Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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1161 Dr. Les Kalman BSc, DDS, (AA)FAAID, DICOI, Professor, Restorative Dentistry, Dental Outreach Community Service : Dentistry Uncensored with Howard Farran

1161 Dr. Les Kalman BSc, DDS, (AA)FAAID, DICOI, Professor, Restorative Dentistry, Dental Outreach Community Service : Dentistry Uncensored with Howard Farran

3/24/2019 9:36:08 AM   |   Comments: 0   |   Views: 147

Les completed a BSc (Hon) & DDS at Western followed by a GPR at the London Health Sciences Centre. He maintained a full-time solo private practice with an emphasis on digital dentistry, prosthodontics and medical device research while continuing hospital privileges at Strathroy-Middlesex General. 

VIDEO - DUwHF #1161 - Les Kalman

AUDIO - DUwHF #1161 - Les Kalman

His research was supported by the Scientific Research and Experimental Development Fund and the National Research Council. In 2011, Kalman transitioned to full-time academics as an assistant professor and outreach coordinator. Kalman’s research focuses on medical devices & technologies relevant to clinical dentistry. He has authored close to 40 articles, holds two patents and has translated two technologies. Kalman maintains his position as the founder and President of Research Driven. He is an active member of the Academy of Osseointegration, the International Congress of Oral Implantologists, the Standards Council of Canada and serves on the Board of Directors for the University of Western Ontario Faculty Association and the Canadian Association of Public Health Dentistry. He has been recognized as an Academic Associate Fellow (AAID), Fellow, Master and Diplomate (ICOI), has been awarded the Schulich Alumni of Distinction Award and most recently the Merck Patients First award.

Howard: It is just a huge honor for me today to be podcast interviewing Dr. Les Kalman, Bachelor of Science BSC DDS fellowship of the American Academy of implant dentistry he's got an AA in front of that associate academic fellow and a diplomat in the International Congress of Implantology he's an assistant professor, restorative dentistry coordinator dental outreach Community Service, president of research driven Inc. He completed a BS and DDS at Western which is a dental school in London Ontario followed by a GPR at the London Health Science Center. He maintained a full time solo private practice with an emphasis on digital dentistry prosthodontics and medical device research while continuing hospital privileges at stratify Middlesex general. His research was supported by the scientific research and experimental development fund and the National Research Council. In 2011 Coleman transitioned to full-time academics as an assistant professor and outreach coordinator, his research focuses on medical devices and technologies relevant to clinical dentistry. He has authored close to 40 articles holds two patents and has translated two technologies. Dr. Kalman maintains his position as the founder and president of research driven he's an active member the Academy of osseointegration the International Congress royal ontology the standards Council of Canada and serves on the board of directors for the University of Western Ontario Faculty Association and the Canadian Association of Public Health Dentistry. He has been recognized as an academic Associate Fellow a AAID fellow Master diplomat of the ICO I has been awarded the Schulich alumni of distinction award and most recently the Merck patients first award. In a spare time Dr. Kalman enjoys time with his family photography and bikes my gosh it is such a huge honor to be on the show. I've been going to your websites and watching YouTube videos at research driven Inc I mean it's almost like you're a Jedi Master in some Dental Star Wars show.

Les: Well I wouldn't go that far Howard.

Howard: It's some heavy stuff you guys are working on salivary diagnose technology and when I got out of school you know the only thing digital the first digital advancement that I thought was the greatest saying the world was the automatic garage door opener because every time my mom pulled up to the home I had to get out and lift a wooden door that weighed more than the house and now it's digital dentistry, 3d printing, 3d printing and metal. So my gosh what has got you excited about?

Les: Oh man I mean I just have a huge passion for the profession you know always have so it's really fortunate how things kind of worked out we're a transition from private practice into full time academia. I mean I'm surrounded by a great team I got a lot of colleagues and now is a really exciting time in dentistry things are moving fast you know innovation is moving at lightning speed we can't always forget those fundamental principles but it's exciting there's so much to do so much to discover so much to improve upon I mean sleep gets in the way.

Howard: I mean when these little kids tell me that they love technology and they love all things you know Apple and their Mac and I said well man if you love digital if you love digital you didn't you need to go into dentistry because it's going from yeah I mean it's going all high-tech but I got it I got to tell you the dark side it this is Dentistry Uncensored a lot of these kids come out of school in America from private schools that cost $100,000 a year and they say come on last time $400,000 of student loans if I buy a CBCT, a LANAP Laser  and a CAD CAM, I just double my student loan debt so they're always wondering if you're $400,000 in debt does any of this technology is that bleeding-edge is that leading-edge does any of it have a return on investment so someday they can pay off their student loans?

Les: I think you hit the nail right on the head to return on investment you know if you're talking to a new grad I think the important part is to work on your skill set it takes a number of years to really tune those in. So again back to fundamentals principles work on patient communication work on learning your skill set learn will start working on treating every patient like they're a family member and that skill set is just gonna be honed right in. You know technology is very very challenging you don't want to you know dump in for a 5-10 year loan and have that unit sitting there so it really depends on where you're practicing what kind of patience you're working on and how much you're gonna utilize it you don't want to use it as a coat rack in the corner of your office and then you got monthly payments going on it. So students got to be really diligent new grads have to be really diligent maybe the best idea is for a multi practice clinic where they share costs you know and get into it slowly. The key that I find if someone's going to get into digital dentistry is to make sure that it improves the experience for both the patient and the clinician.

