Dentistry Uncensored with Howard Farran
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1351 Digitization of Dental Care with Dr. Aalok Y. Shukla : Dentistry Uncensored with Howard Farran

1351 Digitization of Dental Care with Dr. Aalok Y. Shukla : Dentistry Uncensored with Howard Farran

2/10/2020 3:00:00 AM   |   Comments: 0   |   Views: 105
Dr. Aalok Y. Shukla is a healthtech entrepreneur with a clinical background in dentistry. He focuses his work on teledentistry and artificial intelligence to deliver a scalable, data driven approach to oral health care. After running his private practice for 7 years, he sold it in 2016 to focus on the unmet demand for accessible, affordable orthodontic care. He Co-Founded Straight Teeth Direct™, an innovative app and platform offering fully supervised mobile treatment with European dentists and users in 61 countries globally. He more recently launched a second platform focused on dental health, Instant Dentist, to democratize access to oral care and offer a new preventative and continuous practice model. 

VIDEO - DUwHF #1351 - Aalok Shukla

AUDIO - DUwHF #1351 - Aalok Shukla

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Howard: it's just a huge honor for me today to be podcast interviewing Dr. Aalok Yashwant Shukla he is a CEO of uplift Street teeth direct make me clear instant dentist and I love straight teeth he's coming in today all the way from the United Kingdom so it's 12:00 noon here on my lunch hour and it's 7:00 p.m. there he is a health care entrepreneur with a clinical background of Dentistry he focuses his work on Teledyne Street and artificial intelligence to deliver a scalable data-driven approach to oral health care after running his private practice for seven years he sold it in 2016 to focus on the unmet demand for accessible affordable orthodontic care he co-founded straight teeth direct an innovative app and platform offering full supervised mobile treatment with European dentists and users in 61 countries globally he more recently launched a second platform focused on dental health instant dentist to democratize access to oral care and offer a new preventative and continuous practice model straight teeth direct is a direct-to-consumer tella dentistry platform that connects users to online dentist globally enabling at-home cosmetic teeth straightening and it cost savings of up to 70% forget everything you think about you know about teeth straightening this startup is revolutionizing the cosmetic orthodontic market by making invisible liners available without the need for monthly appointments or the traditional hefty costs attached to it using 3d printing they have delivered a liner straight to the door of users in over 43 countries since their 2017 launch by building the very first AI orthodontist an instant smile simulator their vision is to provide a solution to millions of adults worldwide looking to improve their smiles and self-confidence with the option that fits into their lifestyle his mission is to make orthodontic care more accessible and affordable through technology part of some so what you're doing is I'm so excited to get you on the show today how are you doing 

Dr. Aalok Y Shukla: I'm great thank you thank you facing me oh my gosh I invited you didn't invite me

Howard: I'm so excited because I'm what I've noticed I stirred luxury I got out of school in 87 start lecturing at 90 and when the first things I realize is when you're flying around the world that the herd of eight billion humans is very very homogeneous it's kind of like no matter where you measure the cosmic temperature it's like four degrees Kelvin wherever you measure light it's the speed of light 186,000 miles say their hurt is extremely stable so when the pendulum was swinging to the left and getting very liberal it was a world deal when it went to the ride when it had anxiety markets expanding or markets contracting it's a very stable herd and four and a half percent of those Sapien cows are over here and they just did the smiles direct Club which had to be the most controversial story in dentistry and I want to get your take on it because this is dentistry uncensored and I don't want to talk about anything anybody agrees on but look let's just start with this when I got out of dental school a big-screen TV was five thousand dollars now it's five hundred the biggest movie on the blockbuster this year is Ford in Ferrari and when Ford started Henry Ford there were 86 car companies but they just made a few cars a year for really rich kings and queens and Henry said no we're gonna make a car for the modern man so here smiles drug Club said well $6,500 hell it's a lot of money for Dentists just getting out of dental school I mean it's on me so we're going to use technology and eliminate you know everything we can we're gonna replace the orthodontist with AI blah blah blah and we're gonna come out with a low-cost product for twenty five hundred oh my god the orthodontist put him against the firing squad immediately but it's kind of interesting because if it would be any other industry in electronics cell phones computers big screens it would have been cured so why the difference why is using technology and AI to lower the cost of orthodontics why is that such a bad bad thing but not in electronics no

Dr. Aalok Y Shukla:  I totally agree hard like I think in all of the industries when you use technology it lowers the costs like for example and that's the whole point of Technology to democratize access to make things more accessible and affordable but I think that there's been a perception because probably there's been a stable percentage of people that visit a dentist and of that stable percentage of people visiting a dentist a kind of stable percentage within uptake cosmetic procedures so historically there's been essentially a limited patient pool for many practices and I think many practices felt threatened they felt thought that those patients would then no longer come to them for those different treatments and they felt a little bit threatened by that the true advantage of technology is the fact that more people can gain access because if we think about just metrics probably about seventy percent of people have teeth that they would that could be improved through straightening mainly fifty to forty percent of people would be interested in straighten their teeth and then you start thinking about the masses of population all the people that are not in the clinic that's the huge expandable audience so I think the dentists if they start to understand that more and more people will access heed straining there will always be a tear of those people that will require in-office treatment due to complexity severity of malocclusion and other issues that they need as part of their author restorative treatment but the thing is what this movement is doing is helping more people become aware of teeth straightens a bit like contact lenses pretty much everyone knows someone that has contact lenses so in the same way where the line is will be the same way that pretty much everyone will know someone that knows at night let use the liners the simple question will be like where did you get it from and did you get the outcome you wanted and then that's how Trust is is it's kind of established –

Howard: goes from there well in order to get contacts do you need to see an ophthalmologist an optician do you have to 

Dr. Aalok Y Shukla: England do you know the can I just decide anyone contacts and tell them I this is my prescription and have no no I need to have an eye examination first of all and then they would then get their prescription and then they could select the right provider for them but in the same way there's no real difference why someone can't be assessed and then get the different options for them from Primanti's training perspective you'll always need a doctor involved the simple question is like how can you leverage the doctors time efficiently so that it becomes more accessible and more affordable to more people 

Howard: interesting I am so so where are you at now how how long has this been out and where are you at with all this uh where's your journey out right now 

Dr. Aalok Y Shukla: so we live in 2017 and we've got customers in 61 countries and we're growing and we've now launched the second part of the business which is the health layer so the thing is powerless as you're probably aware in medicine you have a medical model and a surgical model so you have the whole preventive early diagnostic level of care that you're doing things and then if you need to intervene into a procedure you would have the surgical model in dentistry clinics have been very good at the surgical model and be able to do lots of different treatments for people but they previously hadn't been very affordable or accessible health screening so with the health platform we're looking to make that more accessible to more people so that we can pick up early signs and symptoms of conditions dry them to dentist so that they're able to get earlier treatment and it's more cost-effective for them and then for the people that are interested in proving their smile there are many different options available to improve it so we just tried to democratize access to oral health if that makes sense you can 

