Dentistry Uncensored with Howard Farran

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Dr David Penn graduated from Sydney University dental school and commenced  practice in Sydney's eastern suburbs. He trained extensively in the United States under two of the world's leading aesthetic dentists and in 1983 he established Southern Cross Dental Laboratories, which has grown to become regarded as one of the leading state of the art dental laboratories in the world.

Dr Penn also lectures and teaches extensively, principally in the areas of aesthetic orthodontics and facial aesthetics. He has taught more than 1000 post-graduate students in the use of Invisalign and in January 2015, he wrote and gained accreditation for a unique post-graduate qualification in Aesthetic Orthodontics.

In 2006, he released a book "A guide to Impressions, Implants and Indirect procedures" which has been used by undergraduates and experienced dentists. Two more editions of the book have been produced, the latest in November 2014.

He also was responsible for the research and development of many unique dental appliances and devices including the Penn Composite Stent, the Atlas Cabriolet orthodontic retainer and a series of accelerated orthodontic devices which in 2015 received a  prestigious grant from the NSW Department of Innovation.

In 2011, Dr Penn won the Ernst and Young Entrepreneur of the Year in the services division.

Dr Penn established Penn College in 2014 and a specific faculty, The PostGraduate School of Dentistry in 2015 , which will provide world class quality niche post graduate qualifications beginning July, 2015.

He is also featured in the NBC Universal TV series, "Changing Faces" which showcases the latest aesthetic dento-facial procedures and presents a unique Australian interpretation to aesthetics.

www.AlignedSmiles.com

www.scdlab.com 

www.penncollege.edu.au 

www.pgdentalschool.edu.au

Howard: It is just a huge honor for me today to be sitting in Sydney, Australia right by the harbor, with everyone’s mentor and idle, David Penn. How are you doing?

David: Hi Howard, how are you?

Howard: My God, you are the busiest guy on Earth. Let me read his bio. David Penn, BDS, MBA, Grad Dip. Aesthetic Ortho Sequential Aligner Therapy. He is currently the Head of the Post Graduate School of Dentistry. He graduated from the Sydney University Dental School and commenced practice in Sydney's eastern suburbs. He trained extensively in the United States under Ron Jordan and Golden Christian, two of the world's leading aesthetic dentists and in 1983 he established Southern Cross Dental Laboratories, which has grown to become regarded as one of the leading state of the art dental laboratories in the world.

In 2006 he released a book ‘A guide to Impressions, Implants and Indirect procedures’ which has been used by undergraduates and experienced dentists. Two more editions of the book have been produced, the latest in November 2014.

He also was responsible for the research and development of many unique dental appliances and devices including the Penn Composite Stent, the Atlas Cabriolet orthodontic retainer and developed a series of accelerated orthodontic devices which in 2015 received a prestigious grant from the NSW Department of Innovation.

Doctor Penn also graduated with a Graduate Diploma of Aesthetic Orthodontics Sequential Aligner Therapy and holds a accredited certification in training and assessment. He lectures and teaches extensively, principally in the areas of aesthetic orthodontics and facial aesthetics. He has taught more than fifteen hundred post graduate students in the use of sequential aligners and aesthetics. In January 2015 he wrote a complete curriculum and gained Australian Government accreditation for a unique formal post graduate qualification in aesthetic orthodontics.

Doctor Penn established Australia’s first government accredited private dental school. The post graduate school of dentistry in 2015 and currently has forty students enrolled in the post graduate programme. He has also published articles in CPD programmes and orthodontic journals, including in 2016, US Orthodontics and the American Academy of Aesthetics Orthodontics. In 2015 Doctor Penn featured in the NBC Universal TV series ‘Changing Faces’, together with Dr. Michael Zacharia a plastic surgeon. Which showcases the latest aesthetic dento-facial procedures and presents a unique Australian interpretation to aesthetics. The real to life six-part series delves into the lives of patients with unique and compelling reasons for a medical transformation, and the journey of a doctor and patient to get there. It is not just vanity that is being satisfied. We see the doctors helping the people to make the most of themselves and live a life full of confidence inside and out. My God, you are just an amazing man. I could go on and on. Your bio goes for about forty days and forty nights. My first question I have to ask you, if your name is David Penn, are you related to William Penn, the founder of the state of Pennsylvania?

David: No, but I’m related to Sean Penn.

Howard: Are you related to Sean Penn?

David: Yes. Basically, his grandfather went to New York, they were actually originally from Russia, and from Lithuania they went to New York, some went to South Africa, and some went to England, and then come to Australia. We’re actually second cousins.  

Howard: So are you and Sean Penn Quakers?

David: I’m not. I’m certainly not a Quaker, and I don’t think he is either.

Howard: Do you eat Quaker oatmeal?

David: I have when I was a kid but that was a long, long time ago. I don’t even know who was president then.  

Howard: Yeah, that was a long time ago, man. Who was that guy Quaker, he was William Penn, that was 1640 to 1718?

David: Yeah.

Howard: The founder of Pennsylvania. Orthodontics always reminded me of airplanes. I grew up in Wichita, Kansas which has made more airplanes than any city in the world, because it made Cessna, Boeing, all the small ones. It seems like airplanes may reach a certain speed of about five hundred and fifty miles an hour, and decade after decade they got bigger and fancier they got whatever, but they still just kept going five hundred and fifty miles an hour. Braces seemed like it had all this fancy stuff, but it was still two years.

David: Yeah.

Howard: But it seems like just recently, you started seeing accelerated orthodontics.

David: Yeah.

Howard: Where maybe they are going to break the sound barrier and instead of doing ortho in two years on everyone.

David: Yeah.

Howard: It might get down to a year. What do you think about all of this accelerated ortho?

David: I think the whole orthodontic realm is changing really significantly. I am a general practice, certainly in crown and bridge. That’s really where I cut my teeth, on material science and crown and bridge. And then Align Technology approached me about 2005, and they said ‘look what do you think of this Invisalign system. How do you think it will go in the GP market?’ When I saw this thing, and saw the implications and the possible things we could do with it, in general practice in particular, it peeked my interest and I said ‘yeah, I would really like to learn about this’.  So I went on this intensive learning programme for a couple of years, and basically stopped really delving into the crown and bridge thing and doing a lot more in ortho.

I started to see the value in clear aligners. Not just from a pure ortho perspective, but from a general practice and being able to move the teeth into the best position. So you can do all the other augmentation as far as colour, as far as shape, symmetry, ginger plasty and all the facial things that went with it.  I started to see this incredible possibility with these aligners. Back then, I must admit, I thought that Align Tech was a great company, but it was more of an art than a science. When the science started to come in and they started to really understand what they were doing, rather than a hidden hope type scenario, and they got these attachments and IPO and very sophisticated materials.

The acceleration that you talk about started to occur, and we started to see people being able to move teeth very accurately, very easily, very painlessly and very quickly. I thought to myself ‘wow, where is this all heading?’ Of course, the orthodontists, as you talked about, being using traditional wires and brackets for so long were very threatened by this technology. Today it is accelerating, not only the tooth movement but the rate of the uptake of clear aligners and sequential aligners. The uptake and number of copycats to Align Technology is burgeoning.

You have probably heard about the Smile Direct Club.  That set a model, if someone would have said to me ‘my God, do it yourself orthodontics and here is a pot of PVS putty and take your own impression’ and that sort of stuff. It just freaked me out.  But, nevertheless, I think the interesting thing is the Gen Zed, the kids who are born say 1990 to 2005, their expectations is that they want it now, they want it quickly, they want it inexpensively and they are impatient, they want things to happen. So the days of putting these wires and brackets on and putting these great forces on and seeing what happens, et cetera, and the inconvenience and discomfort and the pain, I think that’s long gone.

So disruptive technology, I love disruptive technology, I have done lots of that with sleep apnea devices, and I have done so many things like that. Align Tech have got this incredible product, and with the number of competitors you are going to see competition burgeoning. I think that orthodontics is going to get to a stage where you will push the physiological limits. Obviously, it is like how fast can a man run one hundred meters? We remember when Jesse Owens ran in the Berlin Olympics, he thought nine point nine eight or ten seconds or whatever, nobody could beat that.

Then when you see this guy, this Usain Bolt ran the race, you think that was getting down to nine point five, and you think well what are the human limits?  You think you can’t get it down to zero, so how far can you go? I guess with orthodontics how quickly can you move teeth? So I think there are physiological limits, there has to be because there is a cellular interchange with bone, etcetera. But the market place now is determining and putting pressure on us as healthcare professionals. In the old days they would walk in and say ‘we’d tell you what you want’, now they come in and they say ‘this is what I need’.  

We’re seeing a huge change, and it’s a paradigm shift, and to be able to survive, the young kids in dental school now they’re going to have to listen to what their patients want and be able to deliver. To me a successful company, whether it be orthodontics, or implants, or whatever, they are going to have to come up with the goods. So I think we are seeing a big paradigm shift. I don’t think it is only in dentistry, I think it’s in a lot of the healthcare professions. It’s an exciting place to be.  

Howard: So Invisalign, which is owned by Align.

David: Yeah.

Howard: They actually invested in Smiles Direct.

David: Yes, seventeen percent as far as I know was concerned.

Howard: Yeah.

