Dentistry Uncensored with Howard Farran
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371 Aesthetic Dentistry Society of Singapore with Gerald Tan and Guru Othayakumar : Dentistry Uncensored with Howard Farran

371 Aesthetic Dentistry Society of Singapore with Gerald Tan and Guru Othayakumar : Dentistry Uncensored with Howard Farran

4/21/2016 5:02:33 AM   |   Comments: 0   |   Views: 369

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VIDEO - DUwHF Gerald Tan and Guru Othayakumar


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AUDIO - DUwHF #371 - Gerald Tan and Guru Othayakum


Dr Tan graduated from the Faculty of Dentistry, National University of Singapore with a Bachelors of Dental Surgery. Dr Tan obtained his first post-graduate qualification from the Royal Australasian College of Dental Surgery in 2007 and his second from the Faculty of General Dental Practice and Faculty of Dental Surgery, Royal College of Surgeons of England in 2008. He is also currently enrolled in the Certificate of Oral Implantology Program, University of Frankfurt.


After graduation with his bachelors degree, Dr Tan served as a dental officer in Singhealth before moving out full time to private group dental practice.


He has special interests in Cosmetic Dentistry and Dental Implant Surgery. Besides attending numerous conferences both locally and internationally, he is active in promoting Aesthetic Dentistry in Singapore (ADSS) and the region . He was most recently voted in as the youngest President of the Aesthetic Dentistry Society of Singapore. He has identified cosmetic dentistry as an emerging trend and is continuously seeking to upgrade his skills and knowledge in this field.


His professional memberships are listed below:

1. American Academy of Cosmetic Dentistry

2. Chicago Dental Society

3. Faculty of Dental Surgery, Royal College of Surgeons of England

4. Faculty of General Dental Practice, Royal College of Surgeons of England

5. Fellow of the Royal Australasian College of Dental Surgery

6. Aesthetic Dentistry Society of Singapore

7. Singapore Dental Association

8. Singapore Medical Alumni Association

9. International Federation of Aesthetic Dentisty

10. Asian Academy of Aesthetic Dentistry


Besides his busy private practice, Dr Tan is committed to promote the art and science of aesthetic dentistry to the public through awareness campaigns as well as to organize scientific symposiums for fellow dental colleagues through the ADSS.


Dr Guru Othayakumar received his Bachelor of Dental Surgery from The University of Adelaide 2008 - 2012. 


Dental electives, placement, and achievements:

  • Level 1 association, Australian Society of Implant Dentistry (2012)
  • Rural dental placement in Whyalla (2012)
  • Periodontal research selective with Dr Kaur (2012)
  • Prosthodontics lab research with Dr Fung (2012)
  • Geriatric Nursing Home Visits selective (2011)
  • South Australian Certificate of Education, Sacred Heart College Senior (2007)

Howard:

Welcome. This is a huge treat. I'm in Singapore in Dr. Gerald Tan's office, who is the president of the Aesthetic Dentistry Society of Singapore. Thanks for letting me come into your office today.

 

Gerald Tan:

You are most welcome, Howard.

 

Howard:

You're with your friend who is your Guru, because that's his name, Guru. I think that's the most awesome name I've ever heard. You're name is Guru ... How do you pronounce your last name?

 

Guru:

Othayakumar.

 

Howard:

Say it again.

 

Guru:

Othayakumar.

 

Howard:

Othayakumar. You graduated 2003, so 13 years ago, and you graduated, what?

 

Guru:

Three years ago.

 

Howard:

Three years ago, and you graduated from Adelaide.

 

Guru:

That's right.

 

Howard:

Australia, which being in Singapore is about what? Fifteen hundred dentists?

 

Guru:

Yeah, around about that.

 

Howard:

I've already met probably a dozen that graduated from dental school in Australia. That seems to be very common if to graduate from Australia. Tell me, Gerald, how did you ... Congratulations on being the president of the Aesthetic Dentistry Society of Singapore. What is that like? What's the study of dentistry like in Singapore these days?