Howard: now go back and tell me that same what you just said but put it in websites because I have a uplift home for calm I have instant - Dennis calm make me clear straight suit yeah so tell me tell me what um which one in your tire might tell me tell me the same story again because my home is want to know where to find you 

Dr. Aalok Y Shukla: sure so uplift home it has the two platforms the two principle platforms that's for the teeth straightening straight teeth direct calm and instant dentists which is the digital dental health assessment remotely within there basically those two assistive platforms okay so so uplift is the parent corporation exactly and uplift has two companies it has instant dentist and it has straight teeth in direct okay so then 

Howard: what's make me clear calm make me clear 

Dr. Aalok Y Shukla: is actually from a partner mine Andre he's created a software which makes it very easy for doctors within their clinic to be able to create complex treatment plans to help explain to the patient what's what conditions they require and what treatments they require so it makes it really easy for a dentist to multidisciplinary treatment planning and trait like a very detailed report so it helps them position as an expert and at the same time either patient a treatment Pam they could understand I'm not really involved in that business anymore laundry runs that one 

Howard: okay um well I wish he would um I wish he would come on the show and and and the other thing in the United States this is a very obvious is there's a there's ten specialties right and when you go to dental school they ended on us help you learn endow the oral surgeons help you pull teeth two periodontist help you fight gum disease and the orthodontist say yeah you don't need to learn anything over here you just go back their way and any orthodontist who teaches general dentists like Richard Lead who was a chairman of that worth the department University of California San Francisco and then chairman Department University Detroit Michigan he's blackballed from his entire community publish anything so the only people that will ever talk about to general Dennis Mathieu ortho is the blackballed rich clear clit or we have to get foreigners like we get Brock rondo from Canada so I'm knocking on England's door saying by the way I'm this is dentistry uncensored you can tell me to shut up at any time but I am curious because you just passed brexit and I'm wondering what the European Society of Aesthetic orthodontics is European Society of Aesthetic or tolerance is that an orthodontist only association or is that 

Dr. Aalok Y Shukla: more of a general dentist doing orthos dentist Association basically so like helping them helping them and look at different options for cosmetic teeth straightening 

Howard: so back to the smiles direct Club they're mounting a ton of legal challenges for them because in America money's the answer what's the question and what you see is like when you talk about unionized workers well half of America is too poor to be a worker in a union there's only rich union workers like airplane pilots or auto industry and I've always thought the doctors we're the richest Union and in America and now that you're no longer part of the EU now that you've done brexit will you have less regulatory challenges to do to roll out clear aligners in London

Dr. Aalok Y Shukla:  I think all countries will always have the they'll always regulate dentists that they have to practice professionally and have to make sure that they're complying with everything they need to do and then any laboratories that they work with will need to make sure they comply with what needs to happen but I think that yeah different countries will maybe adopt their different ways of running things but um essentially there'll be variations but the UK will just create its own version after the EU laws were in place because the

Howard: of all the countries on earth the United Kingdom fought tooth whitening harder than anybody I was aware of I mean Dan Fisher of alternet spent him over a million dollars in legal fees and lost trying to get his ultra dent opalescence cleared back when he came out in the late 80s early 90s do you do you consider the legal environment for the UK dentistry liberal conservative easy hard difficult how would you describe it

Dr. Aalok Y Shukla:  probably quite conservative also like in the UK it's quite similar to USA that you've got more and more medical legal claims and there's like a defensive style of practice like this kind of culture I think basically 

Howard: yeah so so how's yours so when did you watch when did you say that you launched um in straight teeth calm direct calm 


Dr. Aalok Y Shukla: so we we launched in 2016 - yes in evaluation and see you know like what demand it would be and then in 2017 would be done commercially basically and how

Howard: how's your success so far well it's going good

Dr. Aalok Y Shukla:  so we've been growing like quite a lot each year on year and as I say what we've been focusing on is making sure we get the right outcomes of people because the way we focus it is we've digitized the clinic experience with regards to like having the e consultation monthly reviews making sure that the aligners are delivered in stages so that if there's any refinements required that can happen as well so the way we see things it's just a question of like how to Everage doctors and aunties and help them have their rights technology support structure so they can help more people get what they want basically and

Howard: are you uh is this meeting your expectation or you are you thrilled or you are 

Dr. Aalok Y Shukla: no it bit harder and slower than you thought no I think it's growing it is very good and it's also very exciting when you see like how many countries and how many people are interested in these solutions so for example in Japan for example I think sterilized and sometimes cost 7,000 8,000 dollars no it's a lot of money you know so in many different countries you have people that are looking for solutions but then they couldn't afford it previously so it's quite nice to be able to get nice stories from all around the world

Howard: nice so we're when you look at your what you're doing is a is a digital play I mean it's digitization um you talked about digitization of dental care beyond the clinic what does that mean to you 

Dr. Aalok Y Shukla: so within clinic you'll always have them people coming for assessment diagnosis and then treatment essentially okay but the number of people actually go to a clinic they have to actually generally feel they have a problem and it's got to the stage where they actually feel they need to see a dentist about it so that problem might have been brewing over some months or some time previously so where we see the opportunity is how can you help more people access digital care so digital diagnosis through a mobile phone so if people are able to upload and get regular digital assessments remotely and their data can be tracked over time to see like what's the rate of tooth wear what's the rate of enamel thinning how would the gums all these different elements people can then understand their own unique risk factors see if the way we look at things in dentistry is generally when you go to a dentist what you would get is a treatment plan you go to five dentists you get five treatment plans which is a list of conditions to be well lists list of treatments to be done but what you don't get is a kind of assessment or benchmarking of your oral health status so with instant dentists what we've done is we've created a benchmark of that where we assess you get a digital report which assesses your health across 22 different dimensions and says physical risk factors and we feel if more people can get digital assessments at home and in partially from a data-driven perspective yeah an understanding of what their health is and what needs they have they'll be better empowered to visit their dentist for the actual conditions that they feel is valuable for them to treat so we see the opportunity in more people getting digital dental care through digital dental plans assessments and subscriptions and that will then also help them when they want to go to the clinic to go in a more efficient way basically 

Howard: and why is tell a dentist's tree is it just because it's new I mean like if you google tell a dentistry on dental town the first thread that comes up was I tried to do tella dentistry and I spoke to med pro my malpractice carrier and they said they won't cover you for tell again astray I mean it just seems like one thing after another what way why do you think it's so controversial when something