David: It’s doing very well. I was surprised, when I first about it and spoke to the guys at Align, I thought surely, why would you get involved in something, to me which, I don’t want to say cannibalises, but even bastardizes this brand name of theirs, having the best of this with a direct consumer model. But I think they are going to get away from the original model of just sending pots of putty, and saying do your best. You can imagine what the impressions are like. Even getting a dentist to take an impression, or an orthodontist or somebody to do that is hard enough. Let alone saying to the patient here’s your pot of putty, load your tray and good luck. I think they are moving towards the scanning centres and things like that which is a (inaudible 10:12)

Howard: How long have you been teaching orthodontics?

David: About ten years now.

Howard: And are you an orthodontist?

David: No but I have got a postgraduate qualification in aesthetic orthodontics, which is a new brand of orthodontics. So I’ve basically done the same amount of training, but I have been trained in the newer realm of orthodontics. So the classic orthodontist look at what I am doing, and all my students, and they think ‘well what is aesthetic orthodontics?’ It’s very different to traditional orthodontics. Traditional orthodontics is more like a twelve-year-old kid comes in with a whole pile of crowding, we are going to pull four teeth out and we use the angles classifications and older style methodologies.

What we are doing is what’s called a soft tissue paradigm, where we look at patient’s faces, and we are treating adults, mainly women. Now I don’t mind treating only women, I think that is a very great place to be because we enhance the way that they look. They come in and they don’t want the molar relationships changed, they just want to look good. That’s a completely different game, Howard, a totally different game to what the orthodontists are treating with teenagers. And it is very difficult for a classically trained orthodontist to really comprehend what we are trying to get out. They don’t care, for instance, if there is a cross bite posteriorly, they don’t care if certain things aren’t perfect, if there is a rotated tooth.

They want the anteriors to look good. They want the colour to be right, they don’t want to show too much gum. They want the lip profile to be right. Very, very different. I am a strong advocate and that’s why I wrote this course,  because I think that that’s where the future of dentistry is for a lot of younger people.  

Howard: Does that mean that you are also doing botox and dermal fillers?

David: I have been trained in it, and I do a little bit of botox. But to be honest, I find it to be such an area where you need a high degree of expertise, in my opinion. When I go to Miami, when I go to Florida and to certain parts of the US in particular, I see some of the cases which are not aesthetically ideal. The trout mouth we call them, with the pumped up lips.

Howard: Right.

David: I think that a lot of people can be irresponsible, and not really follow the anatomic and the aesthetic guidelines that we certainly teach. So hence I pass this off to certain healthcare professional who really know what they are doing in that respect.

Howard: One of the best movies Breast Men. So Breast Men came out in 1997.  Did you ever see that movie?

David: No.

Howard: Everybody listening should go back, it was the guy from Friends, David Schwimmer.   

David: Yes, I remember him.

Howard:  … and Chris Cooper.

David: Yeah.

Howard: But anyway it goes back and talks about the story of when silicone breasts started. That was one of the problems, because it started down there in Texas.  It was a Texas medical resident, David Schwimmer, who was played by David Schwimmer and a plastic surgeon Chris Cooper present their invention, the silicone breast implant, to Dow Corning. It was an interesting thing where in Texas they were placing them five times bigger.

David: Yeah.

Howard: Like four hundred and five hundred cc implants.

David: Yeah. Yeah.

Howard: Where in other conservative parts of the country it would be two hundred. I see that in the dermal fill lips, you go to Hollyweird and Palm Springs.

David: Yes.

Howard: The lips almost look like they are cartoons.  

David: Yes

Howard: I also want to ask you about that, because when you look at whitening. In the United States and the Middle East it is just clorox white paint.

David: Yeah.

Howard: Then when you go to Europe, a lot of people feel that that doesn’t look natural.  

David: You go to the UK and it doesn’t happen at all.

Howard: I know. So what is it like in Australia? Is Australia more US, UK, Europe?

David: I think we are nice sort of combination. So Howard, the interesting thing that you talk about here, is that we teach in the school that if you are going to renovate somebody’s teeth, and their dentition, you’re fixing only part of the house. You have got to renovate the whole house. We are seeing a lot of scenarios where patients come in, they’ve got a thirty year old dentition with white teeth, everything in perfect position, the lips have been pumped a little bit, so they have a young woman’s mouth. Though the lower third is there, yet they have these deep nasolabial folds, they’ve got crow’s feet, which looks like Tiger Woods has played nine holes on them, and you’ve got these really big wrinkles on their foreheads.

So you have got fifty year old, forty-five year old and thirty year old dentition.  Now to me that cries out of being unnatural and we teach our students if you going to renovate you have to renovate the whole house. You can’t just go in bits and pieces, you can’t just do the kitchen and the bathroom because everything else (inaudible 15:15). We see this very much, and so it’s an expression that I use a lot about renovating the whole house.  I guess you will see in Australia, what we tend to do is a very natural thing, where we may do a little bit of lip stuff, we may get rid of some wrinkles but we won’t over-bleach the teeth. But it’s very fresh, it’s a very healthy look and without going to, as I said, some of the California and Miami looks which we find sometimes is somewhat disturbing. I am very brutal with our patients.

We teach our students to do PowerPoint presentations and we actually show them the patient’s face and we pick out bit by bit and we say this is what we think you need.

Howard: It’s like a bridge versus a sinus lifts and implant. The dentists have a religious mindset toward the God of odontology, and they don’t want to file down a second bicuspid and a second molar so they think a bridge is horrible.  So they want to do a sinus lift. My ENT friends in Phoenix and these rhinologists, they have hundreds of cases where these have failed, white candida infection all over the sinus. They’re telling me ‘why don’t you leave my damn sinus alone and file down two rocks and do a three and a bridge.

David: Yeah.

Howard: So their sacred gallow is the sinus. They’re telling me some really interesting things, we’re trying to get a course built. People in Phoenix thought they had allergies for twenty years and they finally get into him, and he goes in there and it’s a root canal on the first molar, no (inaudible 17:02) or fillings.  They’ve been draining into the sinus for twenty years and failing implants.

David: Yes. Yeah.

Howard: Causing all these sinus problems.

David: Yeah. Yeah. Yeah.

Howard: Anyway it just depends on what the patient wants.

David: Yeah.

Howard: One of the first implant cases I ever did in 1987, this lady who owned one of the biggest pizza restaurants across the street from me, and I sent them to the greatest lab tech in all of Arizona. His name was Matt Roberts and he charged me like three hundred and fifty, he was up in Idaho. It took about a month to do them. They were the prettiest teeth I had ever seen in my whole life. I’d put him in there and she cried because it was all natural, it just looked stunning. She wanted chicklets.

David: Yeah.

Howard: I had to cut every one of them off, took impressions, sent them to Glide Well.

David: Yeah.

Howard: At $99 a piece, at the whitest shade they had, which in ‘87 that was before the bleaching shades, and put them on there. They looked fake at ten feet, a hundred feet, a mile away and she just absolutely loved them.

David: Loved them. Yeah.

Howard: She had the long finger nails.

David: It is interesting, I always say where does that attitude come from? Like where does the attitude of your patient cohort come from. In Australia when we did the NBC Programme, the ‘Changing Faces’ thing, it was interesting because we showcased what we believed was what the Australian public wanted as far as aesthetics are concerned. Natural, yet clean, yet tidy, symmetrical. There was a whole lot of things that we know. Now where’s that come from, the outdoor lifestyle, the sporty lifestyle, the mix between American culture that we get, a little bit of European, a little bit of UK all rolled into one, and you come up with our philosophy.

So we produced that series because we wanted to showcase, to the rest of the world, what our attitude towards aesthetics is. When I go to the UK and I give them some of these courses, they look at me like I am from another universe, not even another planet. It’s like ‘oh my God, we wouldn’t even think about that stuff because we don’t really care about colour, we don’t really care about morphology’. It’s just a completely different mindset. So when I go to the UK it is very different to when I go to France in Florida.

Howard: But you know what? When you go to Poland, ninety-eight and a half percent of people are polish. When you go to Vietnam they’re all Vietnamese, when you go to Korea they are all Korean, you go to Japan they’re all Japanese. But when I was lecturing in Melbourne yesterday I said ‘raise your hand if you weren’t born in Australia’. It was like eighty-five percent of the hands went up.  It's that way just in Australia, America, Canada, UK. I could see how there could be like a look in Vietnam when the ninety million people in Vietnam are almost all Vietnamese. But I think it will be very hard to find a look in a melting pot like Australia, or the UK, or United States, when everybody’s from another country.

David: Can I say that you would have been a little bit skewed, because the dental schools in Australia are full of East Asians, and Indians, and from the sub-continent, etcetera because they’ve studied very hard. It’s very hard to get into dental school in Australia. Extremely difficult. Only the most studious ones tend to get in and a lot of those are East Asians. They are very clever, they are very motivated, they’re hardworking. They’re wonderful people. They add incredible value to our country. So when I teach it’s exactly the same thing, I walk into a room, there might be thirty.  

My daughter yesterday, who is studying a double degree in Engineering, she’s twenty-two, she gave her first lecture in Engineering Design. She topped the school in Engineering Design and that was her subject, they asked her to be a lecturer. She said ‘dad, I came home and there were sixty students in the lecture theatre. There was one white girl. One white girl out of sixty. Now that shows you.

