Dentistry Uncensored with Howard Farran

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Howard Farran:

Thank you Robert Dharma for joining me today. We're in Medan.

Robert Dharma:

Medan.

Howard Farran:

Medan, Indonesia. And Indonesia is the fourth most populous country in the world. It's China, India, United States, and then Indonesia. It's a huge country, and, since Americans are only having about two babies per family and they're having about five, in just less than a generation, they're going to pass the United States in population. Most of Indonesia is south of the equator.

Robert Dharma:

Yes.

Howard Farran:

But we're north of the equator right now?

Robert Dharma:

Slightly north.

Howard Farran:

Yeah, just technically, slightly north of the equator. The country is just beautiful, it's gorgeous.

Robert Dharma:

Thank you.

Howard Farran:

I know that you're the past president of the Asian Academy of Aesthetic Dentistry. I know you like to talk about aesthetics. Before we go there, I want to talk about one thing I think a lot of dentists are into, and that's Java Man, in the fact that enamel is the hardest substance in the human body, so whenever they find old fossils of any animals or humans, they always find the teeth. You're from Java ...

Robert Dharma:

Yes.

Howard Farran:

Isn't Java where they found some of the oldest humans that ever lived?

Robert Dharma:

Yes. They found it in nearby Solo. Solo's in Central Java. Actually, it was found many, many years ago by a Dutch researcher, Dutch archaeologist, Dubois, if I've not mistaken the name. Since that, that find they only have the skull, the top of the skull. Then after that, they found part of the jaw. They keep that skull in Netherlands for many, many years, and now it's already back in Indonesia in Central Java where they found it, nearby, they found it. That's very interesting, because we call it Pithecanthropus. Pithecanthropus means that the first stand-up ape. It's difficult to explain why it's there. Usually, they found it in Africa, or some in Australia. Maybe Africa, Australia, and Indonesia were still in one big island. There's a lot of fossils there. From human, it's not much, but, a lot there.

Howard Farran:

They think at that time, Indonesia and Africa ...

Robert Dharma:

And Australia in the same big island.

Howard Farran:

Wow.

Robert Dharma:

A sort of continent, at that time.

Howard Farran:

Wow. That is so amazing. I always loved anthropology just because whenever you're flipping through and you see an article, it's always teeth.

Robert Dharma:

Yes.

Howard Farran:

I never could understand how a dentist wouldn't have to stop and look at anything that has a picture of a tooth, but, yeah, I think that's very, very interesting. Tell us ... So Indonesia is about two hundred and fifty million people ...

Robert Dharma:

Yes. Two hundred and fifty million.

Howard Farran:

I've got a picture here of, I think, the number of dentists. Now, 'dentist' here is 'Doctor Gigi."

Robert Dharma:

Doctor Gigi. Doctor Gigi. Doctor is doctor. Gigi it means teeth.

Howard Farran:

G-I-G-I?

Robert Dharma:

Yes.

Howard Farran:

That's funny, because one of my favorite dentists in America is in California, and that's her name, Dr. Gigi.

Robert Dharma:

She was born to be dentist.

Howard Farran:

She was born to be a den- I wonder if her mom named ... I did a podcast interview with her about a hundred episodes ago, and I wonder if her mom pre-ordained her to be a dentist by calling her Dr. So it's pronounced "Gee-Gee."

Robert Dharma:

Yes.

Howard Farran:

Then instead of a D-R in front of it, you put D-R-G, because it's Dr. Gigi.

Robert Dharma:

Yes.

Howard Farran:

Indonesia has twenty-seven thousand Dr. Gigi, and then Dr. Gigi specialists, another three thousand. I did the math on that. The United States has a dentist for about every twenty-eight hundred people; you guys have a dentist for about every nine thousand.

Robert Dharma:

Yes.

Howard Farran:

Tell us, what is dentistry like in Indonesia?

Robert Dharma:

Okay. With the lack of dentists, but also, the problem is, the Indonesian population, not all can afford dentistry, even the government provide that keep dentistry, but still cannot afford, first. Secondly, Indonesia is so big. There's a lot of remote places that not have dentistry services there. The first one. The second one, you notice, from two-hundred and forty million people that live in Indonesia, it's about seventy million live in Java only. The Java island is so crowded, and all the professionals are there. That's the first problem. The second problem is, seventy percent of the dentists are women, and ... Who works full time as dentist ...