Dr. Aalok Y Shukla: is new some people perceive it that way but if you think about other sectors and you look at like the kind of history where things are people have already called things ecommerce these days its commerce right Walmart has its online play and it's at its normal place so you look at retail obviously the majority of transactions still happen offline but an increasing percentage is happening online in the same way if you look in primary medical care you've got in the state stellar dark and you've got all these other different situations where you've got more and more people accessing say digital doctors for their primary health care they also still have to see their physical doctors for physical exams or different development fest occasions and things like this all it is is just an expansion of professional and expertise so in the future we see that like more and more doctors will always practice digitally I mean to be honest you might be using a phone call to talk with a specialist and explaining some things or you might be sending photos through what so everybody's using it to a degree but what's not being done before is an organized system eyes way to communicate directly with the end patient and at the same time to create pathways which are more efficient so all it is is an extension and regular care and over the next four or five years we'll see that blur more and more as people have a combination of em online practiced combined with their physical practice essentially

Howard: I love that ecommerce is now just commerce so tella dense tella dentistry will actually just be dentistry you have a another example besides ecommerce is now just commerce before you go right to the closed tella dentistry will eventually be dentistry

Dr. Aalok Y Shukla:  if you look at dental town itself what is it people posting cases photos of cases and then different dentists commenting and describing what they would do it's no different really that's just like beat it that's like the dentist tele-dentistry essentially they're using images and they're consulting over technology to understand better ways to solve the case it's exactly the same difference the only difference is these days mobile devices have become much lower cost and are very good at camera resolution that information can be captured remotely because then pretty much all of dentistry's diagnosed visually or volumetrically so you're looking at either color changes structural changes or you look at volumetric changes it's all visual pretty much so that means a lot of screening can be done through ways you can get a proxy for actually seen ie photos or video 

Howard: okay so now my homies want to know I'm okay let's just go through your sites what all my homies know if they go to uplift calm will they feel uplifted

Dr. Aalok Y Shukla:  they should do like if they want to be part of like the new new revolution really if they're interested in how to expand access within their practice because the what I would say how it is this tele-dentistry presents massive opportunities further practices which of which utilize technology because what do people want to do they want to go to the dentist get your teeth fixed and then leave basically they want to have one visit dentistry as much as possible they want to have things as efficiently as possible so if a dentist is able to have a full assessment beforehand know exactly why the person's coming set up their CEREC machine or whatever it is to do the quadrant of restorations it becomes much more productive time for the dentist and also for the patient because they knew what they were coming forward and it was just much more easy basically

Howard: you know when you look at the biggest money ever made it's always an insurance banking and financing because if I grow a crop I have to sell to you for money but if you're the guy holding everybody's money it's really if you just make one percent on everybody's money it's so much money so insurance banking and financing are always the most lucrative the make the most money the average person in Manhattan on in insurance baking and finance and it's not unreasonable to see him make fifty million dollars a year next would be media because in media when you're the Superbowl is just it doesn't matter which beer company are the winner will pay the top rate for the ad I'm I'm surprised that you're going first in tutela dentistry instead of tell identity about that since that's obviously in the profit zone you know I love that book the the profit zone it really blew me away back in the 90s where it took each one of the vertical industries and it just measured my profit I take autos everybody would think well who makes all the money in autos they'd say like GM Chrysler Ford Honda you know all the big car companies and when you look at profit dollars that they're on the bottom people who sell auto insurance make more profit dollars than the people making the cars the people who actually finance the cars make the most money so I was just wondering what your thoughts are if you looked at the profit dollars why you would be interested in the profit dollars of actually clear liners instead of just the financing the insurance all that stuff have you thought about that is that Plan B or where is that 

Dr. Aalok Y Shukla: so where we see things is like how to first of all democratize access so if everyone has access to digital dental care then people are able to optimize their health and also improve their smile in an efficient way so that's like level one from all the data that we're capturing there's a lot that we're working on to understand risk profile so we've been creating different risk profiles so we can start to analyze are you able to actually reduce the needs of some people and also help categorize who would be kind of a more wellness plan for example and hot someone who's going to require more restorative work over time it would be a different risk classifications so I completely see in the future did you tell them so data-driven and dental insurance based on like your risk classification and the actual plan that you would get that will come but that will come after more data is kind of captured through the process

Howard: I loved your article from 300 million braces to 3 billion smile introducing the exponential orthodontists what what uh what were your thoughts when you wrote that

Dr. Aalok Y Shukla:  it's simply like the factor like looking at the macro like if you're looking at like how many people are on the planet you look at like the rise of income you look at like how more people want to have like uniform beauty expectations through Instagram YouTube Facebook more and more people are talking via Skype more people are to run Facebook and what's up everybody just want to have a nice smile so the simple question is if you're able to bring the costs down and if you're able to kind of make and deliver things in a systematic way as the cost of 3d printing resin comes down the cost of the plastic that the resin the cost of doctors potentially because they're how much time they requires it just becomes more accessible really so it's like any other health discipline that previously was unreachable but now it becomes more and more accessible already 

Howard: so that article artificial intelligence in digital health a consumer application diagnoses the identification of the nature of an illness rather wrong so where is artificial intelligence I'm I'm very excited about this because as being an Irishman I know the downfalls of natural intelligence I've been very very Pro artificial intelligence how is artificial intelligence how does that look like to you now and when did you write that article artificial intelligence in digital health yeah I think that was 

Dr. Aalok Y Shukla: so the way we see it is that what a dentist is going to dental school what they're doing is they're being trained on there ways to spot patterns spot clinical signs spots clinical symptoms so they're starting to understand what does caries look like what does the process look like was inflammation what does gum disease look like what is an unnatural rate of tooth where you're basically understanding how to classify all these things in your head now as we talked about most dental problems are detected visually or volumetrically so if you're able to train difference in computer algorithms to understand the pictures understand the 3d models and be able to classify what condition does this sit within and there at the same time also apply some current judgment to understand the kind of degree of severity you can then really help streamline the doctors time because the doctor could then straightaway understand okay this is a 29 year old with much more tooth wear than should be normal like the heist the tooth is like a quarter of what it should be so we see the opportunity for an ostrich intelligence is to catalogue and codify and understand all the photos videos and everything being recorded so it's more of a data-driven approach to diagnosis because at the moment there's a lot of variability in what something should be intervened when you would drill something when you would not when you would try a reparative preventive model there's a lot of variance in that so we see the opportunity with people all around the world being diagnosed and being monitored it would then mean that we could start to get a better understanding about what is actually achievable and what is better possible basically for people so what are you most excited about today what are you most passionate about about is like the combination of how you can use technology to help people better understand their own health and at the same time I look like sort of comfort and Trust from them from remotely using technology and connecting them also with different either digital dentists or physical dentists that can help them it's really helping harmonize the whole process and the other thing that becomes interesting is the industry traditionally was taken out of medicine but the mouth as you well know is the sort of many different symptoms of disease or many different issues so if you've got more and more people having digital dental screening you can start to prevent and start to predict all the issues that are happening so it becomes like the first step of essentially wellness really so I think it's very exciting time that we're living in where there's more and more people that are looking at for prevention more more people looking for affordable options and yes it's great to be at a time when the all the trends are doing in the right direction