Howard: That was your daughter?

David: No she was doing the lecture.  

Howard: Oh.

David: But she is lecturing. She’s twenty-two, and she is lecturing to these kids who are eighteen or nineteen. They have actually given her a tutoring role at the university.  

Howard: So your daughter is a double engineer?

David: Yes, she is doing two degrees in engineering at the moment.

Howard: What degrees is she doing?

David: She is doing Manufacturing and Mechanical Engineering.

Howard: So what is your favourite engineering joke?

David: I can’t repeat it.  

Howard: Oh. You can’t. It’s Dentistry Uncensored.

David: I really couldn’t. But she …

Howard: Is it because you can’t remember or it’s that bad?

David: It’s that bad

Howard: Well let’s have a wing at it now.

David: We’ll talk about it after we finish.

Howard: Can I tell you my best engineering joke for your daughter?

David: Sure.

Howard: So there’s basically three kinds of engineers. If you plug it in its electrical, if you don’t plug it in and it moves its mechanical, and if it doesn’t take electricity and it doesn’t move, it’s a civil engineer, like a land or a building.

So the three engineers were sitting around the table and he says ‘God must have been an Electrical Engineer because look at the human, it’s all electricity, the brain, the spine, the nerves, it’s all electricity.  Is this the one you were talking about?

David: No. No, it’s not.

Howard: The Mechanical Engineer says ‘no, no, no, I went to a ballet and all those moving parts, He was a Mechanical Engineer.

David: Yeah.

Howard: The Civil Engineer said ‘no, He had to be a Civil Engineer, who else would put a wastewater treatment through a recreational park?

David: I like it. I like it. I’ll use that one. Yeah, anyway so what I am saying is that the reflection of the healthcare professions as far as the ethnic cohort mix is concerned, isn’t a true indication of the ethnic mix through the whole country.  So it is exaggerated. So might think it’s more of a melting pot than it is. It is a big melting pot but probably it’s skewed, especially in the higher end faculties that are very difficult, Sydney University, Melbourne University, the most difficult dental schools to get into. They’re almost impossible to get into. You’ve got to get these unbelievable marks in high school to get into this programme and that programme. It’s extremely selective.

Especially these Asian girls, they’re very clever, very hard working. But they are also very conservative by nature, and so what actually happens is the type of treatments they deliver aesthetically are also very conservative. It is reflective.  If you have got an ethnic cohort in the faculty and you’ve got a ethnic cohort which is different in the market place. That is hard for the Universities to grapple with as well. Can you imagine Phoenix if we said to you Howard, the school in Arizona, if three quarter of your students were Vietnamese, how that would go then with the rest of the people who lived in Arizona. How do you think that would go down?  

Howard: Well I think that the United States is pretty comfortable with a merit based.  I know when they pass quotas, like you had to have this many percent, mix in all the people.

David: Yeah.

Howard: It was very unpopular. I think Americans don’t like nepotism, which I think is a curse for Central and South America. If you ask anybody with a PhD in Economics why are poor countries poor, they always point to corruption.  They have the corruption index and the economist. So corruption is always the worst and number two is nepotism. So the new president, who runs the airport, his cousin Eddy.

David: Yeah.

Howard: Who runs the schools, his aunt.

David: Yeah.

Howard: America really doesn’t like corruption and nepotism.  So I don’t know but in Australia, are the twenty-five million Australians upset that faculty in the higher grads are all going to Asians?

David: Yeah, there is a little bit of that.

Howard: Yeah.

David: I think. But again it’s an unspoken sort of thing, people don’t go and talk about it. I feel that sometimes, yes.

Howard: When they break incomes in the United States, medium, average income, they break it out for our Asian, European.

David: Yeah. The Hispanics.

Howard: The Latino.

David: Yeah.

Howard: African.

David: African American. Yeah.

Howard: Asians are, I think six percent of the United States, they are always number one.

David: Yeah.

Howard: There is one point three billion Chinese, a billion Turnamine Indians, so you are getting the cream to migratory statistics of a huge crop. You’re getting the fat that floats on top of the milk of two billion people so you know you just get the rock stars that move into your country.  

David: Have you spent any time in Silicon Valley?  I think it is always fascinating to see the smartest Indians, the smartest Chinese. Brilliant place, and that is why look at the sort of demograph there. That just reflects it perfectly.  

Howard: So my homies listening, if they want to learn more from the man, David Penn, you’ve got so many websites. Which one would they go to? Would they go to penncollege.edu.au?

David: No. No, the best one is PGSD, The Postgraduate School of Dentistry.

Howard: PGSD?

David: PGS…

Howard: PG Dental School

David: Yeah, that is the one.

Howard: pgdentalschool.edu.au.

David: .edu.au.

Howard: So what do they find if they go to pgdentalschool.edu.au? What would they find there?

David: What they’d find is a list of our accredited courses. They’d see we have everything from CPD and CE Programmes and webinars, all the way up to the actual accredited qualification which is a graduate diploma. So a graduate diploma in Aesthetic Orthodontics is somewhere between a Masters and a PhD.

Howard: Wow.

David: It is a very high-level qualification. It takes you about two years, eighteen months to two years. It is very intense.

Howard: Now can you do it all online?

David: Yes. Yes.

Howard: A hundred percent online?

David: A hundred percent online, but it’s two thousand hours of work and you have to submit three complete cases. We are using state of the art technology and a learning platform, so basically, if you were my patient Howard, I have to video what I am doing. Somebody has to watch, take a video with their phone of what you are doing. So if you’re taking an impression or you’re doing a consult, whatever you are doing. You have to video and you have to upload it into the school’s portal. So it is totally online, but very interactive. One-on-one learning. There is a mentoring programme there. But, yeah, it’s all online so there is no downtime out of your practice at all, but there is a lot of practical work.

It took us three years to write and a $3 million investment to write this course.  This is no joke. The Australian Government are particularly tough on getting the quality, the regulations around this thing are just insane. So we had three million bucks, it took us three years, and was probably one of the most difficult things that we have ever done.  

Howard: How many dental schools are there in Australia?

David: Nine.

Howard: And what do they think of this programme?

David: They didn’t like it at all.  

Howard: Did they push back?

David: Oh yeah, we were threatened. They got together and they said ‘we don’t want you, we can’t understand how the government let this through’ and we went through about twelve months of angst with the government deliberating.  The government came back and said ‘guess what? This is a great school, it is a private enterprise and you are going to have to learn to compete with a private enterprise’. We know that our offering is just way ahead.  I also did some lecturing in the Engineering School.  At the New South Wales University in Entrepreneurship. So I teach that and I know what platforms they’ve got and we know our school is just way ahead. So we’re very proud of what we have done.  We think it will be very popular in the US, we are just undergoing this ADA CERP thing as well.

Howard: For the ADA civil approval?

David: Yeah.

Howard: Is that the CERP?

David: Yeah, but that is not so easy to get.  

Howard: I know, we have to do it every three years for DentalTown.

David: Yeah, so we’re just about through there at the moment. But yeah, we are very proud of our offering, it’s state of the art, and we know that this is what we believe for the general practitioners, well we believe the biggest growth area in general practice. Aesthetic Orthodontics, so I am not talking about traditional ortho with wires and brackets, I am talking about clear aligners where you can basically do a lot of stuff these days.  

Howard: The best marketing for these institutes is, you’ve got all this material, you should put some courses on DentalTown.

David: Well.

Howard: Then they will fall in love with David Penn.

David: Could they love me more than they love you?

Howard: Absolutely.

David: That’s hard to believe. Ryan, what do you think, is that possible?  I mean this is the man. I am privileged, I am in the presence of God here. It’s like seriously, what am I doing here? I’m in Sydney, Australia in the middle of nowhere. This guy has come all the way across here, and I feel very flattered that I am actually with this great guy because everyone knows you. I mean it, I am not just blowing smoke where the sun don’t shine. You have done so many fantastic things and I think great.  

Howard: Well thanks for that, but Warren Buffett, he owns a third of Coca Cola, and he said that the reason he owns a third of Coca Cola is because if you give him a billion dollars and told him to build, like say, David Penn’s Cola, David’s Cola. He said ‘a billion dollars of the marketing I couldn’t get 1% of Coca Cola’s market’.

David: Yeah.

Howard: So he said the most important thing is to brand.

David: Yeah.

Howard: You want to be Coke, you want to be Nike, you want to be Mercedez Benz.

David: I want to be Howard

Howard: So putting some courses on DentalTown.

David: Yeah.

Howard: Get everyone to know who David Penn is.

David: That would be great.

Howard: That would be the most (inaudible 30:40).  

David: That would be great

Howard: I want to talk to you about the sequential aligner therapy.  Is that the same as clear aligner?  

David: Yes. Yeah.

Howard: So with sequential aligner therapy, are those all clear.  Is that like a synonym for clear aligners?

David:  The idea of, Zia Chishti, the guy who invented this …

Howard: Who is this?

David: So align technology, the whole idea of actually moving teeth with clear aligners, with a piece of plastic, was first thought of in 1947 it was an accident. Some guy left a denture over extended and removed the tooth and the guy said ‘gee, how did this happen?’

