Dentistry Uncensored with Howard Farran
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373 Q and M with Raymond Ang : Dentistry Uncensored with Howard Farran

373 Q and M with Raymond Ang : Dentistry Uncensored with Howard Farran

4/23/2016 6:49:45 PM   |   Comments: 0   |   Views: 382

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Q & M Dental Group was first established in November 1996 in Singapore. We have firmly established our brand name in Singapore, and built a reputation as an established and reliable dental healthcare services provider with multi-disciplinary expertise. From a single clinic with one dental surgeon at Bukit Batok back in 1996, we now have more than 60 clinics strategically located island-wide. Our clinics are highly accessible as they are conveniently located near amenities like bus interchanges and MRT stations.

In addition, we have a pool of more than 180 experienced dentists who are well supported by a team of approximately 300 Dental Surgery Assistants.As the largest private dental healthcare group in Singapore, we currently serve more than 600,000 patients island-wide, providing a comprehensive range of primary care dental services, as well as specialist services which are handled by our dedicated team of dental surgeons with post-graduate training. Patients can choose to pay via Medisave for selected procedures.

www.QandM.com.sg


Howard:

So this is a huge, huge honor for me and all my guests today. I'm in Singapore with Doctor Raymond Ang.

 

Raymond:

Hello. Great to meet you.

 

Howard:

Great to meet you. You are another, what I call a rare dental unicorn. You and your classmate got out of dental school in 1996. You and doctor Ng.

 

Raymond:

Ng. N-g. Ng.

 

Howard:

It's spelled N-g, but it's pronounced Ung?

 

Raymond:

Correct.

 

Howard:

So your last name is Ang.

 

Raymond:

Yes.

 

Howard:

A-n-g.

 

Raymond:

That's right.

 

Howard:

He doesn't have the A, so you're Ang and he's Ng?

 

Raymond:

That's right.

 

Howard:

So Dr. Ng Chin Siau. You guys started...

 

Raymond:

Q and M.

 

Howard:

QandM.com in 1996 with an IPO in 2009 of 30 dental offices owned by 18 dentists and now in 2016 it's over a hundred million dollar company.

 

Raymond:

Yeah, that's right. Me and Dr. Ng, we were classmates in dental school. After we graduated we kind of did our own thing. Dr. Ng started Q and M Dental Group with only one clinic in 1996. From there, we got like minded dentists together. Dentistry has always been a fragmented profession in Singapore and around the world. Everybody's sole prop. So we figured that there's a market for a big dental group. There are big medical groups, but why not dentistry?

 

 

We got together and got 18 partners in all from 1996 to 2009. Where we actually got listed on Singapore's stock exchange. We did pretty well from then on-wards. From 30 clinics in mid 2009 to date we have about 70 clinics in Singapore. We have got big dental centers in Singapore.

 

 

More importantly, we have actually crossed borders. We've got clinics in Malaysia, we have 4 in Joho Baru, 3 in Kawalan Rumpai, 1 in Melaka and more importantly we have hit a very important market in China where many people struggle.

 

 

In fact, we have 3 dental hospitals in China now. We have 3 dental poly clinics running in China. I think we have grown by leaps and bounds in Singapore and in Asia especially. We in the dental industry, we are also in dental supplies and equipment business. We have our distributor ships in Singapore and Malaysia and in China we actually have a whole factory producing Zirconia dental blocks to supply around the world.

 

 

Industry is quite a big thing for us and then we are actually doing a lot of work in that area. I think there are not many companies like us. We are dental entrepreneurs. Dentalpreneurs if there is such a word. That's what we are. We hope to inspire everybody. Not just to be in their clinic seeing patients, but there's a whole business world. Dentistry could actually be a viable business around the world.

 

Howard:

What would be the advantage of dentist in Singapore of just being by myself working for myself versus selling my office to QandM and being part of the corporate world? Why would a dentist want to do that?

 

Raymond:

First of all, there are numerous advantages in terms of... Dentistry, dentists love clinicals. Doing an implant is fun, taking out wisdom tooth is fun, cutting a crown, doing root canals are fun. What's not fun? Paperwork. What's not fun? When you staff calls up and says, "I'm not coming in today." You need a nurse to come in and replace them. What's not fun? Managing inventory. Things like this are really not fun. Where clinical dentistry is fun.

 

 

What we can offer is we take the un-fun parts out because we have a full management team handling that. Let dentists focus on dentistry and let non-dentists focus on the rest of the stuff. That is the primary advantage. When we do a major acquisition in Singapore, we can help you with everything from marketing to inventory, to stocks, all your paperwork, man power, everything. Our team handles it for 70 other clinics. What's one more clinic? No big deal. That's one aspect of it.

 

 

The other aspect of it that most dentists don't realize is that even the fun stuff has a shelf life. By the time you reach late 50s, early 60s, you and I know. Your eyes are not as good as before. You get this ache on your neck, that kind of stuff. What are you going to do with this baby that you've built from day 1? Maybe your kids do dentistry, you can pass it on to them but how many people's kids are doing dentistry?

