core post and the build-up, fiber reinforcement build-up material.

Noritoshi Iwata:

Yes.

Howard Farran:

You have a third of the market-share in Japan. And Japan is unique in one way in the fact that the Japanese government has a dental insurance plan.

Noritoshi Iwata:

Yes.

Howard Farran:

And they just approved your product. They started paying for your build-up, your fiber core.

Noritoshi Iwata:

Fiber core post, fiber post.

Howard Farran:

This year, 2016.

Noritoshi Iwata:

That's right. Just started.

Howard Farran:

Which made your sales go up significantly.

Noritoshi Iwata:

Yes, that's right.

Howard Farran:

And they approved it because some people need a non-metal post because of metal allergies. And some people have high cosmetic needs.

Noritoshi Iwata:

They're the ones trained for the metal-free restoration. They try to forget about the metal post, metal cast core. Everything should be replace to fiber-made post. No metal treatment. Kind of the attitude in Japanese dentistry at this moment.

Also, the metal cast core it used to use silver-palladium alloys. These silver-palladium alloys the price is fluctuated by the market-price. Because this has palladium. So government wanted to forget a way for this metal price struggle, to stabilize the fiber post with glass fiber and core post ready-made.

This is another purpose to change to the fiber made post.

Howard Farran:

Now, one of the dilemmas of your business in Japan is that, in America, the dental insurance companies will pay about a thousand dollars for a root canal.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

Because of that, we have four-thousand endodontists, who just do root canals full-time. And in Japan, they're only paying about a hundred dollars U.S. for that same molar root canal. Because of that, there's almost no endodontists in Japan.

Noritoshi Iwata:

There is small numbers. But now has the tendency of growing step by step. Some [unintelligible] are American introductory treatment technique. They try to import to Japan. But still very small numbers at this moment.

Howard Farran:

But, it's hard to do a root canal for a hundred dollars.

Noritoshi Iwata:

Because hundred is the private practice, actually the health insurance coverage costs about less than a hundred.

Howard Farran:

Less than a hundred?

Noritoshi Iwata:

Less than a hundred for one root canal treatment. That's why, very difficult to keep maintained with the high price of materials.

Howard Farran:

So is the way they do it, they're not going to sit down and do it in one appointment? They're gonna try and do it in how many appointments?

Noritoshi Iwata:

So many, for instance, every two weeks for about three to four months.

Howard Farran:

So they want to see you every two weeks for three to four months? Is it three months or four months?

Noritoshi Iwata:

It depends, it's crazy.

Howard Farran:

And that's because when I see you I can charge out an exam fee?

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

So, how long would that appointment be when they see you for that root canal appointment every two weeks?

Noritoshi Iwata:

After the diagnostic and the studying for the extraction like that, then it can healing time. It requires so long. It depends on the doctors diagnostic onto the root canal conditions. It depends, each patient's case. Each specific term, but maybe about three to four months.

Howard Farran:

Mm-hmm (affirmative)

Noritoshi Iwata:

In just my case, I took also three to four months to finish my root canal treatment.

Howard Farran:

So in America, we would just sit down and do it in an hour.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

But in Japan, because of the third-party insurance.

Noritoshi Iwata:

Yes.

Howard Farran:

They're going to have to see you every two weeks for three to four months.

Noritoshi Iwata:

It depends. Let's say each doctor's, each dental clinic's appointment number is very big. That's why in my experience we see dental treatment, every patient, taking about, around thirty minutes only. No more than one hour. So, chair time, they try to change one by one. More shortcut. To get more patient.

Health insurance treatment, the income is very, very low for doctors, business-wise.

Howard Farran:

The two main areas the insurance company doesn't cover is orthodontic braces, because that's cosmetic.

Noritoshi Iwata:

Yes.

Howard Farran:

And dental implants, just because they don't cover them.

Noritoshi Iwata:

Yes. However, this information is a little bit old. It getting changed. For instance, for the dental implant, it has so many suit or damage at patient. Then Japanese Consumer Association claimed to the government about the situation. Then after that, finally, it was 2014, April. Government started to do health insurance coverage onto dental implant. However, that treatment should be very specific place. Like for instance, university or a surgery place where to be registered by ministry. Not every dental technician can do this dental implant, by health insurance. But they can do private. However, sometimes it causes big trouble for patient.