Howard: That was 1947?

David: Yes, a guy called Kesling. It was a complete accident. But what actually happened was in 1998 these two young kids, Zia Chishti.

Howard: Yeah, Zia Chish?

David: Yeah. Yeah. So Zia was the one …

Howard: Is he a friend of yours?

David: Yeah, I know the guy

Howard: I have been dying … Zia, Z I A  T I S …

David: No, Chishti, C-H-I-S-H-T-I, I think his name is.

Howard: Spell it again.

David: C-H-I-S-H-T-I.

Howard: S-H-T-I?

David: No,  C-H …

Howard: C-H-I

David: S-T-H-I

Howard: S-T-H-I and what’s his last name?

David: That’s it, his first name is Zia, Z-I-A and his surname is, I think, C-H-I-S-H-T-I. I think.

Howard: Z-I-A

David: Yeah, is his first name

Howard: C-H-I

David: S-H-T-I

Howard: And is he in Dallas?

David: Generally, he is …

Howard: Did he start off in Pakistan?

David: He’s a Pakistani guy, yeah.  

Howard: Thanks, yeah, he is the guy.

David: I think he went to Stanford and he did a computing degree and he and his girlfriend, they were having orthodontic treatment, and thought there has got to be a better way to do this and these guys came up with the algorithm.

Howard: So then he started Invisalign?

David: Yeah, he started it.

Howard: Then how did he get booted out of there? What happened there?

David: Yeah, what actually happened was, far as I know, this is what I have been told. Is that he was running the company for about five, six years but it’s a big capital raisings. There was a little bit of conflict in the boardroom. Then he went and started another company, and they bought him out. I think there was some litigation.

Howard: And what was that company called? ClearConnect?

David: Yes. Yes.

Howard: So Clear Align bought ClearConnect?

David: Yes, I think they paid them out. I think it was like, I forget the number now, but yeah, they bought them out. You should check this carefully, the chronology of events, but there was a lot of litigation early on.

Howard: Right.

David: The company didn’t really get going until in the early, probably about 2005. That’s how I got involved, because they asked me to see what we could do with the general practitioners, and as far as accreditation courses were concerned. We had Southern Cross Dental Laboratories with a big company that I had built.

Howard: Is that laboratory only for clear aligners?

David: No, that is a general dental laboratory. We work with a big company in China, a laboratory in China.  

Howard: Was that Modern?

David: Yes. Yeah.

Howard: So your lab was an extension of Modern Dental?

David: We were partners.

Howard: Wow.

David: So Godfrey Nai and I did it in the UK, in Ireland, New Zealand and in Australia and we built up a pretty massive lab. I think you have met Godfrey.  

Howard: Oh yeah, I love Godfrey.

David: Yeah. So Godfrey and I …

Howard: You know where that name comes from?

David: What, Godfrey? No.

Howard: You know what that name is?

David: No.

Howard: So I said to him one time ‘Godfrey, is that your first name or last name?’ He starts laughing and he goes ‘oh you Westerners’. He said ‘when we were in first grade they told us that Western people would never be able to say our name.

David: Yeah.

Howard: So we got in a line, we got up, and there was a box, and everybody in the first grade picked a name.

David: Wow.

Howard: That would be your name you would tell your Western friends.  

David: Wow, I didn’t know that.

Howard: He picked out a name and it was Godfrey, and I said ‘so what’s your real name?’

David: This guy.

Howard: He said Hyayayaya. I go ‘okay Godfrey’.

David: Yeah.

Howard: He is a heck of a man.

David: Yeah. No, he was…

Howard: What a legend.

David: So I met him at the Hong Kong University in 1986 and we started working together and it took us a long time (Inaudible 35:14).

Howard: What was that University called in Hong Kong?

David: Yeah, it’s the Dental School. The University of Hong Kong Dental School.  

Howard: Yeah, but it is called something else.

David: Not that I know of.

Howard: Do you know why that’s the, in my opinion, the number one dental school in the world?  

David: Mainly because they have got so much money because philanthropy sort of feeds that school like you wouldn’t believe.

Howard: In the United States we would not have hygienists if they close down the hygiene schools.

David: Yeah.

Howard: Back in the seventies they closed down all the crown and bridge schools in America. There is only two in a country of a third of a billion of people. In Hong Kong, that dental school, has more dental laboratory students than they do dental students. That’s where Godfrey gets so much of his talent, because he has an endless pool of highly trained…

David: Absolutely.

Howard: Certified dental lab technicians to come work for him at Modern Dental.

David: That’s how the whole thing sort of… back in 1997.

Howard: Of your nine dental schools in Australia, how many of them have a CDT Programme for certified dental?

David: Probably most of them do but the standard is very poor generally. It’s not a burgeoning industry because manufacturing in Australia is very expensive, our labour costs, our rent costs are extremely high here. The reason why our laboratory was so successful was because Godfrey and I leveraged off the high quality, cheap labour in China and we could make an incredible product for not very much. I remember when I came to the market place the first time, the local laboratories, and this is no joke, were selling crowns to the dentist, between two hundred and two hundred and fifty bucks. Our first group that Godfrey and I bought in cost me eleven bucks. Now I sell them for $36, I couldn’t sell them.  

Nobody took me seriously because the differential between two fifty and thirty-six was so great. So somebody told me double the price. So I put them up to ninety bucks, they sold like hot cakes. I couldn’t sell them fast enough. We got to the stage where we were making more than a thousand crowns a day, for a small country of twenty-five million people. We got it right. We got incredible quality, incredible consistency. We had great lines of supply. I ran a tracking system which allowed us to keep an eye on the whole thing, and then we bolstered it with education. We wrote books on crown and bridge work. We supplemented, we lectured and it was a great success. It is now listed on the Hong Kong Stock Exchange, I sold my last share about two years ago.  

Howard: Why did you sell?

David: I think we hit the pinnacle of the value chain and I really wanted to go on and do some other things.  

Howard: That’s where you got your three million for this project?

David: Yeah, I got a little bit more than that, but we don’t need to go into that.  

Howard: You invested three million in your new project, you just said earlier.

David: Absolutely. Yes, very much so. But I’d invested, I’m into all sorts of other things.

Howard: Did you ever think about instead of investing three million in this new postgraduate deal or just getting a divorce.  

David: And give away half my fortune?  No. No, I have got a wonderful wife.

Howard: What made you want to keep your wife and build a programme? Instead of just going…

David: Howard, it may be strange to you in the US, but I actually love my wife and she is my best friend.

Howard: Wow.

David: And she is actually the Managing Director of the largest men’s wear chain in the country, in Australia. We have got one hundred and ninety-six stores.  

Howard: And she is the manager of that?

David: Yes, she is the Managing Director. I’ve actually got a role there as well.

Howard: Well you look pretty fancy yourself.

David: Thank you

Howard: Is that all stuff from her store?

David: Absolutely. But I have actually got a role there, where I work maybe a dozen hours a week. I’m called the CAO of the company, it’s a Chief Agitation Officer. I am serious, what I am responsible for is innovation and basically disrupting everything to try and improve the systems in the place. I love disruptive technology and I am doing it.

Howard: Disruptive Technology. Americans are pretty upset that the American children owe one trillion dollars in student loans. It is starting to make an impact on the housing market, because it is the first generation of Americans that can’t really qualify for housing loans, because we are carrying so much student loan debt. I have got to tell you that I think education has used the least amount of disruptive technology, ever since the computer generation and innovation in the eighties.

David: Yeah.

Hoard: It seems like so many companies in free enterprise went paperless.  There is really only two industries that really didn’t touch that and that was Government and Education. You still have this mindset where a teacher wants to stand up there and talk to the thirty kids when it seems like by now they should all be on modules.

David: It’s ludicrous.

Howard: Learning at their own speed.

David: Howard, that is exactly in the learning platform that we have derived.  For instance, we don’t have any slides in our PowerPoint presentation with text.  It’s all imagery. Everyone is imagery and with a voice over. So it’s got audio, and it’s got video, and it’s got imagery. So I refuse to put a data dump onto a page that is just full of text. All I do is show an image, and will talk to the text, will talk over the text, and will point to it. Sorry, not to the text, to the imagery.  We believe that is an incredible platform, because we believe people will learn far more effectively from visual imagery, and audio imagery than just pure text.  That is where we spent all this money, on this new type of platform.

Now when I go back to the other professional universities, and they say to me they can’t understand how we are accredited. They couldn’t even comprehend what we’ve created. So artificial intelligence, business intelligence, we’re trying into this realm and it is a really exciting place to be. But it takes a lot of work and you have to have a lot of great people around you. A lot of really good help.  And you know what that is all about, to do what you have done you’ve got some great people around you. You need that. I am very proud to say the same thing, I have got a tremendous team. All hand-picked. People in Ireland, people in the UK, people in Florida.

Howard: People in Ireland?

David: Yeah, I have got some really good people there. So I am very careful who…

Howard: I am a hundred percent Irish.

David: A hundred percent?

Howard: Yeah, so you think Conor McGregor can beat Floyd Mayweather?

David: I think he can.  

Howard: I love you even more.

David: I think he’s great.

Howard: David, now you are my new best friend.