Howard: Well said and that is what it's so funny because so many of these people that are so anti DSO's and all that kind of stuff are the ones telling everybody they should have a CEREC machine 140 a CBCT for 100 a LANAP Laser for 135 a Water Layes for 135 and it's like and that is what drove group practice and medicine I mean when they started coming out with MRIs and cat scan well you can't buy an MRI for a solo practicing physician you had to share that with a group. So when I talk to healthcare economists they say what drove group practice more than anything in our physicians was to share the technology and that's what you're saying that with this shared technology that you might need to buy this and have several people use it.

Les: Yeah just step back and look at the numbers you know it's just arithmetic so you know my oldest is talking about buying a car great let's sit down you know let's talk about how much is the car what's going to be the insurance what's going to be the gas and how much is it gonna use it you know we didn't have a little burr back in our day so if he needs to take a hundred ubers a year and he's saving half the money by doing that then maybe that's the economical really he should go at I think clinicians going to do the same way they need to be really diligent about what they're getting into what whether it is a CBCT machine or whether it is a five year subscription to an implant company make sure that you're not buying in for the sake of buying in that it's a pragmatic decision.

Howard: and I recommend lift over uber you said uber but lyft is about 80% of the drivers are women so who would you want to pick you up and give you a ride somebody look like me or some woman. So I and lyft is gonna do an IPO so what technology do you think is here today that will show a return on investment I mean is it oral scanners CAD CAM CB CT what do you think is the buy?

Les: Oral scanners adding digital impressions I really do it's just again for students because I'm in academia or new clinicians there's that learning curve you know if if you and I are going snowboarding and your work last snowboarder I might not hone those skills in our first afternoon session together you know it's gonna take me some time so just there's a learning curve to it and then they have to find a way to implement it into their practice you know. Back in our day we had the E4D so I'm dating myself but that had to be done in a certain particular way if you were doing same day crowns on individuals the workflow is completely different you know you're scheduling is completely different. So again I recommend to young clinicians try to you know book a book an evening with one of the reps at a dental company try it out, see if it fits know that you're gonna have that learning curve. If you're in the implant world yeah I think CB CT is so important I mean it's almost regulatory in some areas so I think that's critical after that you just got a look at your time and see what improves the experience what's gonna save you time time is money in dentistry something that's gonna give you increased predictability but again I can't stress do not forget the fundamental principles. You know I don't know how many times I bumped in to a colleague somewhere tell me a story where I had this great implant click case and the surgical stent is printed and they tried it in their mouth and they had trismus and they could only about open about 25-30 millimeters so just remembering the workflow and that technology really just improves it, it doesn't it doesn't correct it that's the key.

Howard: You've been involved with the standards Council of Canada or do you think CB CT is the standard of care with them as far as placing an implant? How does the standards Council of Canada view that decision?

Les: You know they wouldn't what they're looking at is making sure that if you buy a unit that all the standards are the same and I believe that CBCT is standardized so whether you buy X or Y the quality of the image is standardized that's the key there they wouldn't comment on whether or not a profession would make it to standard of care that's up to our regulatory so by no means do I want to speak speak for our regulatory our CDR so I think what they've done is they presented guidelines that really puts the onus on the clinician saying you need to take adequate records to make a reasonable decision and diagnosis in your treatment planning and that way each clinician kind of gets to pick what they need to do. We know that dentistry is patient specific so instead of setting out just a black and white standard you get to make that decision.

Howard: and I just want to say to all my homies who have so many opinions on different countries never been there I've lectured in Canada a hundred times the last 30 years I think so here's the cheat sheet on Canada it's basically California they're both the same size they both have the same number of people the same GDP the same number of dentist the only thing different in Canada the United States is they have the highest percentage of PhDs of any country in the world they're just smarter more intelligent so if Canada says do this you listen to Canada you don't listen to where I was born in Kansas that still teaches evolution I mean they're just really really smart people and Canada did the single greatest move in my lifetime when the when the lease on Hong Kong expired and you had all these self-made millionaires and billionaires they all wanted to leave Hong Kong before return to China the United States you know they've been anti-immigration since the Bolshevik Revolution of 1917 when they closed down Ellis Island and Vancouver said hey come on down. Oh my god it seems like every single person that came from Hong Kong to Canada brought with them degree a lot of money alot of skill sets I mean I just think in fact if you asked me what my favorite city in North America is its Vancouver British Columbia I mean it's just a rockin hot town. Back to what I like about oral scanners maybe I'm biased because I'm old I got five grandkids but when I scan orally I get to see my prep 40 times larger and I don't know if it's affects Millennials the way it does because I don't remember what it was like to look when a tooth when I was 25 but man when you see your prep 40 times every time I see my initial prep and I go to scan it I think my license should be taken away. I mean it's just a horrific embarrassing time and then and then you're grabbing for sandpaper discs and n cutting bur you're trying to just salvage is prepped it looks like Stevie Wonder cut the whole thing and same thing with loops I mean I go into dental offices and the dentist has loops but as hygienists and assistant dozens like anybody working on a human I mean magnification is just the lowest hanging fruit to increase your quality. Do you agree?