Howard Farran:

Well it's funny how history always repeats itself, because when Branemark started teaching dental implants.

Noritoshi Iwata:

Yes.

Howard Farran:

With the Branemark implant, which turned into Nobel Biocare.

Noritoshi Iwata:

Right.

Howard Farran:

When he first came to the United States, he would only train oral surgeons. He would not train periodontists or general dentists. It was very upsetting to general dentists and a lot of them were very upset that there was companies that were selling products that were not allowed.

And then later on, the general dentists and periodontists started doing implants. And throughout the history in America there were different companies, when they started to launch a product, say with endo.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

They wanted to only sell it to endodontists. Immediately the lawsuits started flying.

Noritoshi Iwata:

Yes, yes.

Howard Farran:

That you can't do that. So, if the Japanese dental insurance is starting to sell, cover implants.

Noritoshi Iwata:

Right.

Howard Farran:

But only in universities, that's a great sign.

Noritoshi Iwata:

They're limited to high-education doctors.

Howard Farran:

But that's a great sign, because history shows now that dental implants got their foot in the door.

Noritoshi Iwata:

Yes, yes.

Howard Farran:

The only thing they're going to do from there is pry the door open. And they'll be covering dental implants for everybody. It's not a question if, just is it going to take five years, ten years, twenty years.

Noritoshi Iwata:

Yeah. Basically, dental implants are very good treatment method. Why don't we do them right way, for the patient?

Howard Farran:

Yeah, absolutely. The biggest clarity. Our dental office vision is we wanted to create a dental office where we would want to be patients.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

And if whenever you get to a fork in the road, if you just say to yourself, well what is best for the patient? Then that's always the best answer.

Noritoshi Iwata:

There is a real reason why dental implant belong to the health insurance companies. Because most of the dental practitioners originally, they didn't do dental implant. It was only for specialized doctors. But, due to the health insurance business, very low income. That's why general practitioners try to get dental implant treatment. To get the income. That's why, only for the calculation purpose. No any detailed education. Only just hitting dental implants. Without the precise diagnostic. It was a bit trouble and the root cause. Why many patient suffer by the dental implant.

The government decided to settle down every situation. It should be shot, inserted, by the specialized oral surgeon only. Of course there are very specialized doctors, implantologists, in Japan. They do very good treatment. It is also very safe. But they are not so many.

But now, patients getting very comfort. No any advertisement. Now we can get more reliable doctors, implantologists. By health insurance, also some place with private practice.

Howard Farran:

You're a businessman.

Noritoshi Iwata:

Yes.

Howard Farran:

In America, dentists can advertise anyway they want. Radio, TV, billboard. In Singapore and Hong-Kong, there's no advertisement.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

What's it like in Japan?

Noritoshi Iwata:

Basically, there is no advertisement on TV. However, years ago one manufacturer started first advertisement on TV. I'm watching a movie, so I was so surprised. Everybody was so surprised. It was Dentsply.

Howard Farran:

It was Dentsply?

Noritoshi Iwata:

Yes.

Howard Farran:

They started advertising on TV?

Noritoshi Iwata:

On TV, yes.

Howard Farran:

To the dentist or the patient?

Noritoshi Iwata:

All the way, both.

Howard Farran:

For both.

Noritoshi Iwata:

Yeah.

Howard Farran:

What product were they selling?

Noritoshi Iwata:

At that time it was a silicone product. It's made of zirconium frame plexus.

Howard Farran:

Zirconium?

Noritoshi Iwata:

Yes. It was kind of a new sign to Japanese society. Going through that kind of commercial of dental itself. After that [unintelligible], the same.

But we have many brochures or magazine. That is our main advertisement way in Japanese market.

Howard Farran:

Is magazines?

Noritoshi Iwata:

Magazines, yes. Weekly magazines. Monthly magazines. So many we have.

Howard Farran:

So a lot of dentists advertise in magazines?

Noritoshi Iwata:

For doctors, yes. There are some advertising for doctors and their clinics. Not only for manufacturers products.