David: I think he is great. I really do, and I think it is not just talk the talk, I think he can actually do it. I am very impressed. What an athlete. What an athlete, and tough. I think the other guy’s…

Howard: The reason I think he will win is remember Sigmund Freud, the great psychiatrist.

David: Yeah.

Howard: He said that the Irish were the only ones that couldn’t be psychoanalysed. We were that crazy.  

David: I love the Irish.

Howard: So maybe Conor McGregor is so dang crazy that might just do it

David: Well did you see the Manny Pacquiao fight against the Australian guy?  

Howard: I did, and the Australian won.

David: Yeah. Any of you boxing fans out there, I don’t know you sort of say ‘is boxing rigged?’ I couldn’t tell you the number of blows Manny hit the Australian guy with, I don’t know, it just seemed to me a bit strange. But anyway.

Howard: The reason I don’t think it is rigged is because I know the Australian Authorities. In the United States and Las Vegas so many young agents, in the FBI, they would love to crack.

David: Yeah.

Howard: A fixed ring like that.

David: Yeah.

Howard: You’d be famous, you’d be on TV.

David: You would also be dead.

Howard: There’s so many people, I think judges are humans too.  

David: Yeah.

Howard: You know what they always told me (inaudible 43:27), ‘if you don’t want to leave it in the hands of the ref then knock them out’.

David: Yeah.

Howard: Manny Pacquiao, and Floyd Mayweather, are famous for just doing the minimum amount of effort needed to win and score the round.  

David: Yes. Yeah.

Howard: Then that is not the way the judge saw it.  

David: Anyway, it will be interesting.

Howard: Back to these clear aligners, the first question that I started off, let’s go back to that. From when you and I got out of school ortho is going faster.

David: Yeah.

Howard: It was standard twenty-four months pretty much in all cases.

David: But Howard, when you think about that twenty-four months.

Howard: How is it going faster? Is it because instead of changing the sequential aligners once a month, you are changing them every two weeks?

David: First there are a couple of things. You’ve got to be very careful with tooth movement, if you constrict the blood vessels around you’re getting too much necrosis. You know what’s going to happen, you’re going to get root resorption, you get pulpal necrosis. We don’t want that. So we can’t put too much force on. What’s interesting about the clear aligners is, the clear aligners puts a constant low-grade force on the teeth. So instead of going like the knockout punch, you have got the jab, jab, type of thing. Now the interesting part about that is, you are getting a lot of cellular interchange.

So, Howard, the key here is, can we actually get the cells to interchange faster?  Howard, if I said to you what actually happens when a tooth moves, you’ve got osteoclast eating bone away, okay and on the other side you getting osteoblast laying bone down. So these devices that I have created, these Munchies and some of the other things that I have done, all they are doing is allowing for fast cellular interchange. Also the devices are more accurate. These are all computer-generated movements. So if I got a tooth, I am not going to put a raw force in. So the first of all I am going to do this and then I am going to do that. I am going to put an attachment on. I can change the engineering principles and I can actually do that, because as a vector all we are getting is a change of movement.  

Howard:  Have you gone down to Costa Rica where they make them?

David: No, I have never been there.  

Howard: What about some of these other technologies like AcceleDent?

David: Yeah, look some of them are better than others. I think some of the vibratory mechanisms work well. But at the end of the day the thing that really makes a difference …

Howard: What do you like most? Go ahead, what makes…

David: No, what I am thinking is if you can get aligner to fit intimately, so the original data capture, the impressions, have to be really really great. Howard, the interesting part is that the aligners have actually got, within their design, they’ve got enough force to be accurate. The question is if you use things like Munchies, the Munchies actually make sure the aligners fit really well.

Howard: Munchies, that’s…

David: That is one of our products we sort of use.

Howard: Yeah, tell me about your Munchies.

David: Munchies are a visco elastic device, so a piece of silicone.  

Howard: Munchies designed to maximise the accuracy, fit and effectiveness of clear aligner treatment.

David: Yeah.

Howard: I provide release of discomfort of all… Okay, so what was the vibrator device called?

David: There was an AcceleDent one.

Howard: That’s the vibrator.  

David: Right, okay

Howard: To really just seat the trays better.

David: No, it doesn’t seat the trays. The whole idea was that the agitation.

Howard: The vibration.

David: Yeah, actually accelerated the intercellular change.  

Howard: For white blood cells to turn into Osteoblast.

David: Yeah. The whole thing would happen and just be shaking the tooth they are saying you will have an increase in vascularisation and change to the tooth movement velocity.

Howard: And that is AcceleDent?

David: Yes, that is one of them.  

Howard: Propel is…?

David: They have got another one, a similar one.  

Howard: What was Propel?

David: Yeah. Propel, the original one, I think Propel actually had one of those devices where they used to puncture the bone. I don’t know…

Howard: Right. Micro perforations?

David: Yeah. That’s a pretty scary proposition for a patient, especially without local anaesthetic. So we tried it but we thought that was a little bit too aggressive. We think the vibratory one is an interesting possibility.  We have got a new device now, combining the Munchies.

Howard: This is the Munchies?

David: Yes, the Munchies are a silicone. It’s a much easier device. It is a visco elastic silicone. So what it does is when you bite into it, it returns the forces and it actually seats the aligners more effectively, it really gets them home. It grabs the crown of the tooth, about thirty percent of the crown of the tooth and lets the tooth really move effectively.

Howard: Who named it Munchies?

David: I did.

Howard: So were you stoned, you had the Munchies? When you thought of this?

David: Well that crossed my mind. The next one we have got is called Munchies Vibe, so we’ve actually combined the Munchies with a vibration device. We’re just getting the patent out on that at the moment.

Howard: So explain what the Munchies are again? It’s a visco elasticity that optimises forces.

David: Yes, it is a piece of silicone. It looks like a three-star thing, it looks like that.

Howard: Right.

David: The patients actually bite into them, into the grooves, and it actually engages the aligner and it engages the tooth and it makes…

Howard: Again you are mainly trained to seat the aligner tray.

David: Yes. That is the thing that people don’t understand. The aligner has enough force in it to be able to move the tooth effectively and efficiently. But what actually happens, if the aligner doesn’t fit the tooth properly, it’s not going to work. We make sure we get great intimacy between the aligner and the tooth and we go from there. We are selling literally thousands of these in the US, in particular, at the moment. We’ve had a great response.

Howard: When are you going to make an online CE course about these?

David: Howard, how many hours in the day are there?

Howard: My gosh, well actually that’s the best hours of the day because it’s so scalable.

David: Yes.

Howard: You put that course up.

David: Yeah.

Howard: You could be sleeping in Sydney.

David: Yeah.

Howard: While they are watching it in Kathmandu.

David: We have got a few key opinion leaders out there who loved this. We are just scratching the surface here, we know that this is going to be huge. We know these things work, we have tested them. We actually won a grant from the New South Wales Government which is a state of Australia. We won this big grant and they actually supported us, which was great. So we know the thing works.  We are changing aligners over every seven days now.  

Howard: So it seems like whenever I talk to an orthodontist, twenty percent of their ortho is clear aligners. Do you see that as a ceiling floor limit?

David: It depends who your target market is.  If you are going to treat adults, then I would say it should be the other way around. Eighty percent you should be treating with clear aligners. On the other hand, if you are treating a twelve year old kid and you tell the kid ‘I want you to wear these twenty-two hours a day’, what are the chances of that? The kid won’t do it so you put him in braces.

Howard: Do you see that too?

David: Yeah, we do.

Howard: I grew up with five sisters, my brother wasn’t born. My brother lives in Sydney. Have you met him?

David: Yeah. Yeah.

Howard: Paul Farran.

David: Yeah. Yeah.

Howard: The nicest guy I have ever met in my life. Just a hell of a guy. My boys wear the same football jersey three days in a row, sometimes I’d have to hide their favourite shirt. I can’t see half the boys that I know wearing their clear aligners.

David: Well I think that is one of the flaws in the philosophy of Align Tech at the moment, is they believe that their big growth area is the teen market. But I think it’s struggling.

Howard: The other thing the teens, they seem to really enjoy coloured rubber bands, changing them for Halloween versus Easter, Christmas or school colours.

David: I think there is two schools. I think the older teens are good with clear aligners, I don’t think it is a problem with that. But I think when they talk about the young kids who have had their premolars taken out, the twelve to fifteen year olds. I think you really struggle to get a twelve to fifteen year old boy. My son was the same, he was a champion tennis player and he would come home from a tennis tournament, and he would go to bed in his clothes with his shoes on. He would be covered in sand from the clay courts and there would be just dirt everywhere, he’d stay like that for two days. You could smell him a mile away.  So what are the chances of him actually changing his aligners over?  The same chance as Donald Trump…

Howard: Telling the truth. Telling the truth. You just walked into some controversial. You just walked into a sliding glass door. You said extracting the teeth. The difference between a fanatic and someone who’s really intense, it’s really neat when someone is passionate about something, but a fanatic is when they won’t change the subject.

David: Yeah. Yeah. Yeah.

Howard: I want you to address, because I know my homies, and probably twenty-five percent of all American general dentists are fanatically against extraction of teeth. They just say zero. Then there is moderates like me that say we can’t say zero, there is no such thing as zero.

David: Yeah.