 

Gerald Tan:

I study dentistry as a growing trend. We see a lot of people wanting to get their teeth look more pretty, so they are actively searching the internet for good cosmetic dentists. I think that there is a growing market for it, and that's why I decided to take part and volunteer in the society, and then after a few years of volunteering, I got voted in to be the president, so it's been great so far.

 

Howard:

What is cosmetic dentistry mostly in Singapore? Is that invisiline, is that bleaching, is that veneers?

 

Gerald Tan:

Yeah, a bit of all the above. It depends on the case. Generally speaking, patients have a rough idea of what they want, but they have no idea of what is possible, what treatment that they possibly could get to achieve that result that they may want. They come in for a consult and an exam, and then we just recommend according to what we see and according to what they want.

 

Howard:

Do you do more ortho, do you do more veneers?

 

Gerald Tan:

Both, yeah.

 

Howard:

Ortho and veneers?

 

Gerald Tan:

Ortho, veneers, whitening, bondings, changing out old amalgams. Those are really common requests. [inaudible 00:02:56] closures, the whole range of different things. Not dissimilar to the aesthetic demands of an average American patient, for example. American patients just want it really bright and white, but Asian patients don't really want to overdo the whiteness of their teeth. They still prefer to have a tinge of yellow.

 

Howard:

Yeah, I've noticed since I've been here. I haven't really seen anybody with the B1 or the toilet bowl ...

 

Gerald Tan:

Extra bleach white? Yeah.

 

Howard:

Kitchen sink bleach white. I don't think I've seen anybody, really, with that shade. It seems like most countries are more into natural shades. America seems to be the queen of the toilet bowl.

 

Gerald Tan:

Yeah. B1's, extra bleach whites. Yeah.

 

Howard:

Yeah. Is your orthodontic tend to be more fixed bands and brackets or does it tend to be more removable clear liners?

 

Gerald Tan:

Both, yeah. It depends on, again, the patients' wishes and needs. We offer both fixed as well as clear aligners. Of course, the top brand here would be Invisalign.

 

Howard:

What do you personally like better to achieve your results?

 

Gerald Tan:

Fixed braces, yeah.

 

Howard:

Because why?

 

Gerald Tan:

Because we get better fine control over the tooth movement and I feel that it's not as finicky as the clear aligners. Sometimes it's not as predictable as the fixed arch wire kind of braces.

 

Howard:

What about patient complaints?

 

Gerald Tan:

Patient complaints, as long as you manage their expectations right from the get-go, it's not such a huge issue.

 

Howard:

With removable ...

 

Gerald Tan:

With ...

 

Howard:

I mean, with fixed bands and brackets the dentist is in control of the compliance. With clear aligners, the patient is in charge.

 

Gerald Tan:

Yes. Yes, of course.

 

Howard:

Do you find longer, treatment compliance, longer treatment times, treatment lengths when the patient is in control of being able to take the liners in and out?

 

Gerald Tan:

Well, anecdotally, yes, but I take a lot of time and effort to sit down with the patient before treatment to ensure that the patient understands that a certain amount of discipline is required, if they would so chose to have a clear aligner. If I feel that this patient is not going to be cooperative or this patient is unable to have that certain level of discipline, I would just say, "You know what? You're probably not suitable for this," because it's a huge headache if patients don't comply and then they don't understand and then they complain, "Why is this taking so long?" You know? The treatment planning stage and the informed consent stage is so very important in my office.

 

Howard:

I want you to talk more about the orthodontic needs in southeast Asia because America is about six percent Asian. It's about 15 percent African Americans, 15 percent Hispanic, the other half is European. Asians have a different mix of orthodontic treatments than, say, people from Europe. Would you agree?

 

Gerald Tan:

I would.