Les: Yeah I mean I grew up with magnification right from dental school so that was a given but absolutely I mean when I remember scanning our first preps with the E4D and now you see it on a screen that's what ever was back in the day 14 by 16 I had to go back and go you gotta be kidding me I mean it looks like the Grand Canyon that's not a margin and it really does change the way you prep a tooth. You know you know that's an interesting topic you mentioned there because the key again when I'm you gotta remember most of my time is with senior dental students third and fourth year the second you pop it under magnification it just goes off you know they see it it's right there you know they can they can assess it and see but a lot of them don't know that you have to evaluate it like that whether it's the prep for the cast so again when we did our little digital dentistry elective with the students that's one of the things that came out is does my prep look like that and I think it's important I think it's important to realize that you might have to change your delivery of dentistry for the modality that you're going down.

Howard: and the number one cause of endo failure is just missing a canal or missing a bunch of material you didn't reach the tipping point of debreeding it enough and all the great ended on us I know they all have a $25,000 the one out of St. Louis Global microscope and they're only using an 8X but they say once every day or every other day they're doing a molar every hour they go to just check it before they operate it and sure enough there's a canal they missed or they thought everything was cleaned in one of the canals still has a bunch of stuff in it and so this magnification is everything. When you were doing this CB CT and you were using e for D and the big one is Dentsply married Dentsply Sirona got marry they have the CEREC machine you know all the people teaching sehr ax say you know they think and preps can mill and deliver in an hour but I just never saw that in private practice how long do you think the reality is when you decide instead of taking an impression and sending it to a lab or an oral scanner and send to a lab  but just to scan and mill it out and do all that in the office so how long do you think that appointment is?

Les: Longer than an hour Howard. Yeah I have to agree you know when you get to the milling you hope that everything moves properly right you hope that the communications area you hope that the prep comes out you know I hope the birds don't collide but then when you get to the staining and glazing that might take a little bit of time so we didn't offer that workflow that often in our office we really like to prep provisional eyes do our work and they bring the patients back. Again if you're a GP and you're doing General Dentistry and you're seeing kids and geriatrics and you do an endows and you're doing removable that workflow is very very challenging I found it anyway to implement okay because things do go sideways and schedules are tight and you're first available is not for a season away and it just brings another layer of stress that we weren't ready to deal with so a lot more than an hour that's for sure.

Howard: and what I don't like is the emotional commitment so if Les comes in my office and I've spent two and a half hours on a molar and I go to deliver it and it's just not quite right I don't have the guts to tell Les, Les this isn't perfect and so you just think oh my god I can't tell I'm just I'm just gonna cement it whereas some someone comes in for a crown seat on those. When you talk about oral scanners it seems like the winner of that game is three shape out of Copenhagen Denmark with their trios I know Align Technology owns Invisalign owns iTero, 3m which is very close to where you live in Minneapolis St. Paul they own true def which oral scanner do you think is better than the other if they're listening right now and they're say come on guys which one would you recommend?

Les: Oh boy I would recommend the one that fits your needs how's that for a nice diplomatic answer

Howard: Are you running for politician of the year?

Les: I am not but you know it's it's one of those ones where if you like all the bells and whistles and you can afford the heated seats and all that stuff go for it again just make sure you utilize it make sure there's no surprises you know are there export fees monthly subscription fees that kind of stuff make sure that it's still keeping you profitable. On the flip side if you want to enter into the world of you know digital scanners and try it out you're not worried about color and all the bells and whistles and maybe one that's less expensive that's a little more affordable get you in the door and then again you hone your skills you refine your craft and then you go back to the market and see if you want to upgrade it so that's that's kind of my angle.

Howard: Do you think the fact that the 3m true def needs powder do you think it's a big deal or do you think that's because you know all the people competing against them are gonna say ah well you cannot use powder do you think the powder with the true def is a big deal or do you just think it's what the 3Shape and Invisalign and iTero people are just gonna say?

Les: I think it's if it fits a big deal to the clinician of the patient then it's gonna be a big deal. You know it's a pretty simple side procedure step you know they've got some studies on it's just titanium dioxide so we're not really worried about things too much takes a reflective coating off again, I'm not I'm not advocating for them what I'm just saying again it just blows out how busy you work you know if you're seeing 60 patients a day in your whack and out crowns and bridges left and right then maybe that little detour is just way too much for you and if you're a comfortable GP and you have a good balance it might not make any difference if your patients aren't too concerned and they trust the literature that I don't think it'd be a big deal.

Howard: Yeah I just think I'm every single laboratory I know says that when they were working with the dentist for a decade and that dentist was averaging 5 to 6 percent remakes when they started doing oral scanners it dropped to 1% I don't know if that's because the magnification that Dennis just made a better prep but gosh I mean think of think if you bought went to oral scanning in four out of every hundred crown seats weren't a reom press and I mean that that that alone that you want to buy it wouldn't it?

Les: Win-win

Howard: and all my all my friends in Phoenix and when I say friend I mean an alcoholic that likes to go drinking with me watching sports games and eating cheeseburgers, the only thing they use their E4D or their sauna for is the scanner I mean they just they just start scanning and the ones that do mill it out you know what they do they mill it out that they scan it and then they temporize it and then at the end of the week they have a lab tech come in their office and mail out all the crowns they did for the week to cement the night but none of them are doing it in the office. 3D printing is that is that what you know is that five ten years down the road is that bleeding edge or leading edge wears 3d printing out and 2019?