Howard: There is just cases where you have to extract the bicuspids.

David: Absolutely.

Howard: So talk about that, because there are…

David: Okay. Okay.

Howard: One fourth of American general dentists are fanatically opposed, they say it is going to cave the face.

David: Yeah. Okay. So I think it very much depends on the ethnic cohort you’re treating. You go to Hong Kong and they have got these mouths and they have an incredible amounts of double digit crowding, teeth which are locked out. Some really serious stuff.  Now the clear aligner cases in Hong Kong twenty to twenty-five percent need extractions. Now you go to Australia which is more of an Anglo Saxon based on an English, Scottish and Irish background, in particular, a big proportion of them. They have got much bigger mouths and they have got more surface area and the likelihood that they need an extractions is a lot lower than it is in the Asian cohort.

So I agree with you totally. Those guys that say never is stupid, the ones that say always are stupid, the guys in the middle say each case it taken on its individual merits. In my opinion it is the healthy way to go. So again you go to Hong Kong very different, you go to Australia. But if you go to other parts of the world where they have got these massive mandibles, massive surface area, you don’t need it. So again I just think you just got to be smart and look at each case on its own individual merits. But I have seen some horrible cases, and we still get them, where they are pulling out these on Anglo Saxon women and you see them at forty and they look like they are sixty. You’ve seen this a million times, we all have, and you think why did that happen?

The interesting part is that we can actually reverse it though now.  And the ortho’s don’t like this, because of the conventional rather than aesthetics orthodontics that I do. Is that what we do is, if they’ve lost the first four premolars and their faces fall in, we expand everything up. We create some space, not enough that you can put an implant in, but enough to give them their lips back, there is no buccal corridor make them look really good. I add a bit of compass on the distal of the canine and some of the mesal of the premolar, and guess what? They love me. We leave space, big deal, you’ve got a one and a half millimetre space on the distal of the canines, who cares? They got their lips back, and women love lips and they like their cheeks to be full. You’ve got a patient for life.

That is the philosophy behind Aesthetic Orthodontics. Angle’s classifications and all these Andrew’s classification of orthodontics, they said you can’t leave gaps anywhere. Who said?  Us as general dentists, we don’t mind making gaps because we can fill them in. Ortho’s don’t like filling gaps in, because they don’t know how, but we do and we know how to fix things like that. So that’s my opinion as far as extractions are concerned. Definitely. If somebody fanatical, says no you can’t. They are the tree huggers, you can’t cut a tree down. Well sometimes you have got to cut a tree down. But then the other ones who say lop all the forests, I don’t agree with that either. Somewhere in between I think is sensible.

Howard: Seriously thirty years ago, when I got out of school, there were orthodontists that I knew where everyone was (inaudible 56:08).

David: Yeah. Yeah.

Howard: Now it seems like it’s gone to about maybe one in five.

David: Yeah.

Howard: Even some of those one in five, I get frustrated with, because you will see them do that. The person had crowns and MOD’s on all their teeth. You could have actually taken out…

David: Exactly.

Howard: All the existing restorations…

David: Yeah.

Howard: And made several millimetres of space.

David: Absolutely. Absolutely.

Howard: So we’re down here down under, we’re in Australia. Who is the most famous orthodontist in the world was from down here studying the aborigines.

David: Who is that? Who is the most famous…

Howard: Who is the most famous orthodontist down here, studying the aborigines.

David: Who? Begg.

Howard: Begg.

David: Yeah.

Howard: Any thoughts on him? Since we are in his country. Orthodontist studying or not really?

David: Not really, I just think that a lot of those ideas are really so outdated it’s…

Howard: Do you think that Begg’s a lot is outdated?

David: Yes.

Howard: Why do you think that?

David: To aggressive.

Howard: What do you mean?

David: Well again, some of the techniques again we’re very much advocates of removing premolars.

Howard: Well in 1954 PR Begg analysed in approximal nutrition…

David: Yeah.

Howard: As a prehistorical universal mechanism to reduce tooth size.

David: Yeah.

Howard: With modern processed diets and a virtual disappearing of constant in approximal nutrition. Do you believe Begg’s theory of in approximal nutrition, or do you think it is not really…?

David: Well it’s interesting because you kind of think that with a very fibrous diet and the teeth are rubbing against each other and they actually getting smaller over a period of time, what’s the likelihood of having crowding? The answer is obviously going to be far less. With today’s diet where you are eating hamburgers and soft stuff all the time, then you are not going to get that in approximal reduction. Actually the mandibles are getting smaller so you are going to end up with more and more crowding. So there could be something to it.  

Howard: Wikipedia say that most modern researchers now back what he said.

David: Yeah. Yeah.

Howard: But the point I want to talk about Beggs is because I don’t think it’s in approximal wear, but I do think the anthropologists are blowing my mind.  When you do Google searches for dentists or ortho, I am just getting any news articles that mention dentists or ortho.

David: Yeah.

Howard: Orthodontists.

David: Yeah.

Howard: Orthodontics. The anthropologist I’ve posted many on my dental (inaudible 58:51) keep asking questions. Why do we not see malocclusion from three hundred and fifty years ago to one and a half million years ago, and the anthropologists are all saying ‘hey, all this malocclusion, it’s a whole new deal’.  Like just in the last couple of hundred years, and it seems like it’s because of these aborigines. There’s a hundred billion sapiens have come and gone since the species started two million years ago. They nursed for a couple of years and they had a very hard diet, they were chewing on bones, and beets, and roots, and tubers.

David: Yeah.

Howard: Now the first time the baby is nursing and shows any difficulty they switch to a baby bottle or sippy cup.

David: Yes. Yes.

Howard: You look at these mothers, they feed it mush out of a jar.

David: Yeah. Yeah.

Howard: So this face’s had no force to spread the pallet.

David: Yeah.

Howard: Spread the face.

David: Yeah. Yeah.

Howard: Probably what the aborigines were doing best was gnawing flesh off of a Kangaroo bone.

David: Yeah.

Howard: Instead of eating apple sauce.  

David: Yeah. Well I think that very much in the vertical dimension, yeah. The other thing is also is life expectancy. I think that is another huge issue as well, because you are talking about people recognising crowding in what we would say is middle age, thirty, thirty-five, forty, forty-five-year olds. They say how many…

Howard: Middle age goes at least until fifty-four, because I am 54.

David: Really.

Howard: I am still in the middle.  

David: I thought you were younger generation

Howard: You want to push me out to older age, as in sixty-two.  

David: But in all seriousness, that’s why I think that you’ve got to look at this carefully. What’s one of the big challenges for dentistry today is that, our kids, if you look at Ryan’s kids, they are going to live until they are a hundred and twenty. Now you have got to manage a dentition from an eruption of six through to one hundred and twenty.  That is really challenging.  

Howard: Don’t tell Ryan, but I neutered him while he was asleep one night.

David: Right.

Hoard: I wanted to stop the madness.

David: You know what?

Howard: He has no idea he’s been neutered.

David: He saved you so much money. He’s such a good guy. He’s a forward thinker. When you got to go and scratch, there is nothing to scratch. But it’s interesting because I think this is a really big challenge this whole thing. Even the discussion about where attrition, crowding of a thirty year old, forty year old, fifty year old. But I think there are so many challenges for us living to our ripe old age. Now I give a lot of discussion to dentists about what actually happens when you can’t see anymore, and your hands are shaking, and you are sixty-five years of age, yet you know you are going to live to a hundred. You have to support yourself financially from sixty-five to a hundred. What are you going to do?

Dentists aren’t good at anything else. So this whole question about life expectancy in the dental world, I think it creates a lot of problems.  You’ve got a great gig, you’ve got a commercial mind and you have done some fantastic things. I am sure you have got so much money that it is not even funny, which is great. But for the average dentist out there you (inaudible 62:03) lot of competition. How long am I going to live for? What type of dentistry am I going to be doing? If I am going to be doing any dentistry. You think at sixty-five, what is a dentist going to do?

Let’s say Ryan’s kid is going to be a dentist and he is going to live to a hundred and five, and at sixty-five he has got the shakes. Now what does he do for the next forty years, financially, to support himself? Now that is really challenging.  I ask most kids when they come into my lectures, when are you going to retire?  These are twenty-five year olds and they say when I am fifty-five. I start laughing, I say ‘you think you are going to be able to support yourself for another forty years?’ Not today when you have got so much competition in the market place. It’s not what it was thirty years ago where you could make a lot of money. Now you can make good money but it’s very difficult, in my opinion, certainly in Australia, to make so much money that you can live on easy street for the rest of your life.

So what does a dentist do when he’s sixty-five? This is a giant. So I talk about reinvention. I talk a lot about having a second career, another skill set. What are you going to do for the rest of your life? You are used to using your brain, used to be highly revered as a healthcare professional. All of a sudden, Doctor Howard Farran at sixty-five years actually retired. He has a couple of million bucks, he’s got some property, he’s got a bit of cash. The interest rates are real, almost nothing. He’s got to go and put on the stock market, he knows nothing about the stock market, he goes into some dodgy real estate deals. It’s not as easy as it used to be.

So this whole thing about life expectancy increasing, as I said, it’s not just crowding, not just attrition, it’s just not theories of malocclusion. This to me is like a really big challenge. Certainly for dentists, and I think this is something that needs to be addressed.  