Howard Farran:

You can't say that a woman dentist is a problem, because your daughter is a dentist.

Robert Dharma:

That's not what ...

Howard Farran:

Are you saying your daughter's a problem?

Robert Dharma:

She will say something. She will serve as something.

Howard Farran:

Does she agree with what you're saying here?

Speaker 3:

Hmm. Not sure.

Howard Farran:

She's on standby, ready to interrupt Dad. The first problem was, most of the professionals are where the seventy million people live, and not in the rural areas.

Robert Dharma:

Yes.

Howard Farran:

That's a problem we see in China, the United States, everywhere, the dentists always want to live in the big city. They don't want to live out in rural. The second problem you said was women dentists?

Robert Dharma:

Yes, because women in this will be, lost about ten, fifteen years of their productive time for family. After that, they can start their professional life, after the kid grows.

Howard Farran:

In Indonesia, you see a lot of women dentists, and when they get married and have children ...

Robert Dharma:

Become a part-timer dentist. It's not full-timer dentist.

Howard Farran:

You've been doing dentistry for thirty-two years.

Robert Dharma:

Yes.

Howard Farran:

This is what you've seen for thirty-two years?

Robert Dharma:

Yes. Yes. I'm actually very active with these kind of numbers, because I was sixteen and a half years in Bureau of Statistic information, Bureau of Statistic, sixteen and a half years. I published stuff in there. I'm also quite active in the organization, professional organization, in Indonesia Abroad. Yes, that's what we find in this thirty years that I saw. Indonesia produces about a thousand dentists every year, but logistic dentist, may be that number, but practicing dentists may be less than that. Full-time practicing dentist I'm sure is less than thirty-something thousand.

Howard Farran:

That's amazing, because the United States and Indonesia are about the same population. You're two-forty, United States is three-thirty, you graduate a thousand dentists a year, the United States graduates six thousand a year. That's amazing. How many islands are there in Indonesia?

Robert Dharma:

Seventeen thousand.

Howard Farran:

Seventeen ...

Robert Dharma:

Thousand.

Howard Farran:

Thousand. How many of those would have people on them?

Robert Dharma:

I don't know, maybe less than one thousand.

Howard Farran:

Less than one thousand? Is there any other country that's people are spread out on a thousand islands, living?

Robert Dharma:

I don't think so. We're proud of, to call us is the jewels of the what you call it? The jewels islands. We are islands, actually, we are not just a big country. These are big islands, a lot of islands. American country has the solid land. We have a lot more island than solid, big island. There's only five big islands.

Howard Farran:

I'm fifty-three, you're fifty-six, I want to ask you a personal question, a professional personal question. Do you think, in your thirty years, do you think decay is increasing, staying the same, or decreasing, in the three decades that you've been on the front line of fighting tooth decay?

Robert Dharma:

Okay. The first thing that I can see is, there's too much work to do. Too much work to do. It means that I saw a lot of new foods produce cavity. Even the promoter, the toothpaste, the toothbrush, the mouth care, dental care, but the food here is really junk. Only that junk food that we can afford by many, many people. For instance, do you know that kid, they eat a lot of car- what do you call it?

Howard Farran:

Carbohydrates?

Robert Dharma:

Not just carbohydrate, sticky carbohydrate. Five, three years, five years old, it's already in there, that thing, and they don't do the brushing. It used to be like that. Once they have problem with cavity, they don't go to the dentist, they say, "Okay, this is only my baby tooth." And that's happened more and more and more. Yes, in the middle class of kid, I think they take care better now, but middle class is always so small in Indonesia.

Howard Farran:

What percent would you say is the middle class?

Robert Dharma:

I cannot say exactly, but middle class in Indonesia it means they have income, about a thousand US Dollar per month. Maybe about fifteen percent, something like that.

Howard Farran:

Fifteen percent? What percent would be the rich?

Robert Dharma:

The rich, oh ... one percent, maybe, but they own about eighty percent of the capital here.