Les: I think is now yeah this is happening this is this reminds me because I have a little bit of experience in photography this remember when the digital cameras came around and we're talking about the film users are saying ah this is this is a fad it's gonna come and go and look what it did I have the feeling it's gonna have the same impact. You know everything that you and I have learned about in terms of our preparations material thickness how much we have to reduce something was based on those prosthesis based on the manufacturing process can we agree?

Howard: Yes

Les: If if 3d printing is gonna give us what we need with a whole different set of physical properties that might really change how we go back and prep so we're fortunate enough to work with a wonderful company called the Adeiss they're just outside of our university gates and their house a couple and they house a couple of Renishaw printers so we've been fortunate enough to work with them and our little research approach we're investigating 3d printing a novel dental implant abutment. So we can appreciate that the dental implant abutment is just so tiny and minimal and how can we do it we've just got some of the preliminary data back and we are absolutely blown out of the water with some of the strengths that this material has. So again just digital workflow that we've been used to in dentistry that's really taken over but now your output is different we're doing it with the additive manufacturing the exact opposite of what we've been doing for the last 20 years with CAD CAM throwing away 75% of material that we didn't need and very exciting I think it's here I think it's here to stay. It's funny mention that I'm going to be chairing a 3d printing conference in Amsterdam in September and we're putting together a real interesting host of speakers bringing in lithos to talk about ceramic 3d printing I'll be talking about 3d printing in titanium and anyone interested reach out to me but just a really fun Avenue that I think is gonna have a real impact.

Howard: So what are you excited about in 3d printing what is it is it fillings crowns impressions surgical splints what is um got you excited?

Les: Fillings yes I'm pretty excited about the fillings to see if we can get you down in new material. Dental implant abutments absolutely ok new avenue for production. Anything that gives us a patient specific dental device excites me you know we can really get dentistry into that patient specific spectrum and just the workflow is when you have a workflow it's so accommodating you know you try something you print it out if you need to tweak it you just go to a screen it's like adjusting a photo in Lightroom it's so it's so fun and it's just a nice workflow so I like everything about it.

Howard: When you're looking at 3d printing they're also starting to do that with metal.

Les: Yeah so this is the one we're working with we're actually printing in titanium

Howard: Printing in titanium

Les: Yes

Howard: So that's for the is that for the implant or just the implant abutment?

Les: Implant abutment so you can appreciate how tiny we're talking about.

Howard: I remember when I was lecturing in Copenhagen like oh I don't know 15 20 years ago maybe was 10 years I'm not sure and I was with them they said well what would you like to do with this and I said well after I extracted tooth I'd like to scan the socket and back then I just know if CAD CAM and I said and mill out an implant set up and so you know I pull up this three root of tooth and then I have to place an implant that's a cylinder and how do you think that's how far away is that from extracting a tooth because you wouldn't even need a CBT if you just extracted the socket and then CAD cam printed a titanium custom implant.

Les: You still probably need your radiographic data so that we can design and mill something socket specific, I don't know. You know whenever you talk about new technology it's not always what's better it's also what industry is ready to bring on you know so that's that's a tough one. Is it possible absolutely is it predictable most likely will it revolutionize things I don't have the answer to that.

Howard: You're also involved with the Schulich medicine and dentistry dental research at Schulich medicine and dentistry you're on their video on YouTube, what is that?

Les: So we are faculty of we have a School of Medicine and Dentistry so medicine and dentistry are together the Dean of Medicine oversees the entire school we have a director for dentistry and that's our that's our academic unit, so that's where the students go for dentistry that's where I teach and we're fortunate enough to have some very amazing research facilities to work at.

Howard: and you're also the director of outreach social responsibility. I tell dentist all the time that the United States there's never been a dentist who's and the president executive house or the judicial supreme court but there's four dentists who are in Congress right now one of them I went to Creighton with Paul Gosar Creighton University from Flagstaff Arizona laughs there's another one from Idaho Texas and when they when anybody's talking about dentistry they're always talking about is it available is it affordable. So what are your thoughts on social responsibility and what are you doing with your outreach program? Is dentistry available and affordable to 38 million Canadians?

Les: Short answer no that's the short answer so again we're a little bit different south of the border north of the border you know we kind of have universal health care we're aware that but dentistry is still a fee-for-service okay, there are social programs in place all right there's some for kids there's some for veterans there's some for different economic groups but there is still a large chunk of the marginalized population that can't get access to care so you know you're sitting there with a sore throat I'm sitting here a little bit tired you know we're trudging through imagine what it's like sitting there with an abscessed tooth now for three months that's killing you that you can't eat or drink you wouldn't be sipping your drink and you don't have enough money to go to the dentist to get it looked after in fact you haven't been in ten years and you don't want to go so how do we reach out to that population and that's kind of what we do with my dental outreach the program's called Docs and we really service that population that has no other opportunity so lower income limited access limited funds and we provide them dental treatments. So we actually go on in the community we pack up a truck we drive to a community agency pick one Salvation Army Boys and Girls Club we'll set up a small mobile clinic in that facility and then we're gonna invite those patients that have having these problems then in an area that they're aware of and we meet them we greet them we diagnose the treatment plan them and then we make that connection and then we say see you later and we invite them back to the dental school and we deliver treatment and that's what we've been doing I've been doing that now for about eight years the poor Stane years old and it's been amazing has been very rewarding.