Howard: So what’s the solution?

David: Don’t be a dentist.  

Howard: Well, yeah, you’re right. I have this conversation with a lot of my friends that are younger. They are pushing a lot more. They’re doing construction, they’re welders.

David: Yeah.

Howard: My son is a cellphone tower welder, and he is only twenty-eight years old and he is saying ‘dad, I don’t even think I can do this when I was forty’.

David: Yeah. Yeah.

Howard: What I have seen a lot of in your field is that when dentist’s hands do start to go, they switch from the blood and guts, the surgeries, the sinus lifts, the root canals to the soft and pretty stuff, ortho, Invisalign, hygiene charts, perio.

David: That’s why, again, I agree a hundred percent. For instance with the clear aligners and the courses we teach, it’s great for second stage career.  

Howard: Right.

David: It’s not so difficult. I target the young ones to do the scans and they put the attachments on. What do I do? I do the treatment planning and I do the talking to the patients. It works and it works very nicely. I think it is very good.  But even so, how long can you keep doing it? Would someone walk in and see me at seventy-five? I don’t think so, it’s hard enough to get…

Howard: Well they actually do, because I have gone to several practices where the dentist was over ninety.  

David: Wow.

Howard: I went and spent the day with them. What you have to realise is that I went into a practice in ninety-two. First of all men die five years earlier than women.

David: Yeah.

Howard: So when you are a ninety-two-year-old man, you’re the hottest piece of real estate in the nursing home.

David: The problem is nothing works.

Howard: All of his patients.

David: Yeah.

Howard: Were eighty-year-old widowed women.

David: Yeah.

Howard: He would see one or two patients in the morning, then go to lunch with one, then he would see two or three women in the afternoon and go to dinner with one.

David: Yeah.

Howard: He was just the happiest guy in the world.

David: Yeah.

Howard: I’ve seen that three or four times. So the dentists that I know that are all practicing when they are seventy-five or eighty, their patients are the same age.

David: Yeah. Fair enough.

Howard: In fact the only reason that I have to keep seeing patients is just for the whining old ladies that insist they have to see me.

David: Yeah.

Howard: I still love it, I have been treating them for thirty years.

David: Yeah.

Howard: But your patient gets older. I want to ask you a very controversial question.  

David: Sure.

Howard: In dental school the oral surgeons teach those kids extractions.

David: Yeah.

Howard: They are not threatened. The endodontists teach them endo, they are not threatened. The pediatric dentist teaches how to do (inaudible 66:30) crowns, they are not threatened. The orthodontist won’t teach these dental students anything.  

David: No.

Howard: When they come out of school, if these kids call up their endodontist and say ‘hey, I don’t have any patients on Wednesday morning, can I come watch you do a molar endo’. What would every endodontist say?

David: Fantastic.

Howard: Yeah. What would every oral surgeon say?

David: Fantastic.

Howard: What would every periodontist say?

David: Also fantastic.

Howard: What would every orthodontist say? Yeah, exactly. Exactly. If you are listening to this audio you have just flipped me off. Why is that?

David: Yeah, it is really interesting. It’s just such a closed club. I don’t know why.

Howard: That’s what it is.

David: You know what’s interesting, Howard, it’s universal.We’ve got Japanese students, we have got people in the Middle East, we talked to others, and it seems to be universal. It seems you do a two or three-year post grad degree, and I’m probably going to get assassinated by the Society of Orthodontists, but it’s really interesting. It’s just such a closed club and it seems, again, it’s universal. Why? I don’t know. When I graduated from dental school, Sydney Dental School just down the road from here, what did I know about ortho? I knew how to refer patients. I knew what class one, class two, class three was. I knew a little bit about some retainers, but not much, and I had on my referral pad this is who I had to refer to. They kept me in the dark. We have had a lot of orthodontists look at our course and they are very critical but they don’t even understand what we are doing. I am really convinced that they don’t understand that there is a whole new realm. This aesthetic orthodontics is very different to traditional orthodontics.  

Howard: One other question. DentalTown has a quarter million dentists and we have fifty forums and one of them is orthodontics.

David: Yeah.

Howard: I hope you create an orthodontic online course and you ought to get your teachers to post some of these cases there. In your signature you have your name, your logo, your website. It would just be phenomenal marketing. So many of the kids on DentalTown, they come out of school and they say ‘I feel ripped off’. I graduated from dental school and I didn’t learn anything in ortho’.

David: Yeah. Yeah.

Howard: ‘I didn’t do one case’.

David: That’s universal.

Howard: I didn’t do Invisalign.

David: It just seems universal.

Howard: So if one of my homies listens to you and says ‘Doctor Penn, I just got out of school last month. How do I go from I have never done an Invisalign case, to I need to do one?’

David: Yeah.

Howard: What would you tell them?

David: Okay. Well the first thing you need to is you need to understand, do a very simple one or two day introductory course.  Basically how to interact with the company that is going to provide you with the aligners. But I would suggest to a lot of these kids, if they’re really serious about building a future for themselves. Something that is going to be meaningful and satisfying, and get into holistic facial aesthetics. Spend fourteen thousand bucks, spend eighteen months of your time and do our course, you will come out there and you will be so highly qualified.

Howard: How much is it?

David: $14500 US. That’s it.

Howard: Fourteen thousand five hundred?

David: Yes. Yeah, and they can pay it off over the eighteen months so their cost is not prohibited.

Howard: Fourteen thousand five hundred.

David: For the whole lot.

Howard: Which would be three ortho cases.

David: Yeah, that’s it.

Howard: So it would cost you three Invisalign cases.

David: Yeah.

Howard: It will take you eighteen months to do?

David: Yeah. The standard’s high and the expectation of our school is high.

Howard: How many times would they have to come to Sydney?

David: They don’t.  

Howard: So they never have to come to Sydney.

David: No. They never have to go out of their own bedroom. Well they’ve got to do stuff in their own practice because they have to submit.

Howard: Sydney is a dangerous city, I was almost run over and killed by a Koala Bear. The run about a hundred miles an hour down the street.

David: Okay, but it was chasing a Kangaroo. But in all seriousness, the return on investment is phenomenal. Any young grad, I would say, that wants to make a serious investment in their future, come and look at our school and get involved.

Howard: What’s the website?

David: It’s pgdentalschool.edu.au. If you don’t find value for money there I would be amazed.

Howard: It’s pg, what’s the pg stand for?

David: Post graduate.

Howard: pgdentalschool, postgraduatedentalschool.edu.au.

David: Yeah.

Howard: So here’s what I like about ortho, implants and sleep apnea. When you are in London, Paris and Tokyo the government bill insurance gives you $100 for root canal. America, Delta sets your fee and ninety-five percent of dentists take Delta. So in all reality ninety-five percent of general dentists are on a PPO, eighty percent of dentists are on two PPO’s, forty percent of dentists are on six to twelve PPO’s and they’re setting the fees below your cost for cleanings, exams, and x rays, and fillings and you’re not even sophisticated enough to do it.

When I go into your office and someone has a cleaning exam and x-rays come out, and the hygienist dismissed the patient, I stop the hygienist and say, ‘did you make $9 on this or did you lose $12? You have no idea. For me to even go in your office and figure it out, I have got to take all your accounting and put it into Excel. I’ve got to take practice manager and put it into Excel. It would take me and my three bookkeepers, Lori, Stacey. It will take us a week to figure out if you are making money or losing money. What are the three things that government doesn’t set the fee on? Orthodontics, Invisalign and implants.

So this is really sad. But when you go to Tokyo, Paris and London and you take those dentists to a bar and you start drinking and you say ‘what do you do when someone comes in and needs a root canal, a molar root canal?’ In America the average fee for a molar root canal minimum $600. A lot of them get $1000 to $1200, and they are running fifty to sixty percent overhead. How do you do a root canal for $100? What do they say?

David: I don’t do it.  

Howard: Yeah. Really. You’re poorer to place an implant, because an implant is $1000 to $1500 and then you put a crown on there and… So I have seen so many NHS clinics where the doctor says ‘I lose money on everything. But I pull out one Invisalign case a week’. When you do fifty Invisalign cases, for $250 000, that’s basically a salary. He says ‘basically, I make two hundred and fifty grand a year because I do an Invisalign case once a week’.

David: Absolutely.

Howard: I think placing implants is an intense surgery. If you love blood and guts, that’s great. But Invisalign, come on. You can’t do Invisalign? They own seventeen percent of Smiles Direct. You can’t do Invisalign so they are going straight to the guy who’s got a patient to bite into a wafer of putty, vinyl polysiloxane.

David: Yeah.

Howard: So the patient can do Invisalign but you can’t. So invest three Invisalign cases, with one of the biggest legends in orthodontics that I’ve ever known. This is the sixth time I have been to Sydney since 1990. Every one of my friends speak so highly of you. Everybody I know speaks so highly of you.

David: Thank you.

Howard: But learn orthodontics because you have margin with orthodontics.  What do you think the average profit margin is on your orthodontic procedures?

David: It’s pretty high, but I would say fifty or sixty percent.

Howard: Yeah, it’s fifty percent.

David: Yeah.

Howard: It’s half.

David: Yeah. Yeah.