 

Howard:

What tips could you give Americans where you do more ortho on Asians? Is there any more tricks, lessons learned? Because you probably have done more Asian orthodontic cases than a 60-year-old orthodontist in America.

 

Gerald Tan:

Yeah, for sure. Generally, from my experience Asian patients are not as demanding and not as difficult as some of the Caucasian patients that I've seen. I really don't know why. When an Asian patient has made up their mind that they want ortho done, they usually set their mind to having the discipline to finish. I just can't explain it. Maybe it's just the culture here.

 

Howard:

That would be the psychological part.

 

Gerald Tan:

That's the psychological part.

 

Howard:

I mean the Asian bimaxillary protrusive, and you treat more ...

 

Gerald Tan:

Yeah, a little more bimax protrusion cases, a lot more class 2, [DF 00:07:29] 1 and 2 cases. Not so many class 3. Would you say you see a lot of class 3? Maybe once in a while, but more class 2 cases, yeah?

 

Guru:

We've got a lot of bimaxillary protrusion. I think if you compare it to the Australian population, I think I see more class 3's here and a lot of orthognatic surgery with ortho, I think, just from some of the national institution here.

 

Howard:

There's lot of orthognatic surgeries done in Singapore?

 

Guru:

Yeah, for ortho, I would say.

 

Howard:

For class 3's?

 

Guru:

Mm-hmm (affirmative).

 

Howard:

Are those usually treated successfully?

 

Gerald Tan:

I would say so, yeah.

 

Guru:

Yeah, I would say so. Yeah.

 

Gerald Tan:

Most of these cases are treated in the government hospitals, in the big hospitals. We hardly see big orthognatic cases done in private practice. They will go to a huge government hospital, and an oral surgeon working there wold take over the case together with the orthodontist.

 

Howard:

When your elite dental group and being president of the Aesthetic Academy, do you also do endo or pediatric dentistry? Do you do [inaudible 00:08:50] or do you just try to focus on cosmetics?

 

Gerald Tan:

Yeah, I focus on cosmetics. We have a teamwork approach in our office, so our associates, like Dr. Guru, would handle, for example, the endos. I've made a choice not to do any endos because I really dislike endos, so I pass all the endo cases to Dr. Guru, and Dr. Guru, maybe he dislikes surgery, so he passes all the surgery down to me. We have a teamwork kind of approach here.

 

Howard:

You're doing more surgeries?

 

Gerald Tan:

I do a lot of surgeries.

 

Howard:

For implant placement?

 

Gerald Tan:

Yeah, implant placement.

 

Howard:

What system are you placing?

 

Gerald Tan:

Megagen, Straumann [crosstalk 00:09:37]

 

Howard:

Why is that? Why Megagen? Straumann? You said Straumann, too? Straumann bought a chunk of Megagen, right?

 

Gerald Tan:

Mm-hmm (affirmative).

 

Howard:

Do you know how much?

 

Gerald Tan:

I don't know how much, but I know Megagen is partly owned by Straumann.

 

Howard:

Yeah. Why do you use Straumann and Megagen?

 

Gerald Tan:

Well, we have two different systems. We have two different systems, and we offer two different systems to our patients because we see a whole range of different patients, and some patients are a bit price sensitive, so they would ask if we have a cheaper implant system so that they simply don't have to pay so much. The Straumann system that we offer is the high end ones for patients who want the best, and then Megagen would be a cheaper alternative for patients who are a bit more price sensitive.

 

 

I like Straumann and Megagen because I'm comfortable dealing with it clinically. I've been for the courses, I know the suppliers, we have a great relationship, and the price is right, too, for my office.

 

Howard:

Have you ever been to Seoul, Korea to see the Megagen [crosstalk 00:10:48]

 

Gerald Tan:

I have, yes. I have.

 

Howard:

You have? Really? How far of a flight is that from Singapore?

 

Gerald Tan:

I travel with Tommy and Andy.

 

Howard:

Right. How far a flight is Seoul fro here?