Howard: so uplift is the b2b Dennis the Dennis website and then the business-to-consumer dentist a patient is straight teeth direct and instant dentist yes so are you trying to build the brand make me clear and I love straight teeth or not really no so three teeth was my old clinic basically so yes armor I don't want to confuse them SSO you're CEO of straight teeth and instant dentist hits some dentists and what about I love straight teeth that was the clinic that we used to have 

Dr. Aalok Y Shukla: so we set that up in 2009 2016 and we were doing online assessments back in 2011 so we start something and help me out because it's tough by the way 

Howard: a lot of people always have sent me things where they'll say hey you know I don't like it when you put out a podcast you'll put like doctor a lock and then your and then you'll put initials after name if there's initials after the name you don't put a doctor in front and I'm like you know shut up yeah I'm if I showed you a dentist named in Saudi Arabia you would know if as a boy or a girl you would know as a dentist when you put a dr in front of it they do the name and i like what they do and I'm in Brazil where they have doctor and draw so if it's dr you know it's a male with dr a it's a female all the business people in the Middle East before their name they put an M R and M s because they know when you see the name I mean obviously if your name is Matthew Mark Luke or John we can figure out your your biology but I'm  just trying to help the international be I don't care if it offends a bunch of people in the United States but um so so your brand is but Dentist are from England or send me back stuff and they're saying that you you would give them their address and say London comma England comma United Kingdom and they're correcting and saying change it to Great Britain I'm not sure I'm not aware of what would I'm so after brexit your United Kingdom but why why is so many dentists in London changing you can I to Kingdom to Great Britain country I've been the desert on the other side of the world but 

Dr. Aalok Y Shukla: so you don't know like your England you got startling you got Wales and you got United Kingdom which is all three of those together and then Great Britain is then like a combination essentially so in there's different ways what's there between I I'm in Great Britain it's a good question

Howard: so I think that's like I think that's like with Wales basics so on your technical address I can just say you're from London you UK or do you like you at London United Kingdom superb London UK and I'm basically London Lisbon in Portugal basically but but UK but right now I mean you're a dentist you would you go with UK or United Kingdom in case just in breathin so yeah United Kingdom UK and would you go with would you go with Great Britain or United Kingdom no UK okay alright so sorry to get my I'm trying to get my geopolitical and then what are the initials behind your name DDS yes into surgery uh-huh and okay so um what do is there a competition between you your general dentist right you're not an orthodontist that's correct do your orthodontist friends like what you're doing or or did you stop getting invited to dinner parties

Dr. Aalok Y Shukla:  so we have digital Dentists that work on our platform so I think we always have people that are for program so we have some some more friends they have very good orthodontic clinics and they're very interested in how things are progressing and interested to see how things go they've obviously got very thriving practices which work very well and to be very very clear how I'd like a very small like a small percentage of cases that are treatable remotely there's loads of cases that need to be treated in clinic and the same time if people looking for more comprehensive outcomes or people prefer to not wear clear aligners they want to have a brace fixed behind the teeth is always going to be cases are required but what's very interesting is that they as technology becomes more popular more people then get their teeth straightened which then leads to more people wanting their teeth straightened and then there's more cases going around for everyone basically 

Howard: yeah and that's what I think is obvious I mean you know a young person doesn't want to have a partnership because they want the whole pie and a lot of times they don't understand that one plus one equals three and then if you and I became partners the pie would not be double and we each get the half pie which is the same as original pie but the pie might be three times bigger and now my half is one and a half times bigger than my whole and free enterprise I'm dentists health care doesn't get it of everyone everyone else knows the like if you see their dentists what is your favorite procedure and he said clear aligners and I'd say okay so I'm the earth just went around the Sun what are you gonna do about your price oh I'm gonna raise it five percent okay well that that's exactly wrong I mean in every the only thing we've learned from Adam Smith in 1776 a Scott to this day was that if you want to grow your business you lower your price and you'll expand your market share in the winter and Airlines is a low-cost Southwest the winner and distribution of furniture is IKEA groceries is Kroger its Walmart and  then these guys get so mad like in Arizona the biggest dental insurance company just lowered their fees and they're all they're all just going crazy and I say okay now you know in economics you should be lowering your fees anyway right so you're bitching about the insurance company and you're supposed to use your brain to figure out how to do everything keep one eye on the patient one eye on cost and make everything faster easier higher quality lower costs more smaller so but Dentists that they don't want to hear that they they want to hear that I sold my car last year for a dollar and next year I want to get a dollar ten I mean it's exactly backwards so you when you say progress you mean better faster easier higher quality lower cost more miniature

Dr. Aalok Y Shukla:  I think as practices so weak technology with tele-dentistry the number of people that can visit a practice will increase okay but then the practice has to change a little bit in how its deliver services because for example ask costs to do increase within a practice I think as there's more regulation as rent goes up there are high ethics costs and I can cause pressure my clinic but and at the same time if you start adopting things like remote monitoring different elements so you have to spend less share time with the patients that you're treating you should then be able to offer a more affordable price to more people so I think it depends on like how people want to adapt but then the same time also you do have different market segments so you always have like the mass market segment but then you also more middle class upper middle class and even like more elite and premium so I guess a simply a question of where the the practice wants to position itself and what what they are really focused on I've always thought it's always more interesting to help more people access what they want and at the same time the market is absolutely enormous so if you help more people then more people can become uplifted and empowered and they can refer more people and you can just go from there really

Howard: and this uplifted feel more power your passion your smile but where does this come from 

Dr. Aalok Y Shukla: well it's just like historically like everyone is happy about smiling everyone thinks it's beautiful to have a smile but in dentistry everyone gets scared about right like so things why can't you utilize technology to actually make it the person feel in control empowered have information have visibility over what they require also have access to information what minimally invasive procedures would be like for example if someone wants to improve their smile there's many non-invasive treatments that could be done by allowing the teeth doing some bonding doing some intrusion but may they not even know these options are available and some may go to a dentist who only does crowns for example so I think by giving people options and access to information at the same time also using technology to make treatments more affordable and accessible you can just help everyone get a better experience of dentistry because then it'll sim Utley if you are able to improve your smile in a non painful way and it doesn't have catastrophic repair and issues then it's just gonna be a more positive encounter than having a large rehabilitation and it all goes really bad basically isn't it 