Howard: You know it was Winston Churchill after war ii that said we're not gonna build a great country if everybody's sick and uneducated. So the first thing he wants to do is get everybody well and you're so right I mean in America there's about sixty to eighty thousand personal bankruptcies a year and the number one cause is health care. Winston Churchill also said that Americans will always do the right thing after exhausting all the alternatives and you're up there with socialized medicine and I know my homies I mean I've lectured a thousand times in America and when you say socialized medicine they're gonna just they're just gonna they're gonna shoot you. So what so you're one of their homies you're a dentist you're like them do you have a different view of socialized medicine than 80% of all the dentist listening to this podcast in America?

Les: Maybe I just have a different connection you know it's... here's the deal I grew up you know with single-parent family and we were marginalized so maybe my exposure my awareness of problems that face those populations is a little more personal okay and being able to give back to the communities that I grew up in is very rewarding you know, even even a private practice let's not talk about dental outreach let's talk about private practice we made it kind of our mission to see you know a dozen patients a year that couldn't out afford treatment and we just deliver treatment to them you know whatever the reason was if they couldn't meet their needs, everyone has a story everyone goes through hardships it's nice to give back we have that ability and we've made some absolutely fantastic friendships over the years. So for me there's definitely a personal tangent you know it's rewarding and it's let me tell you it's really heartbreaking to bump into a classmate from public school or high school and you're providing treatment and they're getting treatment you know just open your eyes that not everyone is at the same level and it's nice to give back.

Howard: You know I when I grew up in on you know I went to Catholic you know school from first grade to end of Creighton University and my favorite nun was my tool the sisters are Catholic nuns and my favorite gnome was Mother Teresa Calcutta and I always thought that the one insightful thing she would say is that a lot of times Americans think well it was this idea you can't help everyone and Mother Teresa always say I don't care if you can't help everyone help one and if you have extra time maybe you can help too but you don't but when you start thinking in absolutes people just throw in the towel they say well you can't help everyone well just because you can't help everyone doesn't mean that you can't help one person and yeah it's I'd say that is such an emotional issue. I don't know why that is such an emotional issue because when I go to the greatest civilizations like Canada, Japan, Australia, New Zealand, Denmark, Sweden, Finland, I mean just the greatest countries in the world they all provide basic health care for their people because. I was reading a story here in Arizona where this some guy was a cutting palm trees in Arizona fell out of the palm tree hurt his back and a year later he still couldn't get out of bed because he can't afford it and well you don't you build a great country if your buddy can't get out of bed for a year and there's a treatment for that the end whatever you spent on his treatment I'm sure he would pay back in tax dollars eventually because his economics but I don't want to but I but I know it's emotional and I don't have a single dentist friend in Arizona who agrees with your system on that deal. I mean I'm just none of them agree it's just so emotional. So I want you to switch your since you're in dental school and you've been watching graduates come out and since all the old people like me read textbooks and all the young people read digital digital books so all the podcasters are pretty much millennials, in fact shoot me an email and tell me how old you are do you know what it's gonna be it's gonna be 30 and under and or if you watch this on youtube put a comment in the comments afterwards and thank you so much for the 10,000 people who follow this show on YouTube under on dentaltown but what advice would you give to dental graduates what patterns of success have you seen with graduating classes where dental graduates do better five 10 years out of school since you've been in there versus other behaviors that don't lead to success?

Les: So what advice can I give to new grads ah I have to step back and just say take your time have some patience you know there's this this rush this formal let's get going let's get moving. Dentistry is very different I think any time that you're using your hands to deliver treatment everyone has a different skill set and you know dental students are brilliant students okay it's not easy to get into dental school so they've done really really well in high school they've done really really well and undergrad and they're probably doing really well in dental school but some things will take a little longer than others to have that skill acquisition. So take the time you know take the time with working on ce to complement what you need to fill in the gaps where you're lacking have a mentorship program with a few dentists to see where they're at what they've done you know don't dive into life head first so that you have a million dollars that there's no reason to buy your practice right away and get married and have two kids and a dog take your time it's a very very enjoyable and rewarding profession but you got to live within your means. You know I had the benefit of back in our day in dental school we had two weeks where we could shadow observe assist whatever you want to call it some of the specialists in town. So I'm in fourth year so I'm thinking I'm you know I'm God's gift to dentistry at this point I'm probably taking you know six hours to do a crown prep and impress and I was invited to watch Dr. ken Hebel who I think might be living in Arizona right now and I watched an, we had a chance to go to his I had a chance to go to his office and watch him prep impress and provisional probably eight or ten units in the maxilla in about two hours and change and let me tell you didn't ever change my perspective on the profession. You know I knew that you had a specialist that was top in his field and I could see what level he was at and what it did is just raised the bar for me and let me know how much higher I had to reach and I've done it with everything that I've done you know whether it's implant dentistry prosthodontics digital dentistry find a good mentor connect with them and try to follow those steps there's no quick fix there's no you know checking the box faster than you can take your time and enjoy it.

Howard: and he has the hands-on training institute right here in Scottsdale.

Les: He does so I've been fortunate enough to be in that back in the day I'm dating myself here the 90s but amazing so I really respect Ken Hebel and I really respect what he does and I've been fortunate to you know work with him and watch him and just new grads need that they need that.

Howard: So are you still buddies with him?

Les: We might shoot an email here in there you know but no we don't we've drifted you know he's moved up outside of London so I don't come to Arizona that often to be honest with you.