Howard Farran:

One percent rich, fifteen percent middle class. Let me ask you another way. When you got out of school in 1984, and the average six-year-old kid walked into your office, how many cavities did that average six-year-old kid have thirty-two years ago, versus today?

Robert Dharma:

The DMF statistic that's set, that's still in the same three-point-something like that in Indonesia, but I don't know exactly, because I'm in the Bureaus of Statistic in Indonesia, but the research for that is only come from a few part of the population. A few part is actually the part that is children of someone who works or goes to school. The rest are difficult to count, difficult to be in a survey. This number is very difficult to say, because that number is came from not a very solid well-spread samples. That's the problem. Thankfully, part in Ilium, very, very east Indonesia where it's very, very remote and very, very traditional, they still have very good jaw, very good teeth, because they eat something hard, something raw. They're still in that age. The DMF is very, very low, except abrasion is a lot. Cavities, very, very low. In the city, we eat a lot of sticky carbohydrates, and that's ...

Howard Farran:

I think it's so fun to go to other countries, because in America you have these thoughts about a country, and then you go to these countries, and a lot of times it's totally different. The funniest experience I had was going to India. As I was born and raised, everybody told me that they were Hindus, they were vegans, they didn't eat meat, they were so nutritious, and I went to New Delhi ... I never saw so many people eat so many snack foods in my life. You walk into a dentist's house and his wife would greet you with a platter of pastas and cookies, and I never ate so many sweets in my life. You're saying that in the big cities, the junk food is getting worse, and the rural areas they're still eating healthy.

Robert Dharma:

They're still somewhat eating better in the rural. Most of them who live in Java have junk food tastes.

Howard Farran:

I imagine in a country where the people are living on a thousand different islands, that you couldn't really implement community water fluoridation, that seems ...

Robert Dharma:

The only thing about that ...

Howard Farran:

What's that?

Robert Dharma:

No fluoridation is in the water, drinking water.

Howard Farran:

Anywhere.

Robert Dharma:

Anywhere.

Howard Farran:

What are your thoughts on that? Do you think, is that what the ...

Robert Dharma:

It's too far for us. Too far for us to have that. It's still too far, even for only good drinking water, it's too far for us.

Howard Farran:

What do you mean "too far?" Too expensive?

Robert Dharma:

Not just expensive ...

Howard Farran:

Too far out to do now?

Robert Dharma:

Too far to provide good drinking water to the population. We just drink everything. In the city, they drink bottled, and in the rural area they drink something they got from the wells. There's some of them that they harm the [inaudible 00:14:23] or something like that. Some of them live very, very east ... southern, they just wait for the three months or four months rain and keep that waters. In some part of Jakarta, the capital of Indonesia, they have good water. In one or two estates, they have very, very good water, but that's all. The rest, no. Acid water from acid rain, there's a lot here. You can see that problem in the teeth, especially in part of Kalimantan, part of Bangka, where there's production of tin there, they make a lot of tin there, and the water there is so bad. One part of Sumatra, in the southern part of Sumatra, they eat a lot of vinegar in daily basis. That's the problem.

Howard Farran:

The acid rain is from burning coal?

Robert Dharma:

Whatever. A lot of them burning coal, even burning forests. They burn forests to have the land.

Howard Farran:

You were the president at the Asian Academy of Aesthetic Dentistry, and one of the things I find the most interesting amongst my dental colleagues is, some are attracted to treat kids, which scare me to death. Some, like you, are into cosmetic dentistry, and that just never really motivated me. I always liked the pain chair. I like the person in pain, and being the hero, getting them out of pain, and getting a tooth extracted or a root canal. I like the blood and guts. I always make fun of dentists like you, I call them vegan vampires. Because a dentist who doesn't like blood and guts surgery is a vegan, and it's like, if you're a vampire ... But what made you get interested in aesthetic dentistry?

Robert Dharma:

There's two stories. There's two things. Before I become a dentist, there's two things, and after I become a dentist there's one thing. One is, my father is a dentist, and one time he came home and bring two part of plastic bottles, and said, "Oh, this is so good." You know what he bring home? It's Adaptec, the first composite ...

Howard Farran:

Oh my gosh, I remember that.