Howard: yeah but I want to I'm but I'm asking for you where does this come from and you I mean this this isn't some you just didn't fall down on this thought I mean when you talk about uplifting and power and all that where does that come from of you is this a childhood thing you get this from your mom your dad come from 

Dr. Aalok Y Shukla: so like I think for my parents and we always want to be very positive and we want to like help people really isn't it that's just a natural human condition everyone wants people to be happy everyone is happier when everyone else happy around them isn't it right so if you can then focus on how you can do more of that and you can also since see if someone's able to sort improve their smile I feel more confident didn't before that unlocks more happiness in them so then it's just a question of like how can you use technology to help more people in a more affordable accessible way essentially but I think like both me and Lissy we're really focused on like how you can have as much impact as possible by you know democratizing and unlocking different stories there's so many people that send us wonderful stories or wedding photos of like you know like their special big day and you know they always wanted to have the smile they wanted and I think that's what any dentist likes I think

Howard: so um how long have you what were your do get out of school and she doesn't for 

Dr. Aalok Y Shukla: 2000-2004 I had an 2003 was 2004 and I can 3 I finished at the end of December basically and I love what I love the most about Britain more than anything is the names of their dental schools 

Howard: I we like in America we say I want a su of a you graduated from the Queen Mary University of London Botts and the London School of Medicine and Dentistry I just love that um so what you got out in 2003 its 2020 a lot of these kids are coming out of school and saying Oh a lock you got out in the easy days and the good days the glory days I just got out an hour ago what are you what do you think how does the future of dental practices look like to you 

Dr. Aalok Y Shukla: so I think the future of dental practices is essentially evolving on this trend so it's it's always gonna be a need for the dentist bill to restore replace or repair and so the question is simply gonna be like how can you get as many different people that require those services and the same time how can you help those people in a very efficient way so I think the practices which using technology so they have a tele dentistry element for example so beyond a website more interaction for example and the same time they're using technology in their practice to minimize care time so then they can have a lower cost per procedure for more people these the ones the way they're gonna be doing very very well because there's always going to be a need for intervention to change the physical shape of the tooth to repair something to replace something even to move the position of it as part of an instance of their treatment plan you can't do you know clear aligners solicited this is driven by a dentist impractical doing a multi-city treatment LAN and more and more tree plans can become a multi-disciplinary isn't this a bright future for dental care when I was at university I was actually doing medicine I didn't want to be a doctor I switched into dental school partway through University so I'd always looked at things little bit differently because I'd always thought like you know you but the medical model and surgical model I think for dentists graduates day it's a very bright future because you can really focus on taking care of people but then if you just clever about how you leverage your time and what technologies you use then you can thrive 

Howard: it seems obvious when you go when you look at the economics of Dentistry from around the world that there's you know it started with peer for Shard the French I'm sure your French wife reminds you every day the dentistry started in France and not the United Kingdom 200 years of Givi black it's pretty much one and a half two and a half three percent growth the only double-digit places we see is implantology and clear aligners you're biased towards clear aligners but how do you if she was listening to you right now and she was a 25 and she just got out of dental school what would be your sales pitch on clear aligners versus implantology

Dr. Aalok Y Shukla:  well I think both of them right why does it have to be one or the other essentially because you're gonna have people that will require at least one to two two teeth being replaced due to fracture trauma or something and if every dentist is able to know how to restore em a missing tooth with an implant either through a short implant or some bone augmentation they can better look after their patients basically isn't it so I think to be a complete dentist you have to be able to understand the different elements or build a team and I think it's important work as a team right no one person can do everything yourself and I think if you build a team then you can then make sure you can you know provide the best care for your patients

Howard: um when you talk about increasing access to care but access to care and availability of care that this seems to be a medical dental doctor access that the rest of the world just figured out by keeping your eye on price I mean if want everybody to have clean water lower the price if you want everybody to have you know whatever you want them to have just figure out how to make it faster easier higher quality lower cost cheaper so when you're talking about increasing access to care how do you how does your amazing mind think about that other than the obvious of just getting your price down

Dr. Aalok Y Shukla:  so there's a few factors in the dearth of the barriers to dental care it's not just price it's also like emotional factors like fear you know being judged to me be feeling embarrassed that you've not been for a while maybe not having a relationships there's many different elements where somebody who doesn't have a regular dentist could then feel disempowered from seeking a dentist so for example the UK there is a socialized dental care system the NHS but you've still got around 7,500 people a week going to their GP their doctor for dental problems not the dentist and the reasons are you know people are scared they don't know who to go to there may be some cost considerations because they're scared that suddenly they do it from one appointment and suddenly they get up a huge bill beyond what they could pay for there's a lot of lack of information so I think the opportunity is in by giving people more information in a safe environment or way they can control they can then be better empowered to then decide where is the best place for them and you are right cost is a massive function of it and in many countries where the costs of running a medical or dental establishments are very high unfortunately there is an intrinsic cost element to it but that's where technology can help because if by offering you know more affordable screening more people can access and in a professional advice and there's instant dentists

Howard: I know on Twitter you have you have basically at straight teeth UK do you have I don't see on your Twitter we use Instagram and Facebook so are you aware that the president the United States one solely because of Twitter I mean I mean yes that may I love him or hate him it's genius marketing because he knew at nighttime with 325 million Americans only 1 million watch CNN and 3 million watched Fox News and combined that's 4 million and he knew that is 25 million Twitter followers would blow that out of the water no one comprehended it no one saw coming but I do notice in dentistry and if you are big money big power manufacturing if you're a mover and shaker they're all on LinkedIn and Twitter I am and if they're really up they're really up there you say are you on Facebook they just laugh I mean really and even the kids so third millennial under they're not on Facebook they're on Instagram yeah and then that middle group is it's kind of like it's kind of like if you say you're on Facebook it's almost like saying you have erectile dysfunction I mean it's uh you know something's wrong with you if you're on that but I'm I find that interesting um so so you're not on so I was right so on Twitter you still have is the make me clear app is that still a Twitter following or is that I I think Andre

Dr. Aalok Y Shukla:  mainly produces the content for brain and hands which is like education for dentists and also through making it clear through Facebook and also some Instagram as well 

Howard: okay so um so your instant dentist doesn't have a deal no not Twitter okay well I'm gonna I'm gonna tell Donald Trump on you I'm gonna tell him there's just London guy who's not on Twitter yeah I create crazy politics for you and us huh did you ever think that um politics would be this strange when you got out of dental school

Dr. Aalok Y Shukla:  I think everything changes I think like him you can't predict how things maybe some things will change faster than you imagine other things will change slower I didn't ever imagine that UK would leave the EU but obviously that happens so yeah I think are you glad they laughed no I don't think it's a good idea you know like I think like ultimately like where we're trying to get to Israel eliminate barriers make things easier more freedom of people more freedom movements and also how to harmonize opportunity globally really 