Howard Farran:

You know one of the most interesting things for me being in your country.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

You have more vending machines than any country on earth.

Noritoshi Iwata:

Cigarette, drinking, everything, yes.

Howard Farran:

You can get anything in a vending machine.

Noritoshi Iwata:

Yes.

Howard Farran:

You can get any snack or, basically in America you would have to go to a 7-11.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

I see you have 7-11s. You have most of the 7-11 stuff that you would by in a vending machine.

Noritoshi Iwata:

For instance, I'm sorry, cigarette so many vending machine. And a cold beverage, Coca-Cola. Or beer also we can buy in a vending machine.

Howard Farran:

Beer.

Noritoshi Iwata:

Even the midnight. Some people say that is very convenient for us, however very dangerous because that is a band cage. Band cage on the road. Inside are the many coins. Some fear, they broke the entire vending machine, carry away, to get the money. So, dangerous, and electricity. They use everywhere right?

So the minister of metropolitan Tokyo said should cut off the night. But still survive in society here in Japan. Maybe this is for the business. We already covered business, and convenience. Probably about, it depends.

Howard Farran:

You know, I used to see it in America. When we used to rent a movie. We used to go to Blockbuster.

Noritoshi Iwata:

Blockbuster.

Howard Farran:

It had a lot of overhead. Because half the cost of any company is labor.

Noritoshi Iwata:

Yes.

Howard Farran:

Blockbuster got bankrupted when another company came out, called Redbox, where it was a vending machine.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

And you could just go get the DVD movie.

Noritoshi Iwata:

DVD movie.

Howard Farran:

And you had no people, so the costs were half the price.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

I see all your vending machines and I think, you know what, when you go into a convenience store in America, they have all that labor. And vending machines, you don't have labor.

Noritoshi Iwata:

No labor, just electricity.

Howard Farran:

Just electricity.

Noritoshi Iwata:

I think just for the beverage company business purpose.

Howard Farran:

I want to ask you a theoretical prediction.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

So when I got out of school in eighty-seven. The United Kingdom had 19,000 dentists and they all participated in the national health insurance. The NHS, would paid very low fees. Kind of like Japan's.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

And they had less than five percent that did not participate, just like Japan. Now you come back to the United Kingdom twenty-eight years later, and 5,000 of those 19,000 dentists said, I'm not going to do that anymore. 5,000 quit, so now you're down to 13,000.

Right now, the Japanese health insurance only pays a hundred dollars for a root canal. All the dentists participate. Do you think ten, or twenty, or thirty years from now, Japan's going to turn into a United Kingdom, where a lot of the dentists say, you know what, I don't want to play your insurance game, I can't do a root canal for a hundred bucks. I'm going to drop it and just charge my own fee.

Kind of like what Japan does today with orthodontics.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

Do you think that's the future of Japan? Or do you think the Japanese culture will be different?

Noritoshi Iwata:

I will say Japanese culture will be different, yes.

We would do our own way, I think. Because it would depend on the Japanese population. On age structures. And the material cost price situation. And government policy with the health insurance system itself. It depends and it should be very flexible. For this total service to patient, I think.

Howard Farran:

So what is, so you've been in dentistry for twenty-three years.

Noritoshi Iwata:

Yes, twenty-three years, since 1993.

Howard Farran:

1993? So what's got you excited? Why are you still in dentistry? Do you think you're going to stay in dentistry another ten or twenty years?

Noritoshi Iwata:

I would like to do that, yes.

Howard Farran:

You would like to do that, so would I.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

So what's got you excited? Why are you passionate? Why are you in dentistry when you could be in any one of these ten thousand million companies in Japan.

Noritoshi Iwata:

I would say first, because this is a very small world. Only this here. Very small space. So many technique. We need to use into the patient. Comfort.

Second, almost every year, or less than every year, on a monthly basis, material technology, or treatment technique, it changing very frequently. In comparison with Japan and the United States, or Europe, it has so much difference.

My preference is to communicate with American, European doctors, or practitioners, for Japanese dentist doctors, institute in the patient. To sky gate between these line. So this is my passion. To introduce and follow the American latest anecdotic material. Or German latest ceramic material exact.