Howard: Well statistically I don't know if you know this but 10 percent of the homes in Phoenix Arizona are owned by Canadians it is if you're east of the Mississippi River you go to Florida and if you're west of the Mississippi River or Canadian you come to Arizona and I mean my gosh and it's funny because most of the Americans don't fly the flag when they're here but maybe a couple holidays but the Canadians always fly the Maple Leaf it's because it's a social deal it's letting all the other Canadians know where you are and they're just they're great people and my gosh and a lot of them a lot of them when they come down for the winter do not fly because if you've ever driven from like Edmonton to Phoenix it's a thousand miles through Idaho and Utah the Grand Canyon and the first time I ever drove to Canada I packed up a I bought a su an RV put my four boys there I think they're like ten eight six and we drove up to Edmonton and it was like you thought you were on another planet half the journey. So if you're Canadian you'll be living here eventually someday so you and Kenneth will hook back up someday yeah. So what'd they do on the real estate is it's all it's all based on that the u.s. dollar - the Canadian dollar and whenever the Canadian dollar goes up and the American dollar goes down they all pour into real estate down here and then it reverses it'll be on slow but right now it's it's about 10% so which is just amazing. So I gotta ask you I'm that the two things that I like when I look at patterns of success so many when you go to countries like Japan and France and England where the government reimburses you solo for a filling that you can't hardly do fillings exams cleanings x-rays but all these countries don't set fees on implants or ortho so when you look at the most profitable procedure it's always the implant part of the business or then and the orthodontic Invisalign and you are a little you have so many credentials in implant dentistry so what would you say to a new graduate, I've always said they should add a new specialty at least every five years and what specialty would you recommend they add first out of dental school and they get their skill set up of doing fillings crowns and then they're getting you know their patient skills and they're starting to hum along would it be implants or ortho Invisalign or implants which one do you think is the better return on investment?

Les: You got a biased guy here I gotta go implants you know and it's uh it's the gold standard or replace a tooth I don't usually use the term gold standard but I think it's a gold standard but this science is just moving so quickly you know there's so many advances and you know a lot of geographical locations are really changing their guidelines from regulatory so we have that now where if you're gonna be restoring implants you need a certain amount of CE and if you're gonna be surgically placing them you need a certain amount of CE. So until dental schools kind of keep up with what's current that's definitely what I'd recommend.

Howard: and then they're gonna ask you I mean right now as we speak the IDF meeting is going on in Cologne Germany and you don't even want to know how many implant companies bought a booth there this week we have the editor of dentaltown magazine there right now and Tom Jacoby and I mean there's almost 400 different companies. So she's driving to work right now and she doesn't want to go figure out 400 different companies she wants to know what company do you recommend and why?

Les: Well taking my diplomatic stance Howard you know what I say is get involved with an organization first forget about the company join an organization you got so many good ones to choose from you get AAO you get the ICO I which I've been a member for almost 20 years now that I think is so worthwhile join join one you know get to network get a few mentors see what's out there when you go to these conventions conferences for instance the ICOI was just in Phoenix you're gonna have a ton of implant companies there, they're gonna have their surgical platform that's so they're restorative platform go ask questions try things out don't always look at the cost factor look at something that's predictable that has a lot of studies behind it but maybe if for you know the restorative dentist the restorative platform that's nice and easy. So get out there check ones out see what fits your needs and then make a decision you know dentist are smart people.

Howard: I got to tell you a funny story about that meeting it's got so I wasn't even thinking about that and I decided me and the president or company Lori we're gonna go to dinner and we went there and didn't know that meeting was there and we hadn't even ordered appetizers and every five minutes some dentist walking over to her table saying oh my god you know it was so much fun, there's so many meetings going on all the time, you just don't even know where they're all going when they come out of school they want to get an associate job well there's two types of dentists in my mind there's the ones who love blood and guts like me you can even see it in their endo when they do a fill they want to be apical barbarians get to the very end and get a puff of sealer out and then you've got the people who are you know light and fluffy they like bleaching bonding veneers they respect the last millimeter of the canal chamber and their pulp lovers I call them. So if you're a pope lover and you want to do bleaching bonding veneers and and Invisalign that's a business model but I guarantee you the blood and guts dentist that can do molar endo extract a painful tooth and place an implant those people build practices on average twice as big as the pulp lovers. So are you an apical barbarian when it comes to endo and like that puff of sealer or are you a pulp lover and what to respect the last millimeter?

Les: Well I did GPR I did a GP under two amazing oral surgeons we did hospital dentistry I maintain hospital privileges so I think you know I really enjoy surgery. You know it's funny I enjoy both ends but I definitely lean towards that and I think you made a really nice point you know, if we talk about what new grads you probably can do it online now right in five more years you can do everything online but if you have a colleague referring a friend to you for your skill set those are the best practice builders that will never go away you know people tend to see people for what they can deliver for their touch for their bedside manner for their fit and I think that's an important part of dentistry that we can't forget.

Howard: I want to talk about something else a totally different subject, you know the American Dental Association recommend recognises nine specialties and everybody wants to talk about the orthodontist oral surgeon the pediatric no one wants to talk about public health dentist and nobody ever talks about dental school instructors now that I'm 50 I'm class of 87 I've had two classmates of mine after had the most amazing practice for thirty years a st. Louis Becky Sissel decided you know what might I'm gonna go to teach and then now Brad Gettleman who was single-handedly the greatest endodontist in Arizona for three decades decided he'd rather go teach endo what was a like going from private practice to teaching the next generation what made you go back to dental kindergarten and decide you wanted to babysit the kids?