Howard: so you know okay so so again so uplift is the platform parent company of instant dentist and straight answer and straight teeth okay well I'm really interested in your other one do you still have that asou comm click convert cell docks so that was in

Dr. Aalok Y Shukla:  so in 2014 and 2013 we implemented an online assessment system for our clinic where people could answer different questions tell us like if they want to get straight teeth by specific dates when they preferred something behind the teeth or removable all these different elements and then they were also sending us photos and we would then send them like personalized videos information so we found it many patients came to our practice even traveled quite some distance to see us through these online consultations and online booking we had them and then we found many people inquiring all over the UK and so we wanted to then help direct them to other practices so that's where we created some different courses and training materials for the dentists to help them actually attract similar people that want to straighten teeth so as a sore thing no we stopped doing that in to focus on dirtily dentistry elements basically 

Howard: so you said so um so we're all get rid of eye issue calm and and make me clear maybe still running laundry runs that and any student very well who's this andre guy 

Dr. Aalok Y Shukla: so Andre George Andre Kondo so he's quite renowned and he lectures a lot internationally he teaches an interdisciplinary restorative dentistry and he's created some very good training through brain enhance and it's a website and get the link for afterwards and it's all about how to have a systematic approach to treatment planning and with make me clear it helps the dentist create a compelling reports for the patient in the clinic which creates a oral health score and at the same time what the current dentition is what the proposed treatment is the risks and consideration is a very professional approach with very little time the dentist is able to create a very professional reports for the patients who actually um utilize and as I've been going out as I've been going well yeah it's going well so it is more and more dentists using that to help the associates in their practice do interdisciplinary treatment planning and also helping more of the that want to do more of the implant restorative combination cases do that well because most software if you're trying to create riripon which is I've got implants restorative elements different things like this in orthodontics it doesn't present visually it just looks like a list of all different procedures and you can't create like option a dream plan option beep to plan very visually make me clear labels you to do that in a very nice way systematically and I see a general dentist or an orthodontist at prosthodontist so lake her so he needs further trading in prosthodontics prosthodontist ah that was very interesting that was the prosthodontist very interesting and he's in a Porto he is he Elizabeth or is Porto so he's in in just near Porto so isn't she a senior just in the north of Portugal it's beautiful place

Howard: Wow and that's a home of pelo do you pronounce that pelo Melo or pelo mallow yeah he's not like and he's got very very large and in plank Linux isn't it and trait Leo LAN for procedure as well but he just filed for bankruptcy yeah I think there were some issues there butt that well that that's a good lesson and I wish you come back on the show and talk about it because it seems like life is two steps forward one step back just because the  new arrivals don't learn everything the easy way by reading history books they have to go back and touch the hot stove again and he so he was doing great and then he decided to carry his own paper and finance his cases and I still you still have that popping up again in America I thought it was laid to rest in the 80s and now it's back and then Dentists start a pelo mallow pelo mallow mother so it's both Paulo Malo  all sing it and pound of Malo Paulo mallow yeah Paulo Malo um you know those those arches are expensive it's 25,000 arch that's 50,000 full case you thought you know what I'll just carry the paper well are you a banker do you do FICA scores do you do you have salt I mean did you study insurance banking and fine is this your core competency oh hell no it just everything looks easy to a doctor because we ever you're a doctor you just assume you're smarter than anybody I mean I'm surprised you don't see Dentists walking up to like welders and saying give me that welding machine I'll show you how to well I mean they just think they know everything and he got bit bad on bad paper and people are crazy and you got to remember is that you can't repossess an all on four you can't go in there and take their teeth and I don't care they'll give you their house that what they won't give you is their smartphone and their car that's the only thing people care about it's like man if I owe you 20 million billion dollars I'll just get my car take my iphone and leave I mean that's  humans for you so you don't carry paper man you have to you know it's  not your core competency and I hope you kids listening that I mean I never thought someone as smart as Paulo Melo Paulo mallow would do that but um but you do like this on this make me clear but please tell please tell your friend I'm George Andre Cardozo in the Porto area Portugal that my gosh we'd love to hear more because I say that the orthodontists aren't gonna teach us anything in America we'll have to go all the way to Brazil or Portugal by the way one out of 20 Portuguese speakers are in Portugal 19 out of 20 are in Brazil okay so we've gone so then so I I love straight teeth talk co uk you're not doing that one either and that was the clinic before that was like sold in 2016 so now you're not a practicing dentist no and how was that a long-lost love or are you glad or you miss it or what's that like

Dr. Aalok Y Shukla:  essentially it's an extension of like what what we're doing before just helping more people through systems and technology but now I'm very happy with what we're doing at the moment it's very interesting and challenging being able to you know growth companies and 

Howard: your wife um you said she's is a notion your wife's a lawyer yeah so she's managing director she who runs the businesses like 

Dr. Aalok Y Shukla: so she's like head of growth products and operations yeah and so then I'm trying to think um you said so I'm gonna go back to clear liners when I got out of school you know what

Howard: clear liners were lingual braces really well they didn't have clear they didn't have clear liners so if you wanted if you weren't tough and everything then what's that your Kesling sets up and you had like manual sets ups and everything they didn't well when I graduated school you remember t-rex was still alive and there were some but in 87 if you didn't want your braces to show there weren't clear aligners you had to do lingual lingual braces that was your only option and now I'm starting to see lingual braces I come back do you think lingual braces are gonna be a challenge to clear aligners is that gonna be competition 

Dr. Aalok Y Shukla: I think very popular when I had the clinic file of straight teeth about 80% of what we did was lingual braces because people wanted the outcome without people seeing it but didn't necessarily want to do anything right because there's massive compliance issues with aligners not everybody wants to wear a line is also some people prefer having something fitted behind the teeth which may work quicker or in different ways so there's there's different options for different people honestly Howard leg is just a question of like you think about the percentage of people that would like to improve their smile ups and it's people that could improve they're smarter is straightening and then you think about which different technologies or modes of treatment would suit as many people as possible I mean the percentage of people getting their teeth straight in the moment it's a tiny tiny percentage of that so I think there's a long long way to go through many different modalities to help more people get what they want so I think lingual braces will definitely become more and more popular there's more systems which can make it easier for general dentists or orthodontist to do it without expensive lab work as well you know the last time we talked we talked about