Robert Dharma:

Yes, and, "Oh, this material can mimic tooth color. I can mix it." That's the first thing. The second ...

Howard Farran:

Adaptec. Who made that? Was that 3M?

Robert Dharma:

I forgot. Just small, wire. Adaptec. After that, I'm going to dental school, and the third years, someone bring "Change your Smile" book. That's really interest me, and from that time, I make the paper of everything in school as cosmetic dentist or in aesthetic dentistry field. Then after I graduate, I met someone, a patient who don't have any money, but his boss said, "Please treat her." Because this young girl, very shy, because her teeth is not so good. So okay, I make, if I'm not mistaken, three or four fillings. I saw the life-changing of her direct in front of my eyes. How from very shy, now is become very nice girls, and have boyfriends, and then married, and then have a good life.

That picture, that case picture, I bring to San Francisco, I bring to Hawaii in the AACD congress, and that picture won two prizes, one in San Francisco, the first prizes, and in Hawaii second or third prize for that case. That makes me, "Okay, I have to be the hero."

Howard Farran:

You know what? It proves the point that, as dentists, the patient's mental health is more important than their dental health. We're treating a human that needs to be happy and healthy, not a bunch of rocks in their mouth.

Robert Dharma:

Yes. That makes me, "Okay, I have to go this path."

Howard Farran:

Is aesthetic dentistry, do you think, the same in every country around the world, or do you think aesthetic dentistry is used different in Milan, Indonesia, Medan ... Medan, Indonesia, versus where I live in Phoenix, Arizona?

Robert Dharma:

Okay. We don't know about aesthetic dentistry before. All our models go through United States, because they're the first modern cosmetic, aesthetic dentistry. The implementation of the concept of the test book of all the numbers from United States, from Europe and United States, it's very difficult to put it in Asian people. The number is off. For instance, you can have cut the gum only by two millimeters and still have two millimeters that you leave out. We cannot do it here. [inaudible 00:20:08] is very, very clean. Bite type is very sharp teeth. It's quite difficult. The problem, also, because all the metric, or all the system, all the bracket, they're made in the number of Caucasian, not for Asian.

Asia is different profile. Bimax in Asia is normal. It's normal, it's good. Because they use that number of the bracket, they make it as a Caucasian, now we see something strange. Asian, but just like, Angelina Jolie. Asian just like [inaudible 00:20:55]. Something like that, that "Okay, we lose something." Now Japan and Korea are starting to do the better research. Hopefully everything will balance out ...

Howard Farran:

We said that to our instructors at the University of Missouri Can't Say No School, when they were showing us these orthodontic patterns, then they were saying that ninety-five percent of Japanese and ninety-five percent of Africans were under the pathology side, the bimaxillary protrusion, and we're just raising our hand saying, "Well, if ninety-five percent of everybody has something, wouldn't that be the normal?" That's just simple statistics. It reminds me of when the British started making the maps first, they always put Britain on the top, and Australia on the bottom, and I love it when I go to Australia and I see global maps, that has Australia on the top and Britain on the bottom. Explain that, I think that might have spoken up your head, explain what you mean on the aesthetics for Caucasian versus Asian bimaxillary protrusion.

Robert Dharma:

Okay. First thing that I find in my professional life, I saw, first thing is about the movie. Hollywood movie is ... Everywhere, we watch the Hollywood movie. In that line, maybe seventy-something, there's a lot of good movie from Taiwan. Taiwan is in Asia. All of the players, all the movie stars there, have teeth crowned at that time, to make as good as Hollywood smiles, Hollywood film smiles. Everything's like that. At that time, the first time, I say, "Okay. Something odd, but okay, that's the trend." Everyone say that beauty is just like what we saw in the movie.

Howard Farran:

You're saying that Bruce Lee had all of his teeth crowned?

Robert Dharma:

Yes.

Howard Farran:

Are you serious?

Robert Dharma:

Of course. Bruce Lee, and all the women, all the girl, crowned. All.

Howard Farran:

In Bruce Lee's movies?

Robert Dharma:

In Bruce Lee- yes.

Howard Farran:

Wow. I never knew that. When I was a little boy, he was my hero.