Then it is take time, to raise that for Japanese [unintelligible]. So, I will put to correct everything as much as I can. Going through the every dental congress in states or Europe.

Like last week, I went to a meeting in Chicago, all the way to Chicago for dental laboratory scanner business access. That is new passion for me and also new train for Japanese marketizing. One step behind these American line. So this should be controlled well with much high-speed, to get to use the Japanese market. Doctors, patients, everything.

Howard Farran:

And you know, a faster way of flying from Tokyo to Chicago for the Chicago mid-winter is Dentaltown.

Noritoshi Iwata:

Ah, that's a good way.

Howard Farran:

On your app. About ten percent of Japanese dentists read English, so we do have Japanese dentists on here. But I would sure love to get more Japanese dentists because it's a lot faster and easier to learn what the Germans and the Americans are doing on Dentaltown, then having to fly around the world.

Noritoshi Iwata:

Yeah, no need to fly to Chicago.

Howard Farran:

How long was you flight? Was it a non-stop from Tokyo to Chicago?

Noritoshi Iwata:

Yes we have a non-stop by A and A. Eastbound taking about ten, eleven hours, but westbound taking more. Thirteen hours.

Howard Farran:

It was ten hours in the jet stream.

Noritoshi Iwata:

Yeah, jet stream.

Howard Farran:

Then thirteen hours coming back?

Noritoshi Iwata:

Yes, that's right.

Howard Farran:

I think it was twelve hours. But I'm in Phoenix, they don't have a non-stop to Tokyo. So I have to fly to L.A.

Noritoshi Iwata:

L.A. Okay.

Howard Farran:

It was an hour from Phoenix to L.A. Then twelve and a half to Tokyo.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

Then six and a half to Singapore. Then a hour down to Indonesia. When I left my house on this trip. I went Phoenix, L.A., Tokyo, Singapore, Medan, Indonesia.

It was thirty-two hours.

Noritoshi Iwata:

Thirty-two hours.

Howard Farran:

When I left my house to when I got to my hotel room.

Noritoshi Iwata:

How many in-flight meals you took?

Howard Farran:

Ha! So, what has you passionate about Pentron? You started out the first ten years for another company. What was that?

Noritoshi Iwata:

Yes, it was Japanese company. San-King. At that time it was belonged to Degussa Company.

Howard Farran:

San-King. And that got by Degussa in Germany.

Noritoshi Iwata:

Yes.

Howard Farran:

Which they got bought by Dentsply.

Noritoshi Iwata:

Dentsply, yes.

Howard Farran:

Which now just got married and merged with Sirona, another German company.

Noritoshi Iwata:

Yeah, that's right.

Howard Farran:

So, it goes to show you that all these dental companies, they all are born. Then they all have an exit strategy. They all end up dying, merging, getting acquired.

Noritoshi Iwata:

That is, I would say another excitement. There is no stabilized business position. That is why always we need to adopt to the change happening in the states or Europe. We need to do much effort to do that. To get the right thing to do for Japanese market with good product. Because Americans are changing a lot. We need to keep maintain the supply with Japanese doctors. That is another passion for me.

Howard Farran:

Now, one of the biggest companies in Japan ever was GC.

Noritoshi Iwata:

Yes, GC [unintelligible].

Howard Farran:

But GC was the biggest weren't they?

Noritoshi Iwata:

I would say yes.

Howard Farran:

And they just moved their headquarter to Switzerland?

Noritoshi Iwata:

Yes, I think that it was for the taxation purposes.

Howard Farran:

That was for taxes.

Noritoshi Iwata:

Yeah, that's right.

Howard Farran:

And you see a lot of German companies moving their headquarters to Austria for taxes.

Noritoshi Iwata:

Austria, ah really? I never heard that.

Howard Farran:

Or Luxembourg.

Noritoshi Iwata:

Luxembourg yes, very famous place.

Howard Farran:

In the United States they move them to Vegas or the Bahamas.

Noritoshi Iwata:

I see.

Howard Farran:

What did you think of the Dentsply. Because your last company got bought by Degussa, which got bought by Dentsply which now married another German company. Does that effect Japan in anyway?