Howard: you were saying about that you love my virtues a profile dentists video and how a teenager can run McDonald's with more systems numbers than than a dentist can and that you really wanted to improve the dental business through practice software starting with helping Dennis increase treatment acceptance increasing patient all these things like that I have believed that the reason dsos have taking over America I mean it's the fastest-growing part of the market what people don't realize is it's gone from zero to twelve to eighteen percent that's been at the expense of private practice and I don't see it turning because for 32 years I've told Dennis you need to know your numbers your your dendrix an eagle soft doesn't hook up with your your QuickBooks accounting you don't know your numbers you don't track how many people land on your website how many of those convert to call how many calls answer does it take to convert to coming in how many people come in and need clear liners before you convert one two but they basically say I don't want to know any numbers I don't want to know anything I got my eyes closed I'm having a beer and stay out of my way and that's why in Arizona 18.6 percent of all dentist work for a DSO and i still don't see it changing do you see it changing for where you're at because to put this into context for the kids when i got out of school and the united kingdom was well far ahead of us in this NHS experiment where the dentist the government was gonna highly regulate dentistry it's kind of like the airline industry everybody knows if the fastest way the only way you can make a billion dollars in the airline business is you start with two billion and you end up with one and imagine an airline business where oh to take off oh I need permission from the government Oh to land I need permission oh I can only take off and land in your government Airport so the government just regulates it until it's dead and then they're just shocked why it's so expensive and the NHS was in this two decades before I got out of school and now three decades out of school it's like but when I was born there was 3 billion people in 62 when I got a dental school in 87 there were five billion people now there are seven and a half billion people but I've watched for thirty years people trying to get out of the NHS system and go back to more of a free market and kind of in the same way a brexit where they're just done of all these big government agencies trying to make their life easier just and so where is the unraveling from the NHS a try now do you see young Dentist coming out of school saying I'm in HS here you know I'm yeah yeah yeah or is it more like oh my god avoid that like the plague I think it's a mixture I think the NHS is very very valuable and it's brilliant because it means that people so for example in the USA one of the main reasons for personal bankruptcies health expenses right like so in the UK I mean let's talk facts so it's 40 to 60,000 Americans declare bankruptcy each year number one is cashflow number two health care but forty to sixty thousand on three hundred and twenty five million people I mean that's not even a rounding error but continue 

Dr. Aalok Y Shukla: okay so what's nice is that like for severe medical conditions or different health problems there is a system in place to help look after you and as that would be insurance and 

Howard: that would be insurance which we're all for you wreck your car your house gets fire you get a big disease but but that but those insurance things aren't even ten percent of the health care costs it's the coming in for a cold and a flu and a sniffle

Dr. Aalok Y Shukla:  so in dental like the spend on dental care is pretty similar to spend on say furs on the cancer care and as people live older and as people yes technology moves on and things are more advanced it becomes difficult to understand what is the core elements of health which are trying to look after and what are the all the new procedures which are may be outside the scope of like maintaining and preserving health so and things like with the NHS it does provide a valuable service in many different areas but the same time it has to be realistic about health preservation stabilization and then you're looking at the other different types of treatments which need to be made more affordable for more people so then they can access different kinds of care but I think it provides a very good service and a core level but dentistry over time has to just become more affordable and accessible through  the lowering of costs essentially because as populations grow the same health care budget cannot scale to everybody with the same and scope of care for everybody basically 

Howard: so when you watch my 30 day dental MBA which is now on YouTube and iTunes and the virtues of propyl dentistry did it apply do you think it applied to the United Kingdom as much as it did where it was made in an Arizona replace 

Dr. Aalok Y Shukla: everywhere isn't it like I think one of my favorite bits was when you talk about orthodontics he says rubberband and glue which bit do you understand the Rope under the glue my orthodontist friends hate me my god they hate me but anyway no whole systematic approach to just like what do people want what people need and how you can use as you talked about general business principles to deliver that in a more efficient way for more people it's completely applicable everywhere isn't it 

Howard: yeah one of the things that I like the way you talked about was helping dentists increase treatment acceptance I mean god they don't even track it I mean I mean I mean like today yesterday everybody was talking about how the date was a pallid Iran you know zero to day zero to I mean you know a month day year it's like dude you don't even look at numbers um they don't like selling they say I don't want to sell they don't track sure implant acceptance first of all how do you track tree implant acceptance a lot of people start talking about a number and there's no definition on it I mean you know how do you track treatment plant acceptance within a practice 

Dr. Aalok Y Shukla: they would be looking at like how much they've diagnosed what they've diagnosed different people so for example through make me clear people are able to like look at the plans they diagnosed look at the understanding and then follow up with those cases to see how that's kind of working with instant dentist what we're trying to do is like level things up so in most dental care there's an information asymmetry the doctor knows everything the patient doesn't really know very much the doctor looks at the patient sees all these different conditions and then tries to create a plan for that patient without really understanding their financial or personal desires or how things are going so in the same way if you can apply a more data-driven level where the patient is able to understand more about their conditions and at the same time communicate with the doctor in an open way saying I see I have these cracks here this is something I would like to take care of over the next six months can we prioritize what we need to do it can be more of a discovery discussion I think using technology so that internal cameras photography reports and benchmarking of where you are versus somebody else it just makes the whole process more  efficient so and from a doctor's perspective they can have an understanding about okay what so that you people have specific conditions what so these people did I recommend this too how are we moving forward in this way it's just helping people get the health care that they actually want really but making it in a way which is a partnership with the person 

Howard: so is incent Dentists how is that going I mean is that is that taking off 

Dr. Aalok Y Shukla: yeah it's it's really early days but it's really it's going very very well and what we find it that's really interesting is like I say because we create this report where people get their health assessed in different dimensions and information we found that people have gone to their dentist and said hey this concerns me I understand doing this and they hadn't previously had that conversation with their dentist but now they can see where the crack is or where the problem is becomes very interesting there's a few dental practices were working with to also do reactivations because the percentage of people in their practice of not visited for 18 months or more so they're offering digital dental assessments to those patients to then help them understand what their needs are so then they can reschedule for treatments so I think it's very exciting to help more people understand the true picture of their needs and then they can be empowered to decide what is right for them to do at what pace basically

Howard: it's kind of a.m. it's kind of a big marketing thing because you know when I got out of school the currency for marketing was money like  when I grew up and the reason the fortune 500 controlled everything is because there's only three networks so if you're ABC CBS NBC and you buy and you're sell cereal and you buy all the primetime commercials during cartoons for your Wheaties and Cheerios and whatever but now in a highly fragmented market that the fortune 500 can't really do this and it seems like the currency for a dentist is time so if I sign up for instant dentist and some consumer patient contacts me if I work that lead I may be able to close the lead and convert them to schedule an appointment to come in is it is it more is it really a marketing thing

Dr. Aalok Y Shukla:  I think it's more of it like it's an awareness and diagnosis thing right and that what we want to do is link up with practices they're also treatment plan and do treatment from a adhesive mentality like a biomimetic minimally invasive because then you can match up the patient who understands what their needs are and a minimally invasive way to solve their problem with a dentist that also has the same kind of philosophy so it becomes a good marrying an element between those two people 