Robert Dharma:

Yes. You just try to find old Taiwanese movie, all is crowned. All is crowned. The [inaudible 00:23:24] is the best [inaudible 00:23:25] and crown is the best.

Howard Farran:

Why were they doing it? To make their teeth whiter?

Robert Dharma:

No. Because they want to mimic that film star in Hollywood movies. They have straight, [inaudible 00:23:40] teeth, something like that. Asians slightly protrude, Asians are bimax, actually.

Howard Farran:

So are Africans, right?

Robert Dharma:

More.

Howard Farran:

Africans are more?

Robert Dharma:

Africans more, and longer, thicker, the biotype of the gum is different, and in Asian, the biotype is very thin, biotype is very scalloped. The teeth is short, that's Asian.

Howard Farran:

A couple of things, lecturing in Africa, the African dentists on the ground all tell me they only see a fraction of the gum disease as reported in European countries and America. When in Korea, the founder of Megagen said he started his Megagen implant company because Nobel Biocare would not listen to the failures they were having, and what they were telling them, "Okay, this might work in European people, but this is not working on Koreans. They have a different biting force, a different chewing pattern," and the Swedes were like, "No, no, people are people."

Robert Dharma:

Korean is something ... you're talking about implant. What implant from African people is very easy. Big, a lot of bone, a lot of very good gum. For Korean, also good, because usually Korean have a very big jaw, lower jaw. It's typical that they're, Korean, have a strong jaw, and usually it's quite bigger. Koreans slightly different because the profile or the face structure, the bone structure, is slightly different than the other Asian. Korean and Mongoloid are slightly same, but Japan, even in same three, Indonesia, Maresias, sometimes it's more petite than the ... That's a very, very complex situation. Yes, we can say that nine or ten millimeters implant is standard, but it's not easy to put it in this type of people. Eight millimeters.

Megagen, they make a big one, a very big one, because most of them have a very big jaw, very good muscles there. Now they use a lot of [inaudible 00:26:18] on a lot of borders to reduce the muscle and the bone, to make it ... It's the same as the east part of Indonesia, also, big jaw. Yes, we still develop, we have some research, but we still have to research what we need, actually. Indonesians only have one pattern for implant, and this pattern is produced by Korean, not produced by Indonesians. We start. We start.

Howard Farran:

When you lecture around the world on aesthetic dentistry, what do you like to lecture on?

Robert Dharma:

The first time I lecture is the work bonding, because that time, bonding, I got that concept from [inaudible 00:27:15] something like NYU at that time. That's a real case, okay, bonding, that's very nice. It's very, very, very, very ... It's like I found something that I'm looking for many, many years. The wet dental bonding system, something like that from [inaudible 00:27:34]. That's the first thing that I like about aesthetic dentistry. Before, we do cements, now it's bonding. That's the first time that I really liked about the dentistry, and the first time I go deep through the bonding system. Something I do is a lot of bonding. Then, I have a lot of inspiration from Beyung Sun ... Have you ever heard ...

Howard Farran:

Oh, Beyung Sun and Biscoe foundry outside of Chicago.

Robert Dharma:

Yes. I went there, and the bonding, that's changed three times. That's the first step I like to do. Lately, now, I do two things. One is biomimetic, the other one is minimally invasive, to do, actually.

Howard Farran:

First, do no harm.

Robert Dharma:

Yes, please.

Howard Farran:

Save the tooth. I remember one of my instructors, the first thing he taught me in operative dentistry, he said, "Hey, kids, when your grandma turns ninety years old, if she's still alive she'll have nine teeth, and guess which teeth those are?" We're raising our hand, we're saying, "Incisors, the canines, the premolars." He goes, "No. They're the only nine teeth a dentist never touched. Every time you touch that tooth, you're going to condemn it to re-treatment. If she lives long enough, no matter what you do it will fail, and eventually that tooth's going to be in the trash can. Rule number one, don't touch the tooth."

Robert Dharma:

The most advanced dentistry now is the dentistry that can keep to nature as much as possible.

Howard Farran:

In your practice today, in aesthetic dentistry, is that bleaching, bonding, veneers? Does it include orthodontics?