Noritoshi Iwata:

I would say, yes, something effect it. But always we confused. What was the original company policy. They change very frequently. Of course I know the German style by Degussa and second, American style going through Dentsply. And next, there is KaVo-Kerr Group. Is very good for my experience. I understand everything about German sense, American sense, and something the others.

But for the Japanese society, I'm not sure what is good, what is bad.

Howard Farran:

Let me ask you this way, a lot of people say that Dentsply kind of had the old analog world of impressions, and fillings, and crowns.

Noritoshi Iwata:

Yes, everything.

Howard Farran:

And Sirona was the new digital age with CAD/CAM, with CEREC, with Galileo CBCT. So it's kind of, Dentsply didn't have a future digital strategy and Sirona wanted some of the material blocks.

Does CAD/CAM have a big future in Japan? Or do you think it's going to stay more with impressions and dental laboratory technicians?

Noritoshi Iwata:

I would say CAD/CAM technology and the requirement is growing very faster.

Howard Farran:

It's growing fast?

Noritoshi Iwata:

I agree. That's why I am tracking the situation. Going through Chicago last week, scanners, meeting machines, also 3-D printers. Material wise [unintelligible] etc. I like to change it out.

So, we need to do much more faster movement to import for Japanese doctors and patients.

Howard Farran:

So, it's hard to get exact numbers, but it seems like American has about 13,000 CERAC machines being used and a thousand E 4-Ds.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

Japan has 100,000 dentists. Do you know how many CERAC machines or E 4-Ds?

Noritoshi Iwata:

I'm sorry, I have no idea of that.

Howard Farran:

No idea? Would you think it's less that one percent? Would you think it's two percent?

Noritoshi Iwata:

Because I know many dental clinics using these CERAC, by their clinics. But those clinics are very good business. Rich dental clinics only. But majority are not very rich.

Howard Farran:

Are those clinics participating in the Japanese dental insurance or are those private clinics?

Noritoshi Iwata:

That is another point about the new health insurance system. It was last year 2015, April, government stated [unintelligible], to be health insurance coverage.

Howard Farran:

For a crown.

Noritoshi Iwata:

For a single crown.

Howard Farran:

And what is the crown fee in U.S. dollars? In the United States it'd be about, I'd say the average PPO price for a crown is about $850.

Noritoshi Iwata:

I remember, about 8,000 Japanese Yen.

Howard Farran:

So what's that Ryan, what's 8,000 Japanese Yen?

Ryan:

It's about seventy, seventy-five dollars.

Howard Farran:

So, they're only paying seventy-five dollars for a crown.

Noritoshi Iwata:

One crown, but cuspid and bicuspid only. Not for molars.

Howard Farran:

What do they pay for molars?

Noritoshi Iwata:

Not stated that, but starting from coming April, it will be applied also the molars. After that we can check see how much.

Howard Farran:

So they're only going to pay seventy-five dollars for a crown.

Noritoshi Iwata:

Yes. But using the composite resin block. Composite resin.

Howard Farran:

How much would they pay if it was a porcelain crown, made at a lab by a dental laboratory technician?

Noritoshi Iwata:

More than two-hundred dollars I think, three-hundred, four-hundred, it depends.

Howard Farran:

It would be three to four hundred dollars?

Noritoshi Iwata:

Yes, is not health insurance coverage, is a private practice. Very expensive.

Howard Farran:

Interesting. Because I really believe, money's the answer, what's the question? When you go to a country, if they're only getting a small amount of money for a procedure. Usually they're saying if you want more of something, subsidize it by the government or don't tax it or raise the fee. And if you want less of something tax it and if you want more of something subsidize it.

So, it seems like a lot of countries, the fee the dentist can charge for the procedure really determines the utilization. I'll give you a classic example.

Roentgen discovered x-rays in 1895 and x-rays were never used in dentistry until all the way in almost 1958. And then out of nowhere, dental insurance pops up. Private dental insurance that's paid for by the employer. And they covered a hundred percent of x-rays.

So, just like a domino effect. From coast to coast every dentist in America bought a x-ray machine. Because if I took an x-ray I would send it in to these Longshoreman's Dental Insurance of Long Island, and they'd pay a hundred percent.