Howard: What do you think the average profit margin is on an MOD composite?

David: You’re lucky to get ten percent. I’d say. Twenty percent.

Howard: Yeah. You would be very lucky to get ten percent and most offices are losing money.

David: Yeah.

Howard: On cleanings, exams.

David: Yeah.

Howard: X rays, fillings.

David: Yeah.

Howard: Posterior composites.

David: Yeah.

Howard: They don’t even know it. If it wasn’t for them doing crowns and root canals, they wouldn’t even be making profit.

David: Yeah.

Howard: So you want to avoid loss leaders and you want to make some profit.  The other thing is, some of these kids walk out of school and they don’t like blood and guts.

David: No.

Howard: I mean I do, I am a apical barbarian. When I do a root canal I am going to get all the way patency and I want to puff a sealer at the end. I am not one of them pulp lovers that stop a half millimetre short and make it all look pretty. I figure a flap twice as long takes the same time to heal as one half as long. I lay a flap like peel a banana. I pop that wisdom tooth out so damn fast. I love blood and guts, but half these kids don’t like blood and guts.  

David: Yeah. That’s true.

Howard: So if you don’t like blood and guts learn clear aligners.  

David: The interesting thing, Howard, I think you hit the nail right on the head.  The amazing thing that we see, is once we educate them and open their eyes to see what they can treat, all of a sudden, they see these diamonds in their backyard. Then all of a sudden everybody comes in with lower anterior crowding, all along with the over-erupted lower anteriors. There is cases in your own backyard that you don’t even know they are there.

So I suggest, come and learn what to look for because they didn’t teach you this in dental school.  Howard is a hundred percent right, the ortho’s won’t teach you. We will teach you for very little and you will get so good at this. You will be able to do a hundred cases a year, and you will be able to buy the Ferrari that Howard has got. You know he has got a Golf 3 550, that is impressive. If he said it can sleep thirteen people. If he links to Sydney in one go, he doesn’t even need to land in Maui anymore, although he does for a round of golf. So this guy is a clever guy.  

Howard: So do you teach any lectures or is it all online? Do you do any lecturing programmes?

David: Yeah, I do. I do.

Howard: But is your programme mostly all online?  

David: Yeah. Yeah, the grad diploma programme is all online, that what took us three years to write, and record, and all its money to get on there.

Howard: Do you do some intro, one day or two days?

David: Yeah, we do. We do some webinars, we do some live gigs.

Howard: Do you ever lecture live in the United States?

David: No, I’ve done Europe, I’ve done Asia, I’ve done UK, Ireland, and Hawaii, I’ve done some lectures in Hawaii.  

Howard: Do you ever want to lecture in the United States?

David: I am getting too old to lecture in the United States. I am happy to be online. That’s really scalable.  

Howard: What I like the most about online is so many people forget there is two million dentists on earth.

David: Yeah.

Howard: You can’t lecture to two million dentists on earth.  

David: We can try, Howard. Global domination, that’s what it’s all about.

Howard: I have lectured one thousand times and I haven’t even scratched the surface.

David: Wow.

Howard: A thousand times.

David: Wow.

Howard: Since 1990 in six continents. How many continents were you in last year?

Ryan: A whole bunch.  

Howard: Basically everything but penguins.

Ryan: Yeah.

Howard: Those damn penguins.

David: You should go down there, it is great.  

Howard: I want the polar caps to melt because the penguins have never invited me down to speak. I want global warming just to get back at those penguins that won’t have me lecture down there.  

David: I took my daughter down there a few years ago. What an experience.  Really before you die, seriously go down to the Ushuaia in South America. Go down to the Drake Passage. That’s a nasty piece of water if you ever want to go down there.

Howard: You went to Antarctica from South America?

David: Yeah.

Howard: Yeah.

David: That was a great experience.

Howard: How far are we from Antarctica here in Tasmania?

David: A long way still.

Howard: Is it closer from the tip of South America.

David: Yes, because the Antarctic has got a Peninsula.

Howard: Oh, yeah.

David: Where the Atlantic Ocean meets Pacific, it’s like a big washing machine down there. So we were on a ten thousand ton boat, I was sick for four days.  You just throw up for four days. But all of a sudden you get there and it is great.  But what an experience. My daughter and I went there on a scientific expedition about three years ago. Best two weeks of my life.  

Howard: Do you know Jeff Knight?

David: Yeah, I’ve met him. Yeah.

Howard: He wants to summit the highest mountain on every continent.  I did the highest summit in Australia with him.  

David: Mount Kosciuszko?

Howard: Kosciuszko.  

David: Seven thousand feet. It’s like a hill.

Howard: I know, it is the shortest one.

David: Yeah.  

Howard: It’s the lowest one. I did Kilimanjaro, which is in the middle of nineteen thousand. He did Antarctica.

David: Yeah.

Howard: He said that that was the coolest thing he ever did.

David: Unbelievable.

Howard: I am trying to get Ryan to do it with me.

Ryan: Yeah.

David: You should take him to Everest.

Ryan: He is trying to get me to go to Everest.  

David: You should go, you should do it.

Howard: I am going to do Everest but I’m going to…

David: Next time you come to Australia, you should go to Papua, New Guinea and go on the Kokoda Trail. That’s a really interesting one. They’ve still got head hunters up there. I am not joking.

Howard: Yeah.

David: You should go, that is a real experience.  

Howard: Oh, the head hunters, I know. Did I tell you about my missionary dentistry trip I did in Tanzania? You know those kids that are born with vertigo?  

David: Vertigo. Yeah. Yeah. Yeah.

Howard: Vertigo.

David: Yeah. Yeah. Yeah.

Howard: They’re hunted by witch doctors for lotions and potions. So we went to an orphanage where they had a twelve-foot wall with razor wire all around it, and they needed some dentists to come in and do some dentistry on this orphanage. The orphanage is filled with a couple hundred little kids, and they have to keep them in there until they are old enough to defend themselves from a fifty, or sixty-year-old witch doctor.  

David: Wow. I’d be an orthodontist.

Howard: The lady orthodontist said they were worth what a black rhino costs.

David: Wow:

Howard: Those witchdoctors need their body parts. So yeah, there’s still head hunters.

David: That’s bizarre.

Howard: Isn’t that just crazy?

David: Unbelievable

Howard: But anyway David Penn, it was an honor that you came by today.

David: Thank you, it is an honor for me to be here. As I said, I am in the presence of greatness here. All of you young kids out there don’t forget this guy, this is a serious rooster, as we call them in Australia.

Howard: A serious rooster.

David: As I said, everyone in Australia loves you and it is great when you down to visit us. I think he feels very comfortable here, which is great, because I think we’ve got a lot of similarities to the Americans, which is great, we’re great allies and we love going there. Every time I go to the States I say ‘it’s on my bucket list, I am coming down there’. It’s great, and we love the Americans coming here, and we love going there. I go every year, I go with my friends, we fly to Dallas and we play some golf in Dallas and then we fly up to Pebble Beach and we do about a week around there as well.  That’s just magic.  

Howard: You know my brother moved here.

David: Yeah.

Howard: I told my brother, I said ‘I have lectured everywhere forever and every single time I fly back from Sydney to the United States, I don’t know why I am flying back’.

David: Yeah.

Howard: If I had to pick one other place other than Phoenix to live it would be San Fran or Sydney.

David: We are very lucky. I say to my kids ‘you don’t know how lucky you are that our ancestors actually settled here or came here, certainly from Russia and all those crazy places they came from, and lobbed in to Sydney and to the best part of Sydney. We live in the Eastern suburbs near the water. Every morning we wake up and I say to the kids ‘you kiss the dirt’ ‘when we get off the plane.  You kiss the dirt’, because you don’t realise how lucky you are to live in this beautiful harbor, and beautiful temperate climate, politically stable. We are very lucky and blessed here. Any of you guys watching out there in the US, come down and visit us. Drop in at Double Bay and say hello to me. We can take you around and have a look. We are very proud of where we live.    

Howard: And be smart. Three Invisalign case fees and you can take how many hours?

David: It takes a while.

Howard: But how many hours on that?  How many online CE hours are on your programme.

David: Just two thousand.  

Howard: Two thousand hours of online CE. Master that because no government is, in the near future, set a fee on a cosmetic procedure.

David: No.

Howard: Its hard to justify a medical need for orthodontics when United States has one third has obesity, myself included. I don’t think there is any logical justification for saying ‘if I don’t straighten this guys teeth he’s going to die of starvation’.  

David: It is funny, we actually had a government scheme that was finished about four or five years ago, where everybody if they had a medical condition that was related in any way to dentistry, they received a $4000 rebate. It was amazing. They spent more than a billion dollars on these rebates, and it almost drove the government broke because everybody was claiming. Like if you had an ingrown toenail, somehow it affected your teeth. It was really sort of bastardised but the interesting part was that so many people had so many procedures, whether they were necessary or not. That was a very intriguing one. Let’s also say that when the government found out it was being (inaudible 83:47) they pulled back on it and it stopped.  

Howard: If you want more of something subsidise it, and if you want less of something tax it.  

David: Absolutely.

Howard: So that’s the bottom line.

David: It’s a very wise way of doing it.  

Howard: Alright, thanks for coming by.

David: Thanks so much