 

Gerald Tan:

I forget. I think seven hours maybe.

 

Howard:

Okay. Long way. How was that?

 

Gerald Tan:

That was fun, yeah. That was fun.

 

Howard:

Fun times? I'm so excited the rest of my life when someone asks me, "Who is your Guru?" I'm going to say, "Guru." His name is Guru. Your mom named you after the Guru? After the  term?

 

Guru:

Well, my parents back in the day were pretty superstitious. I think with Indian people ... You can calculate with Indian numerology what name you should give and stuff like that.

 

Howard:

Seriously?

 

Guru:

Yeah, yeah, yeah. They ended up with Guru.

 

Howard:

I never even knew anybody was named Guru. Sorry, Ryan, I did not think of that when I named you.

 

Guru:

It's not an uncommon name in India, I don't think.

 

Howard:

It's not an uncommon name in India?

 

Guru:

Yeah, it's not uncommon. Yeah, there are a fair few people called Guru, I think.

 

Howard:

How do you divide it up, then? There's two of you working here. You do the surgeries, you do the cosmetics. You do endodontics?

 

Guru:

Yes. Obviously, he's patient based, and then I've got my patient base as well, and so obviously aesthetic stuff as well. I'll do it. [crosstalk 00:12:09]

 

Howard:

You kind of have separate patient bases or do you guys both work on the same patient or ...?

 

Guru:

We do sometimes, as in for surgical cases, like big surgical cases I'll refer to Dr. Gerald, and then for some of his endo cases, it will be mine, but then if it's aesthetic cases, he's got his own aesthetic cases. I've got my own aesthetic cases. We've got separate cases as well, but sometimes we do cross over when ...

 

Gerald Tan:

We help each other out.

 

Guru:

Yeah, we help each other out.

 

Gerald Tan:

Yeah, we help each other out. The patient feels good because patients can see that they've got several dentists looking after them, and patients appreciate that we have a joint consultation with myself and Guru in the room together with the patient, if patients feel that they're being cared for by two or three different other dentists. We also have visiting consultants, visiting specialists that come on an ad hoc basis. When we need them, they'll come.

 

 

We have a visiting prosthodontist. We have a visiting oral surgeon. We have a visiting anesthetist. In Singapore ...

 

Howard:

Anesthetist?

 

Gerald Tan:

Yes, anesthesiologist? Anesthetist.

 

Howard:

You put them to sleep?

 

Gerald Tan:

Mm-hmm (affirmative). We have a licence in our office for intravenous sedation. We do offer nitrous, but a lot of times, from my experience, this is anecdotally, for a big case, nitrous is simply just not enough. Patients would rather be put to sleep. We work with a very talented anesthetist. He comes in. He sets up a drip. The patient drifts off to sleep and I do my think. The anesthetist will sit and observe and watch the patient's vital signs as I'm doing the surgery, whatever I need to do, and when I'm done, the anesthetist will wake the patient up, and then he leaves. Great. I love this system. That's something that we offer, too, in our office.

 

Howard:

Is that [crosstalk 00:14:05] word of mouth referral practice builder, word gets out [crosstalk 00:14:10]

 

Gerald Tan:

Yeah, I would say so, yeah. I have identified that the main issue that people have in Singapore visiting the dentist is dental anxiety. I initially thought it was cost, but when I did a survey, the number one reason why people don't go to see the dentist here, from my experience, is anxiety, fear. Irrational fear of the dentist.

 

 

The second issue that people have is convenience. People don't go to see the dentist because it's inconvenient for them to see the dentist. Is the dental office near train station, for example. Is the dental office open in the evenings or at nights? Is the dental office open during the weekends? Because most people work from 9:00 a.m. to 6:00 p.m. and they're only free to see the dentist after 6:00 p.m. Most people take a bus or take a train, and it would be great if the dental office is right next to a train station. If the dental office is far off, they say, "Aw, it's just too inconvenient to see a dentist."