Noritoshi Iwata:

Really, a hundred percent?

Howard Farran:

So, Roentgen had a x-ray machine for half a century and they weren't used.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

And then when a third-party said, oh we'll cover x-rays at a hundred percent, they were all used. So, history usually repeats itself. I think a lot of Japanese's future will depend on what the dentists can convince the Japanese insurance companies to pay.

Noritoshi Iwata:

That's right.

Howard Farran:

And you got your fiber core post covered this year.

Noritoshi Iwata:

Yes, right.

Howard Farran:

And that's chain sales. So, where the money flows, the dentistry will follow.

Noritoshi Iwata:

Yeah, that's right. Also the microscope business. I think it could have a similarity with x-ray I think. Not like a big domino, but step by step it gets started now. Because a microscope, so far very expensive one, was released to the market. But now the price market is getting lower and lower.

Then realizing that the government state, also the health insurance coverage, to check by microscope. Starting from maybe a practice, that could also change for the kind of new domino effect. Every clinics use microscope for the treatment. Not for the root canal treatment, but also just checking the margin line, or what. [unintelligible] That could be also a new trend for the Japanese market I think.

Howard Farran:

I also want to ask you, you've been in dentistry twenty-three years. What's the state of silver mercury fillings? What percent of the filling market in Japan is silver fillings, versus.

Noritoshi Iwata:

Are you talking about mercury?

Howard Farran:

Yeah, mercury, silver, zinc, copper, tin.

Noritoshi Iwata:

Very rare.

Howard Farran:

Very rare? How rare?

Noritoshi Iwata:

I cannot say any figures, but this is also health insurance system. They try to move out that mercury treatment.

Howard Farran:

So, the Japanese health insurance quit paying for mercury? When did they quit paying for mercury?

Noritoshi Iwata:

Most probably from this April.

Howard Farran:

Just this April.

Noritoshi Iwata:

Yes.

Howard Farran:

So you Americans heard it first on Dentistry Uncensored with Howard Farran, breaking news.

Noritoshi Iwata:

I need to take one second.

Howard Farran:

But it was this year?

Noritoshi Iwata:

Some people say from April.

Howard Farran:

2015.

Noritoshi Iwata:

Under the discussion among the community of the insurance.

Howard Farran:

They just quit covering mercury.

Noritoshi Iwata:

They try to move out from.

Howard Farran:

You know what I think the final straw with mercury was, because you know, the bottom line is, the whole time I've been talking to you, I can't see any of your molars. I can see your front upper sixteenth, but I can't see any of your molars.

And you probably can't see any of mine.

Noritoshi Iwata:

Some but, I have mercury here.

Howard Farran:

Yeah, and so do I. And the bottom line is they last forever. But the last straw for me is when I read the data. Because mercury inside a human, I don't care what anybody says, I can't see how you can prove that causes any harm. Because it's an insoluble solid. If you swallow an amalgam, twenty-four hours later you pass it.

But when you cremate humans, that accounts for six percent of the atmospheric mercury.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

Is from America cremating three million dead humans a year. And they put them in the oven and they turn them to ash and those mercury fillings turn to vapor. Mercury, ethyl-mercury, methyl-mercury, it's too toxic. So, it's pretty dead.

I want to ask you another interesting question.

Noritoshi Iwata:

Yes.

Howard Farran:

One of the things I love traveling around the world is everyone always says that, as the sugar has increased in the diet, so has the decay rate.

Noritoshi Iwata:

Yes, right.

Howard Farran:

But you know, but when you go actually meet dentists in Indonesia and Malaysia, and Singapore and Japan. Every fifty or sixty year old dentist I talk to says that the amount of sugar has massively increased in their lifetime.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

But the number of cavities has declined. And that the reason it's declined is because the consumer, the parent, is getting involved in brushing and flossing.

Noritoshi Iwata:

Right, brushing.

Howard Farran:

And that it's not related to, like Japan doesn't use fluoridated water.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

Singapore does. America does in seventy percent of towns.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

Here in Japan, in Tokyo, decay's plummeted. Because the people are brushing and flossing. So, at the end of the day, it really comes down to, do you brush two minutes every morning, every night? Do you floss before you go to bed? And that is gonna determine your decay rate. Not water fluoridation or they drink a soda pop.