Robert Dharma:

I'm a GP, actually, I'm a general practitioner ... That's funny, actually. Me, myself, I like and love aesthetic dentistry or cosmetic dentistry, but most of my patient came because painless dentistry. Why? Because I care, I don't want to do too much to their teeth. That makes the patient look for me, not for the aesthetic. That's quite interesting, actually. Now, in my office, I have sort of professional, I'm old so I have to limit my practice. I have my own personal endodontist, I have my own periodontist, I have my implantologist. I've just become the conductor.

Except for people that are really close, patient that I've been close for many, many years, become my patient, and I keep the patient, and now their grandchildren is my patient too, okay, we can interact well. What interesting case, my chart says aesthetic dentistry chart, not for family dentistry. Bridging, I don't do bridging, it's too easy, I have someone else to do it. I like to decide. I like to make a treatment plan. I like that better. Veneer, I like very much. Especially the thin, thin veneer. I do it myself, especially with CAD/CAM, I do it myself, everything.

Howard Farran:

With what kind of CAD/CAM?

Robert Dharma:

CEREC, I use ...

Howard Farran:

So you do veneers with a CERED CAD/CAM?

Robert Dharma:

Yes. I do it. Because this makes a lot easier, I can just melt the block, and then cut back, and then do something to edit. I like that. Stranger, for old people.

Howard Farran:

No. I always tell dentists, at the end of the day, I just want them to be happy and healthy. I don't want them to kill themselves, I don't want them to go home and get drunk every night, I don't want them to eat pills, I want them to just be happy and healthy. If that means buying a laser or being a cosmetic dentist, or treating kids, I don't care. Are you happy? Are you healthy? Because once they start doing something they hate for money to pay their bills, it always ends in a train wreck.

Robert Dharma:

I like it with this CAD/CAM, because I can throw it at stack of porcelain powders. Now the plate just, it's already at the base, comes up to here ...

Howard Farran:

When you say minimally invasive dentistry, some of the cosmetic dentistry, they say minimally invasive means I'm going to do composite direct veneers.

Robert Dharma:

No, okay.

Howard Farran:

Then, some dentists call themselves minimally invasive dentistry, but they prep the teeth, they drill the teeth down a millimeter and a half, so how do you rationalize minimally invasive with preparing teeth for veneers?

Robert Dharma:

Okay. It's very easy to make some explanation with veneers. I like to do orthodontic first before veneers.

Howard Farran:

Okay. You do ortho too?

Robert Dharma:

Why not? Lingual, anterior, why not? This is simple.

Howard Farran:

You then design? How are you doing ... What brand are you doing for lingual and anteriors?

Robert Dharma:

DENTSPLY, GAC.

Howard Farran:

DENTSPLY? TAZ?

Robert Dharma:

GAC.

Howard Farran:

Oh, DENTSPLY GAC.

Robert Dharma:

Yes. Only if for the front. If we can make the teeth straight and bring a little bit back, [inaudible 00:33:36] we'll be.

Howard Farran:

Why do you think braces on the buckle are so popular, but the solution which can be all done on the lingual, is so rare that people go to remove all retainers, which allows the patient to take over on compliance or non-compliance ... Why do you think lingual braces are so slow to catch on?

Robert Dharma:

It's difficult.

Howard Farran:

Difficult for the dentist?

Robert Dharma:

The dentist.

Howard Farran:

Exactly.

Robert Dharma:

That's difficult for the dentist, but in the front it's okay.

Howard Farran:

It's a lot easier?

Robert Dharma:

It's faster. First of all, we have to wait. Few weeks. In Indonesia, we have to wait about eight weeks. For simple crowning on the lower, we have lingual, eight weeks and we're finished. But in a more severe case, yes, we have to wait. But if just mild crowning on the lower anterior, it's very easy to do that.

Howard Farran:

The problem with lingual braces is, when you do braces on the buckle of the teeth, it's a smooth area to bond a bracket. When you bond a lingual brace, you've got the lingual cingulum ...

Robert Dharma:

No, it's not that. It's easier to see direct [inaudible 00:35:00] than it is to see ...

Howard Farran:

You think it's just the direct versus indirect?