Les: This uncensored?

Howard: Yes

Les: You know this is a real I have to meet you one day it's real interesting story how this precipitated but my private practice I really enjoy treating patients but we started doing some research and believe it or not the research part was going really strong it was a lot of fun and so we had a real interesting balance I was one at one of the few dentists and I'm not trying to toot my own horn I was just a workflow and so the opportunity to go to dental school primarily was related to some of the research that I was involved with so that that was a nice stepping so that was always nice. The second part Howard is back in oh three I did some outreach dentistry in Ecuador and again it strung a real good nerve and I came back and did some some public service announcements and saying how we should do it and when the school was looking at outreach I think my name came to mind so I was there but returning to academia from private practice first of all hats off to all my private clinician colleagues because that is a day of work we forget what it's like okay you come in you start early you work late you squeeze in a bathroom break it's busy busy busy. Academia is much more balanced and it tends to come in in different waves you know but it's challenging it has its challenges too you know. Generationally I'm starting to be a little disc active from the dental students so you know I try to stay young and and try to be a prawn figure out what things are watching and what things are doing incorporate them in the teachings and they have their unique challenges of getting into dental school getting out and then practicing so it has just been such a challenging yet rewarding approach that I never thought it would be but to have an impact on dental students and you bump into them at a conference so their email you and they remember that tidbit that you told them it's pretty unique. You know dentistry is wonderful you get to improve people's lives through you know delivering treatment but dental education is for the ones that it fits well with it's amazing.

Howard: I want to switch gears completely because humans are visual animals all the apes and primates are visual and they see they they understand with their eyes and birds and reptiles are sound I mean when those birds set up in the canopy and they hear all those chirping that makes sense to them it doesn't and when you look at the average dental website for every 100 people that go to the website only one to three convert and call the office but who's converting the most people from website to calling is if I'm gonna go to your office because I got a loose denture and I'm thinking about implants I want to see your photos of your work on your website and you're an accredited photojournalist, what did versed of all what is a MotoGP photojournalist and what advice would you give some kid because when people start by talking about technology the cheapest piece of technology you get is a digital camera and put your own work on your website and by the way I want to tell you on dentaltown the dentist reviews that has photos of is before and after implant cases or braces or whatever and it says this is this is Les's own work I mean they have people jumping on Southwest Airlines in flying from Parsons Kansas to Oklahoma City so tell us what is a MotoGP photojournalist and what advice could you give some young dennah that needs to start photo documenting their cases from silver fillings to tooth colored fillings braces implants what is the MotoGP photojournalist?

Les: Okay did you see that there you see it oh yeah see MotoGP is the pinnacle of motorcycle racing so these are the guys that go around tracks when they swing their leg around their bike to risk in their live every race and they're going anyway up to 350 kilometers an hour we're going around these tracks okay and they go to different tracks you know they had just one in the Middle East they're off to South America they'll be in Texas for that one so that's MotoGP so the pinnacle of motorcycle racing so I'm a motorcycle enthusiast and over the years I've had the opportunity to be an accredited MotoGP photojournalist which was you know kind of a life one of my bucket listers. So I get to go to these races and photograph these amazing riders and interview them and do stories and just kind of complement my other portfolio with this I mean it's a passion and I love it. Now it's not easy taking these photos I'm gonna be honest you need the right gear okay these guys are going fast you got a second to get an image you gotta edit your photos you got to get them off to the editor it's a whole different workflow but it really sets the tone I see that if you're gonna be taking images of a patient that's not moving that's static that's laying there you can really tell your colleagues that it's not difficult to take images of dental things. So I'm with you 100% on I think dentists need to document things digitally so the one thing they should do is probably stop taking photos with their iPhone and just buy a camera buy a mirrorless camera get a mirrorless camera yeah. You know and the reason I say that it's everyone everyone's taking photos with their iPhone I do the same but when we're talking about patient cases we're talking about records and we're talking about security and we're talking about privacy and what you want to do is you want to get a dedicated camera where you take those images and they're not clouded and they're not on your device so that if you leave your phone out or someone gets hacked people are not seeing that Jim's wearing dentures okay we don't want to know that. So buy a dedicated camera and just like we talked about just work on your craft start a little mention so.

Howard: Give them an exact name of a mirrorless camera to buy give him a name

Les: I'm a Canon guy any Canon mirrorless EOS m will work any of the EOS families will work you're talking anywhere from while go Americans since we're u.s. dollars probably three hundred to fifteen hundred US dollars.

Howard: and I'm telling you that you know that everybody's convert first of all when I go into a dental office they don't even know what their conversion rate is they have no idea how many people bounce off their I mean if I was in London Ontario or if I was in Toronto and I searched dentist in Toronto how many would Google serve me up?

Les: Alot

Howard: Yeah so you don't understand that I want to call I want to talk to your dentist so I call them up and it goes to voicemail well I'm not gonna leave a message I'm just gonna call the next dentist and then when they go to your website if I want a certain type of Dentistry I want something I want to see I mean we got to build trust you're selling the invisible they know the iPhone is but they don't know if you know how to straighten teeth or do bleaching bonding veneers or place the implant and by the way when you're doing these cases don't think like a dentist I mean when you show a before and after implant case on grandma they don't want to see blood and gingival and patellas they want to see her happy you went the before picture where she's a little stressed or scared or not sure and then the after she's just beaming and that big transition is what secretes the dopamine and serotonin get a Canon mirrorless camera. Okay just for the person I got a Canon mirrorless camera what does a mirrorless camera as opposed to a camera with a mirror?