 

 

We're located at this area where it's really easy for patients to come by train or by bus, and for those patients who drive, we've got really good, ample car park space so they can just park their car and take the lift up. So convenience, dental anxiety top two, and the third one is price. "Too pricey to see the dentist."

 

Howard:

What percent of Singaporeans use care versus public transportation, train, bus?

 

Gerald Tan:

I have no idea, but if I were to make a guess, it would be 10 percent.

 

Howard:

Ten percent what?

 

Gerald Tan:

Of Singaporeans drive.

 

Howard:

Ninety percent take public transportation? Yeah, I've noticed that most people don't use a car. Correct?

 

Gerald Tan:

Mm-hmm (affirmative).

 

Howard:

Ninety percent?

 

Gerald Tan:

It's very, very expensive.

 

Howard:

Explain the car situation. You have to buy a license?

 

Gerald Tan:

You have to buy a license to buy a car.

 

Howard:

How much is a license, usually?

 

Gerald Tan:

It's a Certificate of Entitlement. That's what they call it. Certificate of Entitlement. It's a COE. That certificate entitles you the privilege to buy a car.

 

Howard:

How much is that?

 

Gerald Tan:

It ranges from 50 thousand to 100 thousand Singapore dollars just to get that certificate.

 

Howard:

Then when you buy a car, you can only keep it for ten years and then you've got to ...?

 

Gerald Tan:

Not quite. You can keep it for ten years, and then after ten years you've got to buy another certificate to extend that privilege of owning the car for another ten years.

 

Howard:

What was the logic behind ... Singapore's logic to have 90 percent of the public ...?

 

Gerald Tan:

Our transport minister thinks that because Singapore is such a small country, they want to control the vehicle population. They don't want to create a city like [Jakarta 00:17:09], like Bangkok where you've got too many cars and everyone's stuck in a jam all the time, so they thought it would be a brilliant idea to tax the people so only the rich people can drive.

 

Howard:

Singapore doesn't have natural resource, doesn't make it's own gas or oil, right? You have to import all the gas.

 

Gerald Tan:

Our natural resource is our people.

 

Howard:

Do you know many other dentists that are doing IV sedation? Is this ...

 

Gerald Tan:

I do.

 

Howard:

Is it very common? Out of 15 hundred dentists in Singapore, is this very common or ...?

 

Gerald Tan:

Well, you're sitting in the Orchard Road belt. This is the main central activity hub of all of Singapore. That's like the Rodeo Drive of Singapore. You're sitting in this stretch right now. All the top dentists are here. Most of the top dental offices in this belt, in this street, do offer that option of intravenous sedation. The further out you go to the smaller suburbs, you get smaller clinics and they don't offer that.

 

Howard:

I heard all the gurus were on this street.

 

Gerald Tan:

Yeah. That's right. Yeah.

 

Howard:

You said anxiety was the number one. Convenience was number two. What are your hours?

 

Gerald Tan:

We open our office at 8:30 in the morning until about 6:30 at night, in the evenings. Saturdays we open from 8:30 to about 1:30 p.m. We close on Sundays.

 

Howard:

How many hours do you work a week?

 

Gerald Tan:

Oh gosh. I work those hours. From ...

 

Howard:

How many is that?

 

Gerald Tan:

I forget. It's eight hours a day, so that's 40, maybe 45 hours a week.

 

Howard:

Is it 45?

 

Gerald Tan:

Forty-three? Five and a half, yes.

 

Howard:

Figure it out.

 

Guru:

That's about right.

 

Gerald Tan:

Forty-five, yeah.

 

Howard:

I find it very interesting in southeast Asia that most dentists work 45 to 52 hours a week.

 

Gerald Tan:

In the US it's 32, right?