Robert Dharma:

Yes, because if you use the indirect placement, it's more cost with that. Now they have the computer-aided design of braces for the lingual ... I don't know, is that not proper and even, I don't want to use it. It's too complicated for me to place that. Even if I try, "Okay, just put that section of holders..." I put it ... No. I have a lot of water guard. If I have the problem, I give it to the orthodontic surgeon who's the best for that, not me.

Howard Farran:

I want to ask. We're running out of time. I want to share something I've observed all around the world- that occupations, they generally run in families. I don't care if you're a goat herder, your dad was a goat herder, your grandpa was a goat herder, it just seems like, wherever I go around the world, if I meet a dentist, in their family tree there's a whole slew of dentists. I have had dinner in houses where literally a dozen dentists, I mean, the mom, the dad, three kids, their wives, I mean ... I think the record was in Brazil. I think there were twenty-seven dentists alive in this one family tree. You said your dad was a dentist. You said your daughter I just met, she's graduating in a year or two. In Indonesia, is the profession of dentistry a family affair? Are most dentists born into dentistry through the family?

Robert Dharma:

Okay. I like you asked this, because I can talk about this one many, many hours. Okay. First, in Indonesia there's one family have more than fifty dentists.

Howard Farran:

So you think it's a genetic disease?

Robert Dharma:

No. The problem with Indonesia is, we cannot separate between the real sector and the financial sector. What we know as a dentist is only the real sector. We live with the real sector that, "Okay, we can live well in the real sector." Why we have to move to other place that we don't know about the financial sector of the life, of the business, of this world. Everyone is going, "Okay, go to dentistry, it can give you good life." But they only know that thing, that's so narrow about the life, about the occupation. In this family with the narrow-minded, most of them, "Okay, after me, you. I have a good life. I can go everywhere, I can have a good car, I have a good home. I have a decent life. Why you not go here?" That's the problem about this kind of situation, what I see in Indonesia. Everyone's like, "Okay, this is ours." Everything we bought with our money, and we got it from there.

They buy their own things, but, actually, it's too much you spent to get something like that. Even to my daughter, I said, "Okay. You learn dentistry because I like it. I hope someone want to be my successor, which I like it, I love it. I ask her, after graduate, you have to go do something else than dentistry at least two years before you choose to go to anything else. I asked her to go to MBA. To go to the financial sectors. I said, "Please, check it, which one is good for you?" In this real sector, to become a dentist, I know a lot, don't worry. But on that financial sector, I'm dumb. Please go. And then discuss. That solved the problem of us. Luckily, this fifty more dentists family have one son, a dentist from England, and somehow his mind is go in the financial sector. And he supported by his sister, also. Quite like this financial sector. I saw this family become very good in this business. Financial sector and the real sector.

That's actually, I decided, "Okay, we have to see out the box, not just the thirty-two teeth only. There's something else that you have to learn. Maybe after this, for the next generation, it can balance it back there.

Howard Farran:

It is true, in the United States if you listed everyone who made fifty million dollars take-home income last year, every single one of them is in insurance banking and finance.

Robert Dharma:

Yes.

Howard Farran:

It's not dentistry and dermatology and obgyn.

Robert Dharma:

Yes, yes. They don't know, but, okay, I get one hundred, it's one hundred for me, they don't know what ... This company, you'll only get maybe thirty percent or forty percent of the [inaudible 00:40:48] for the company. They don't ever think that. They don't even think about the position of the investment. They don't think that you have to spend so much money to get so little compared to all the others. [inaudible 00:41:04]

Howard Farran:

Do you still like to lecture?

Robert Dharma:

Not as much as before.

Howard Farran:

How many times have you lectured?

Robert Dharma:

In a year? Ten, fifteen?

Howard Farran:

Ten or fifteen a year? You think we could ever get one of your courses on DentalTown? Then these dentists would be able to watch it on their iPhone.