Noritoshi Iwata:

Not by water, but kind of the kindergarten, or TV program for the small children, they used to show the exercise of how to make the brushing. With nice music. So even though my kids, they are very happy to see the TV program, it shows how brushing teeth everyday, morning, night. So that a habit, custom.

Howard Farran:

Yeah.

Noritoshi Iwata:

Learning from the tele, education. Yeah, enough of that in that kids, decay is declining. Not by adult. We need more advertising.

Howard Farran:

So, last question. You just got back from Chicago mid-winter. What got you the most excited at the Chicago mid-winter?

Noritoshi Iwata:

This time the intra-oral scanner [unintelligible].

Howard Farran:

Now are you talking about the intra-oral scanner for the dentist to scan an impression and then email it to a lab, and then they make the crown with CAD/CAM.

Noritoshi Iwata:

Right, yes.

Howard Farran:

Or are you talking about the dentist scanning and milling it chair-side?

Noritoshi Iwata:

I think the first one.

Howard Farran:

Sending it to a lab.

Noritoshi Iwata:

Sending to lab.

Howard Farran:

And you know what, that is what I think is the business model shaking out in America. I know so many dentists who started with the oral scanner.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

And milling out chair-time. And now they're realizing, my god, I'm spending an hour or two milling out this crown, when I could have seen another patient and prep out the upper crown.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

And they really bought a $150,000 dollar machine, and they docked themselves from a dentist to a lab tech. Or they try to get their assistant to do it, but their assistant is not as fast as a dental lab tech that's been doing this forever and only does one thing.

I think the next stage of this market, I think the bleeding edge and leading edge were, I'm going to oral scan and mill it out in the chair-side. But I think for the mass-market, it's going to be, I'm going to oral scan and send it to a lab and let him CAD/CAM it.

Noritoshi Iwata:

Yeah, that's right.

Howard Farran:

And it's a lot easier for my assistant and me to make a temporary, than to make the final restoration stain glaze match.

Noritoshi Iwata:

Yeah.

Howard Farran:

If a dentist wants to be a lab tech, he wasted a hell of a lot of time in dental school. So, is that what you think?

Noritoshi Iwata:

Yes, getting more prepared. It was a time, CAD/CAM symposium, last year November. I went to the Anaheim. So, some doctor said every success of the crown depends on the impression. Not by the technicians technique. If dentists took a right impression, the finished crown may be perfect. So, in this case, this intra-scanner, made the perfect job for the patient going through dental technicians. So, that what makes me very excited. In future, maybe, every dental clinic have one intra-oral scanner.

Therefore, the impression material business, may be declining in future.

Howard Farran:

That's why Dentsply wanted to buy Sirona.

Noritoshi Iwata:

For the future trade.

Howard Farran:

I also think this scanner. The simplest way for a dentist to increase their quality. And by quality, a low quality would be an American Chevy, Chrysler, Pontiac. And a high quality would be Toyota or Honda.

Noritoshi Iwata:

[laughing]

Howard Farran:

I so have to hand it to you, I think the only great cars in the world are made in your country, Nippon and in Deutschland. I don't think they're built in the United States. But the easiest way to go from low quality to high quality is magnification.

When a dentist puts on loops and can see two and a half or three and half times bigger, they just do far better work.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

When the endodontist drops a microscope and they can see the inside of that tooth, just eight, ten, twelve times higher, the quality goes through the roof.

When I started, when I got my oral scanner, I got a CERAC machine. When I started scanning those preps, and I could see my prep, you know twenty, thirty, forty times larger, I was just like, oh my god. I felt embarrassed.

My best take away from an oral scanner is that you get to see your magnification.

Noritoshi Iwata:

Yes, that's right.

Howard Farran:

It's all about magnification. And in the old day we would take an impression and then we would look t it under a light and we'd put on our loops and we'd try to see, but you couldn't really. And the assistant's like, do you think it's good? And you're like, yeah I think it's good.

Well now you see it forty times larger on your computer screen.

Noritoshi Iwata:

Yeah.