Les: You remember the big metered cameras we've been used in with the lenses and the ring flashes are like this babe we've taken the mirror out of it so it's a lot more compact it's about as thick as maybe two iPhones together still has lenses that are interchangeable but now the back of the camera is just like any iPhone where you see what you're shooting in live and most of them are touchscreen so you can press where you wanted to focus so the operation is just so simple.

Howard: Yeah and I was lucky because my dental assistant for 15-20 years I'm Krystina she just loves photography and she got into it as like a first it was a personal thing than a private deal then she started taking glamour photos for her friends you know events or whatever and it's really nice when you can get one of the wet hands and if it's not your thing maybe you know this is something that someone else in your office wants to do maybe one of your dental assistants and what would if you offer this your dental assistant do is there any online training or any training to learn how to use the mirrorless camera or do you just recommend trial and error how would you...?

Les: There's so much online I actually teach a course both in and outside of academia it's like a two-hour hands-on that we go over and talk about the different workflows so shameless self-promotion but that's something I do but there's lots out there as well let me reiterate one thing you said though our and that is you have to show cases that you have completed if they keep using stock photography for things everyone's everyone knows that okay anyone can just download an image from Google Images but if you show actual patient cases and you show what you can do when the results you achieve you're right people are gonna jump on planes to come and see you.

Howard: Well tell you what if you want to fill up your hands-on classes you should create an online course for dentaltown. We put up four hundred and seventeen online courses that cost about the price of a lift and not uber a lift with a really really beautiful woman and you know they're like thirty six bucks in the 20 richest countries and we don't charge in the poor continents of the developing nations but man if you put an online CE course would you ever consider doing that?

Les: Damn right I would

Howard: Oh my god Millennials love doing it on their iPad their iPhone or whatever and it's the best marketing for for you because if they what look at that course and they want more now they're turned on to you but again I cannot say when it comes to marketing most of what everybody talks about has nothing to with marketing what marketing is first of all is 39% of your calls go to voicemail there's a hundred and sixty eight hours in a week you only answer your phone 32 hours so you're missing so 39% of your practice got it got a voicemail and went somewhere else and then the bounce rate. I mean if your bounce rate let's say the bounce rate off your website so you have a really really good website and three out of a hundred people convert well you got a digital camera and took an online C course and got that to 6% to convert you just doubled your entire practice and when you sit there telling a patient that she has that interproximal cavity he's gonna needs endodontic therapy and a post build-up and a full cover dress she has no idea what you're talking about but when she sees a before and after picture crooked teeth sad smile teeth. I mean you know and it's the same thing with patient reviews you know people get annoyed when you say Oh will you leave an online review on for our website don't do that wait till they say it say something and then say oh my god I wish instead of hearing you say that I wish I was reading that on our Google review our facebook reviews anyway you would say that again on an online review because that's social confirmation but they want to see your own work and they want it and when you have picture so that camera man this podcast if I'm gonna online see course I do you on digital photography I just hit a home run that is that is amazing. What did you want to talk about that I wasn't smart enough to mention?

Les: No you hit you covered it all you're the magician.

Howard: Well all I want to say is about that motor spur when you said they were going 300 kilometers per hour, I'm just when I might not be your mom or your dad but you should never be going 300 kilometres an hour on a motorcycle so I think I should go to Canada and give an online course of all the reasons they should stop doing that that is just you remember that when you look at climb Mount Everest and you see all those corpse those were all once some of the most motivated people on earth and now they're just décor on the side of the trail. That's a crazy I I love it when they're going around the corner and they drop their knee and they're sliding their knee on the ground.

Les: They do their elbows now.

Howard: Oh my gosh it's like what crazy lunatic and thought of that first.

Les: You got experience when you got to go to Texas and see Circuit of the Americas it's up in April but check it out.

Howard: and then I also have to ask you how can you morally ethically be a dentist in Canada and love hockey it isn't hockey the most anti dental sport on earth, every time you see a Canadian hockey team and they panned the bench I mean everybody's missing half their teeth can you can you love hockey and be a dentist?

Les: You can love hockey and be again yeah absolutely

Howard: Seriously it was just a huge honor for you to come on the show today you have so many credentials from A to Z everybody loved listening to you. Les Kalman bachelor science DDS FAAID diplomat International Congress oral implantology and look for his next online course on digital photography and go out biggest takeaway go out and buy a Canon mirrorless camera and when you get out of school remember when you get out of school it might take a year or two to really get a good photo documented before and after case of an amalgam to a composite crooked teeth after Invisalign replacing a missing tooth with an implant because I remember when I got in digital photography you thought it was a good case until you got the pictures back and it's like I mean when you're starting out how many before and after cases do you have to do photo document in your first 5 years out of school before one of them is website ready?

Les: Exactly they got to be perfect everything about it has to be perfect.

Howard: Yeah so get that mirrorless camera today and start photo documenting your work and show those people your own work but Les thank you so much for coming on this it was an honor to podcast interview you.

Les: Thanks so much hopefully we'll connect soon.

Howard: Okay well I'm sure you'll retire here it's just a matter of time.

Les: Maybe 


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