Robert Dharma:

I will show some concept that I tried to build. It's a concept that we called monolithic. Actually, it's one step ahead from no post, no crown, after endodontic. Because there's new material, and I make a hybrid ceramic that we have now. It looks so nice, I think this concept can be used to minimize the use of crown and post by most of the dentists for molars area. The standard is, after endodontic, post, crown. I have an arguing with the university, I said, "No, you do mutilation, you not do preserving. You cut, cut, cut, cut, cut it, and then finish, and then you do the extraction and the implant. If you do monolithic restoration with this new material, available, you can reduce the use of posts, the use of crown, where you have to mutilate the tooth. Maybe I can start it. I like that.

Howard Farran:

I wish you would, because some of it just gets crazy, like on lower incisor root canals. They'll say, "Well, to save the tooth I need to shave all the remaining teeth structure down." When they're done prepping it, the only thing there is is the gutta percha, and it's like, you just mutilated the entire tooth to save it?

Robert Dharma:

Yes. That's how you have to do a crown to protect the tooth. What you protecting? You ground off everything.

Howard Farran:

Yeah. I love these podcasts and I love these online e-courses on the iPhone and the Android phone, well, the smart phone, because I never ever see a dentist. I always think, there's seven billion humans, there's only two million dentists, and every time I see a dentist, I only think about the three thousand people in that village counting on that dentist to take care of them. Any course you can put up, if it only helped one dentist in each continent, save ... I mean, the leverage is amazing. Help a dentist, you help, what is the number, Ryan? What was seven billion divided by ...

Ryan:

It's about thirty-five hundred.

Howard Farran:

Yeah, I mean, helping a dentist is the ultimate leverage, because ...

Ryan:

By the way, we've got more time, just keep on going.

Howard Farran:

Every time you help a dentist, you help thirty-five hundred humans. How can you not want to teach dentists, when the word "doctor" comes from "docere," meaning "teacher," knowing that when you teach that one doc, thirty-five hundred people are going to have better dentistry.

Robert Dharma:

For me, I just want to go down to the word again. "Doctor" means "guru." "Doctor" means "teacher." In the words of "doctor" came from Greek, it means "teacher." Why not do it? Your life as a doctor, as a teacher, a doctor is a teacher. The meaning of "doctor" in Greek is "teacher." Why not teach to someone, either to a colleague, to someone else, up to you, but, be a teacher. Maybe in dentistry I like better be sharing. I'm not the one who knows and knows and knows. Everybody knows something and can share it.

Howard Farran:

That is one of the greatest things in the book "The Seven Habits of Highly Effective People," it's talking about, don't think in fear and scarcity, think in abundancy.

Robert Dharma:

Yes.

Howard Farran:

I always notice that the dentists who shared the most, helped their fellow dentists the most ...

Robert Dharma:

Get most.

Howard Farran:

Get the most. They get the most ...

Robert Dharma:

Everything.

Howard Farran:

In everything.

Robert Dharma:

Not just money. You get happy, you get friends, everybody go it's nice place because the people nice to you.

Howard Farran:

Yeah. I think you're a wonderful person.

Robert Dharma:

Thank you.

Howard Farran:

Thank you so much, at the end of a long conference, to spend an hour with me on a podcast. I really do hope you grace our site with a course that you're talking about on a root canal post fill-up crown alternative with new materials, and congratulations that you're born from a dentist and you created one to replace you. I tell my four boys not to go to dental school, it will be a lot cheaper just to marry a dentist. If your daughter's not married yet, I have four ... I only have one married, I have three single boys, and, let's see, I'm trying to think of which one I'd want to get married and move off to Indonesia. That's you Ryan. You're here. Hey, thank you so much, though.

Robert Dharma:

Thank you so much. It's a pleasure to meet my guru, my first guru in dental economics.

Howard Farran:

Am I? Is that right? I was your first ... Those must have been desperate times, if I was your first guru.

Robert Dharma:

No, because I see, my father a dentist, and my nephew is all dentists, and then same part, do traditional dentistry. Then you came with thinking about the financial sector, the money. It's not something bad, money. It's good. How to make it, not something many profession, yes? Do something that you have to do for money, and do the professional things to be professional. That I cannot find it in my father and also my nephew. That's what happened.

Howard Farran:

Well, it was an honor to be your first financial guru.

Robert Dharma:

Thank you.

Howard Farran:

All right. Thank you very much. Thanks, Ryan, for filming the podcast and for being the butt of all my jokes.