Howard Farran:

And you're like, what the hell is that over there?

Noritoshi Iwata:

Yeah.

Howard Farran:

You jump back in the chair and you put an end-cutting barrel burr, and you get soflex disc and you smooth everything out. I think the magnification is amazing.

Noritoshi Iwata:

Yeah. And also technology wise, improvement changing a lot. Originally it was using a powder spray, to get the correct scanning data. But now everyone is changing to the powder-free system itself. That is a new challenge and kind of new changes.

Also, this time in mid-winter Chicago, I found no American products. No European products. One is Korean product, second is from Israel. They are offering a very price information.

Howard Farran:

For an oral scanner?

Noritoshi Iwata:

Yes, intra-oral scanner.

Howard Farran:

Out of Korea and Israel?

Noritoshi Iwata:

Yes. Those companies very, very nice I think.

Howard Farran:

Do you have the websites for those?

Noritoshi Iwata:

Yes, I will send you later through email.

Howard Farran:

You don't have it with you?

Noritoshi Iwata:

No, not now.

Howard Farran:

Okay, well send me the websites later.

Noritoshi Iwata:

Yes. One of the very nice Korean manufacturers.

Howard Farran:

It's just an oral scanner.

Noritoshi Iwata:

Oral scanner, also they have a system is milling machine and the 3-D printers connecting together.

Howard Farran:

For the chair-side?

Noritoshi Iwata:

For chair-side, yes.

Howard Farran:

You know, I have to say that I've had CERAC. I had the CERAC one in eighty-seven. I had the CERAC two, the CERAC three.

Noritoshi Iwata:

Yeah.

Howard Farran:

I've had CERAC my whole life.

Noritoshi Iwata:

Yeah, the chair-side system.

Howard Farran:

But you know what, I don't buy the chair-side milling. I don't buy it. I don't think, when I go to a dental lab and they're using CAD/CAM, those lab techs are making fifty crowns a day. And they've been doing it for five, ten, fifteen, twenty years.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

And me and my assistant just can't compete with that. They just do it so much faster.

Noritoshi Iwata:

Mm-hmm (affirmative)

Howard Farran:

And the belief that the patient wants it the same day, well we mill it, we can make it the same day. But most people don't ask about the same day. Most people ask, just like we were talking about, how much does it cost?

Noritoshi Iwata:

Yeah.

Howard Farran:

That's half the market.

Noritoshi Iwata:

Yeah, that's right.

Howard Farran:

And then the other half says, is it going to hurt? Or what is it going to look like? Or what is it gonna feel like? I mean, having it in the same day that's not even one percent of the market.

So, I think the oral scanners and then the lab, and then someone in the lab who just focuses on making fifty crowns a day, is the future.

Noritoshi Iwata:

Yes, that is the future. I think the chair-side is only for inlay. Very good for inlay services. But for crown, that is another story.

Howard Farran:

Yeah.

Noritoshi Iwata:

Too much lose the shape.

Howard Farran:

You're right, we're not in crowns. Especially anterior crowns.

Noritoshi Iwata:

Yeah, anterior crowns, yes.

Howard Farran:

Yeah a posterior inlay or a posterior crown on a short, fat, bald guy like me, who doesn't care what it looks like, cause no one's gonna see it. And just wants, I mean all mine are gold. I just want it to work. You can do it on a fifty year old grandpa, who just wants form, function, quality.

Well hey, you've been, I can't thank you so much for coming by.

Noritoshi Iwata:

Oh, my pleasure.

Howard Farran:

It was just an honor to meet you and congratulations on your country, I mean my god. It is just so amazing.

Ryan, thank you for being on vacation with me for eighteen days. How many podcasts did you film in four countries?

Ryan:

Thirteen.

Howard Farran:

So when dad said hey, do you want to go on vacation with me to four countries, did you know that you'd be working from five in the morning to midnight seven days a week, the whole trip? Did you know that?

Ryan:

Yeah, I was assuming that.

Howard Farran:

He was assuming it. Good son, good son.

Noritoshi Iwata:

Very good, very good.

Howard Farran:

Okay, thank you so much.

Noritoshi Iwata:

You too. Thank you so much. Thank you very much.