 

Howard:

When you go the United States, I say, "Well, what is your big problem?" They go, "Well, I've got 350 thousand dollars of student loans and I bought a practice for 600 thousand and a house for 600 thousand and I'm 25 years old and I'm a million dollars in debt and I'm stressed out of my mind." I say, "Well, what are your hours?"

 

 

"Monday through Thursday, 8:00 to 4:00." It's like, "You don't even have a full-time job." Then when you say to the American, "Well, maybe one way you could make a lot more money is you could work like an Asian and instead of working 32 hours a week ...

 

Gerald Tan:

It's a culture here in Asia.

 

Howard:

... you could work 52 hours a week."

 

Gerald Tan:

We work really hard yeah.

 

Howard:

They immediately say, "Well, no. I want to work smarter, not harder." The last thing an American wants to hear, "Is you know what you ought to do? Why don't you just work five and a half days a week?" When I opened up my practice, I opened up in 1987. I opened up 7:00 to 7:00 Monday through Saturday and I did it for a decade, but I paid off all my bills. I saved up a million dollars. All that stuff like that, but it's just hard to get ... Why do you think every other dentist site ... Everybody I meet in Singapore works 45 to 52 hours a week and in America they work 32? Why do you think that is?

 

Gerald Tan:

I think it's part culture. In Asia all of us have this culture of being really hardworking. We just simply just do not want to lose out. We just want to work hard, like you said, clear our debts, and being men, I suppose, we have to upkeep that image of being the breadwinner for the family, and for us who are privileged enough to own a practice, like you and me, this is our baby. We get consumed by it. Naturally, we think about our practice day and night because we want to work in it and we want to build it up. We want to build a goodwill. I cannot imagine any practice owner not wanting to work hard to build up the practice.

 

Howard:

I want to ask another thing. Do you think it's an advantage or disadvantage that there's not insurance in Singapore, because you practice next to Australia and New Zealand, which is huge, a lot of dental insurance. Everybody knows that the United Kingdom, their NSH pays very, very low and America is, I think, last I read in American only three percent of dentists don't take insurance. Do you wish Singapore had dental insurance or are you glad ...

 

Gerald Tan:

We actually do. We actually do have dental insurance.

 

Howard:

It's not a big part of your ...

 

Gerald Tan:

It's not a big part, but we do. We do have dental insurance.

 

Howard:

Talk about dental insurance. What's dental insurance like in your practice in Singapore?

 

Gerald Tan:

Well, the individual Singaporean person is not able to buy individual dental insurance plans. However, if you are a business owner, you can purchase dental insurance plans for your entire company, for all your employees. Those companies who have employees that enjoy dental benefits by way of their bosses buying for them dental insurance plans, they can go to dentists in a approved list and get dental treatment done and paid for by the insurance companies.

 

Howard:

Is it very common, though?

 

Gerald Tan:

It's getting more and more common.

 

Howard:

What percent of your patients have dental insurance?

 

Gerald Tan:

Thirty?

 

Guru:

Thirty.

 

Howard:

You think 30 percent?

 

Gerald Tan:

Seventy percent private paying patients but 30 percent insurance.

 

Howard:

That's the highest percent that I've met so far. Most of the dentists I've met so far say that it's under five percent. Like ...

 

Gerald Tan:

In Singapore?

 

Howard:

Yeah. So far of the dentists that I've talked to. They say it's about five percent, but you're ...

 

Gerald Tan:

My office is quite new. I just created this office less than two years ago, so for new practices, it does make sense to work with insurance companies just to build up that patient flow, especially when we're in a mall, like this, we're in the seventh floor. We hardly get any walk-ins. Not like today's dental is a huge building all by itself. The visibility is high. Patients see your practice and they just walk in. We hardly have any walk-ins, so we really depend on tie-ups with insurance companies just to get that flow, that initial flow. Once we've built th goodwill, we start to taper off with the insurance.

 

Howard:

I like to talk about things that are different with your country versus others. Talk about your advertising roles in Singapore versus, say, Australia or the United States?