Howard: and is that just a UK thing or is that can I in the United States at the moment

Dr. Aalok Y Shukla:  it's just the UK but we are in talked with a few doctors in the USA who are very interested like for example we've also got a dental scope which is an internal camera a Wi-Fi control camera and we're looking to create a digital dental plan in a box for and consumers and they're able to then see what's going on track how things are and a few dentists have said to us actually USA dentists have said can we provide this for our own patients as a way to help monitor what's going on for those people but now I think the more people are empowered about their oral health the more people that understand what's going on I just think you got to prevent and help more issues before they actually become a big issue and you are how many dentists and how many countries are using this now how how are just rolling out its early stages we're trying to get more traction at the moment with in Europe and the UK but as I say it's growing step by step over time we're looking for the rights and dentists they're interesting to help but implement this in their area so we're always open to listen to and progressive proactive dentists and and as that ax is out

Howard: is that turning out like you thought

Dr. Aalok Y Shukla:  yes it's everything new takes a little bit of time but it reverie we're very and excited to see how people are responding to it and we're quite surprised also like how many people who hadn't been to a dentist for a long time got the report and then suddenly our booking appointments and going for different treatments so it's quite it's quite rewarding to see that right 

Howard: well was there anything you thought we were going to talk about today that we didn't talk about everything I'm interested in what your perspective is like within your practice because you still practice in your in your place don't you yeah worked three days last week most people they just assume I'm a a model that just you know does a photo shoot and gets on the cover of magazine but yeah I'm I am I still do dentistry and like say I think I I don't think you can be all things all people I see people crushing it who are really implant driven or really clear aligner driven I am I I'm in Phoenix I'm not in Scottsdale Paradise Valley I'm still that uh I mean I my practice 32 years old I've you know been seen a lot of people for three decades it's so funny I'm because now when I you know a lot of my patients I saw last week I can remember when their mom carried him in in a baby seat and now they're coming in carrying another kid at a baby seat then it's just it's just so fun but I think this clear liners thing is very serious because at the end of the day were a species the number one goal of a species is to reproduce have offspring when you look at what a peacock does when you look at all the complex mating when I lecture around the world I mean I don't care if you're in Katmandu Indonesia Nepal anywhere you go once the waitress finds out that you're a dentist they start asking about Invisalign and braces and you're looking at this I mean it's just so huge the need to reproduce have offspring is so huge they'll do anything to increase their appearance until they've successfully made it and had offspring so you know anything that anything that can increase your chance of having a baby and anything a grandparent can do to increase their chance of their children to mate and all that stuff I mean it's just it's  the cat's meow it's the basis it's it's you know it's just it's everything and

Dr. Aalok Y Shukla:  from your perspective you must be using quite a lot of Technology in your practice to help all the people you know through the local networks and everything so where do you see the opportunities for example for dentists to be able to evolve and grow their practice 

Howard: um I I think like amalgam last 38 years composites last six but they want the natural teeth when I tell someone they have 11 cavities and gum disease they asked me when they can start Invisalign and bleaching their teeth the so the  future is how do you marry the values of I'm a dentist I want you to keep your teeth for life and be free from disease especially inflammation because the chronic inflammation we think that's it's totally related to total inflammation which is heart disease cancer all these autoimmune disorders you just need less inflammation that's what we want to get done in a parental way and then the patient they just want to have bright-eyed beautiful teeth and  look gorgeous for their Instagram selfie that they take nine times a day in their bathroom mirror and keep posting on Instagram so I think the future is how do you how do you do the dentistry they need while making them whiter brighter sexier teeth by the way when I was in England every time I'm in England they kind of laugh about how white the teeth our needs are in America and the Middle East now I get the Middle East because if you're completely wrapped in a veil and sorry and the only thing that shows is your eyes and your teeth I mean gosh - and you're wearing black I mean oh my god so I get it in Saudi Arabia in the Middle East where they want Clorox wipes but Americans Hollywood they're not far behind him but a lot I've noticed a lot of people in Europe kind of thought nah not not not that straight not that way because I feel like in the United Kingdom they feel like yeah if it's too white it's too straight it's too perfect it's fake and phony do you still sense that so there's different trends I think like the European aesthetic is more natural and kind of like perfect imperfections like

Dr. Aalok Y Shukla:  so I think there is a trend towards kind of a more naturalized smile but then there are many people that like the US look as well so it depends on the audience essentially but like the u.s. look is always going to be driven by essentially like some form of like restorative and the same time some orthodontics so many years and some straightening combination of those things but the people that prefer the more be happy with straightening whitening maybe some bonding essentially

Howard: so if you heard what he just said I want to make sure this in flower head so if you're in a dental school in America and you're thinking about marrying a girl and she's not European that likes that natural and a flaw then don't buy her a natural diamond buy her a zirconium diamond it's flawless it's completely perfect and it only costs three dollars at Walmart you do not need to buy that natural flawed diamond for your girl but hey thank you so much for coming on this show this is the the hottest subject in dentistry is implants and clear aligners and it's always fun to go across the pond by the way they just started a nonstop flight to Phoenix to London nine hours straight I love that flight and every day at noon in Phoenix you can see this big ole British Airways 747 taking off and it's go go the way London it's the best flight in the world and my gosh if you haven't been to London go up there and the other thing to the American home is in Canada is United States has a very fragmented dental industry and uh where all 50 states have a state meeting and it's very fragmented whereas Europe I mean my god the whole country has one meeting every other year in Cologne and cologne is uh it was the furthest out reach of the Roman Empire to partager Mesa but the only part of Germany where there's a lot of Italians Italian restaurants but are you a big fan of the Cologne meeting

Dr. Aalok Y Shukla:  not had a chance to go yet but I know it's enormous like

Howard: it's absolutely enormous it's a hundred and ten thousand dentists show up to that thing and when you're at a booth is so cool because if you're at a booth is Chicago made right now at the Yankees going on at the Boston Oh last weekend I mean when you're at the Cologne meeting whenever you're at a booth there's five dentists on each side of your talking and language you don't even know what they're talking about but they're all dentists are all fighting the same disease and the and how everybody sees it slightly different is  so when the nuances and I just love Kalam because it seems like every conversation you have for a Medina psyche maybe he's from Lagos Nigeria or maybe he's from Korea and no matter what they say you always think why never I never quite really thought about it with that little detail on that little touch it's it's so interesting but I'm hey if you ever want to hit America in a big way make us an online C course or an article or because this is the future and all the kids here want to learn more about clear liners and please tell that to George Cardozo that they  can't hear enough about this stuff no absolutely no thank you very much all right well I hope you have a rockin good evening what time is it now it's what is it at 8:15 there now yes 8:15 all right well it's past your bedtime go to bed and I will talk to you again soon okay thank you very much all right thank you

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