 

Gerald Tan:

The Singapore government, or more specifically the Ministry of Health here, has set out a set of very, very strict publicity guidelines. I'll just summarize these guidelines for you. We're not allowed to have before and after photos in any of our marketing material. We're not allowed to have celebrity endorsements in any of our marketing material. We're not allowed to have patient testimonials, whether it's a good testimonial or a good review or whether it's a bad review, all reviews are against the law.

 

Howard:

A patient can't leave a Google review?

 

Gerald Tan:

No. It's against the law.

 

Howard:

Google doesn't not allow reviews, then?

 

Gerald Tan:

Google allows patients to write the review, but the responsibility of the owness is on the practice owner or the dentist to ensure that patients don't put reviews up on Google.

 

Howard:

If one of your patients left and said, "I really like you," and put a nice review, then you would try to contact that patient to take it down?

 

Gerald Tan:

To take it down, absolutely right.

 

Howard:

Seriously?

 

Gerald Tan:

It's ridiculous. It's ridiculous.

 

Howard:

Wow. Now, on your private website can you put before and after pictures?

 

Gerald Tan:

No.

 

Howard:

No?

 

Gerald Tan:

No.

 

Howard:

In a way, that just means that you can't rely on external advertising. You have to do internal.

 

Gerald Tan:

Internal, yeah.

 

Howard:

Then what do you do to build a practice since you're not allowed to do external, direct mail, fliers and all that?

 

Gerald Tan:

We have patient referral programs. We have a robust system to thank our patients for referring to us. We're currently building on it to try and improve on it. Maybe you can give me some tips. We feel that building the office goodwill by way of word-of-mouth referrals is the strongest and best way because our business is built on trust.

 

 

Like you correctly said in your lecture yesterday, patients who get referred to us by existing happy patients tend to spend three times more than those patients that have seen us, got to know us through a magazine or for a website or fancy article somewhere in the papers or whatever, yeah. We get a lot of shoppers, dental shoppers. They see an advertisement and then they call and make an inquiry, but they're not so serious about making an appointment. Do you have experience with those kind of patients?

 

Howard:

Oh, all day long.

 

Gerald Tan:

Oh, I'm sure. Yeah. I've tried. I've tried and tested spending a huge amount of money on fancy advertisements and ...

 

Howard:

I thought you just said you can't really advertise.

 

Gerald Tan:

We can, but to a very limited to degree. We can have a fancy advertisement with a fancy tagline, but we cannot advertise promotions, like, for example, discounts. We cannot use [lodgitary 00:27:47] terms like, for example, I cannot say, "I'm the most gentle dentist in Singapore." I cannot say, "I'm the most famous celebrity dentist in Singapore." I cannot say, "I'm the cheapest dentist in Singapore," whereas in the US you can make such claims, right?

 

 

Celebrity Hollywood dentist. You can say whatever you want about yourself, but if you dare to make that claim, you better live up to that expectation, right? In Singapore, because our Ministry of Health wants to create a level playing field, they have all these restrictions. A level playing field between the smaller boutique offices like mine versus the big chains, but there's only one big chain. There's only one Aspen in Singapore.

 

Howard:

There's an Aspen Dental in Singapore?

 

Gerald Tan:

No, no, no. I'm just saying an Aspen equivalent.

 

Howard:

What is the name of at one?

 

Gerald Tan:

Q&M.

 

Howard:

Q&M, right.

 

Gerald Tan:

Yeah, Q&M.

 

Howard:

Then in Australia it would be 1300 Smiles and Pacific Dental?

 

Guru:

Yeah.

 

Howard:

Pacific Dental?

 

Guru:

Yeah.

 

Gerald Tan:

Aspen is what? One hundred and fifty practices now?

 

Howard:

In the United States?

 

Gerald Tan:

What is it? No? Aspen?

 

Howard:

Oh, Heartland has 15 hundred.

 

Gerald Tan:

Okay.