 

 

You want to sell it off to your associate? How much can they afford? You're not really going to get a lot of money for that. You need to think of what to do after you reach a certain age. The best time to think about it is 5 to 10 years before you reach that age. By the time you are at the age where you want to retire, the value goes down. You are the good will.

 

 

A lot of dentists in Singapore and around the world who are in their 40s, 50s. They are starting to think, "What's going to happen to my practice after I retire? How can I monetize it? Is there a value to it?" These are the important questions that we seek to help answer.

 

Howard:

Back in the United States, one of the largest corporations, Hartland Dental, all of my friends that had offices doing 3 to 5 million dollars a year, they were il-liquid. Nobody could buy those. No kid could come out of school and buy a big 10, 12, 15 operator y, 3, 4, 5 million dollar business. One of the reasons Hartland got so big was they were liquidity exit strategy for all these il-liquid huge, corporate practices.

 

Raymond:

Certainly.

 

Howard:

That had no one to sell to.

 

Raymond:

That's right.

 

Howard:

You said, when talking CAD/CAM. You have done so many CAD/CAM. Do you recommend, do each one of your 70 offices, do you scan it and mill it? Or do you scan it and send the image to a lab and mill it? Do you think it's a return on investment to have each office invest in a milling machine? Talk about... because I know you really like CAD/CAM.

 

Raymond:

The business of CAD/CAM dentistry. The traditional way of CAD/CAM dentistry was erected enormously well was to have your own scanner, your own miller in the office. It comes with a large investment both in terms of money and your time. Now, if we work together with good laboratories, forward thinking laboratories what we can do is just scan it. After we scan it, we send it electronically by email to the dental laboratory who will do the milling. He will give it back to you.

 

 

How many percentage of your patients really need it on the spot? I mean if you tell the patient, "You come in the next day and they'll be ready", they're quite happy with that. It actually brings the costs down. You need to invest only in the scanner, not the miller. You also don't need to spend time sitting in front of the computer doing the design work. Some people find it fun. I don't particularly find it very fun. I find it more fun cutting the prep than to design the ...[crosstalk 00:09:20]

 

Howard:

Who makes more money, the lab man or the dentist?

 

Raymond:

The dentist because the margins are fantastic at the dentist. The lab man charges the same cost regardless of whether it's a CAD/CAM lab or normal lab.

 

Howard:

You recommend just scanning.

 

Raymond:

I would say scanning. In fact, for people who want to just start, they don't even need to scan. They can still take an impression as per normal and send it to the lab and ask for a CAD/CAM crown. They pull your impression out in the lab, scan it for you and then give you the crown. There are advantages of a CAD/CAM ceramic crown as compared to the traditional full porcelain crowns.

 

 

If anybody wants to start off with a CAD/CAM crown, you don't even need to buy anything. You jut take an impression as per normal, cut it in the way it's supposed to be cut, and then send it to the lab. They will pull out the impression, scan it for you and give it back to you.

 

Howard:

I find it interesting because you're publicly traded. You're the only publicly traded dental corporation I'm aware of that's in more than one country. Australia has 1300smiles.com and what was the other one?

 

Raymond:

I think Pacific. [crosstalk 00:10:39] I think there's some in Brazil or so...

 

Howard:

Pacific Smiles...

 

 

But you're in Singapore, Malaysia and China. I think the most #1 favorite hobby of all dentists around the world is to raise their overhead. They just jump at a chance to buy a $150,000 3D x-ray, CAD/CAM, $75,000... but you being public traded, you have found out that you just want a scanner.

 

Raymond:

That's right. You see, the millers can be put in the labs. If you have a big center like down here. We've got like 20 chairs. Okay, economics of scales comes in. Having your miller on the same premises makes sense, but if you've got a practice that's got 2 or 3 dental chairs, does it really make sense to have your own miller? No, not really.

 

 

Of course it's a toy and they just love toys.

 

Howard:

Boys and their toys.

 

Raymond:

Yes. My toy is bigger than your toy. (laughs)

 

Howard:

What scanners do you like?

 

Raymond:

Currently, we are working quite closely with 3Shape which is Scandinavian.

 

Howard:

When you say, Scandinavian, there's 5 Scandinavian countries...

 

Raymond:

This is Danish, from Denmark. It's giving us very good results so far. The scanning technology is very accurate and it's quite easy to use. Small and light. It's something that we like at the moment.

 

Howard:

How much is the 3, trios.

 

Raymond:

The trios, in Singapore, you can pretty much get it for about 60,000 Singapore dollars.

 

Howard:

Right now, US dollar is worth 70 cents in Singapore.

 

Raymond:

1.50 around there. I mean 1 US dollar is maybe about 1.50 Singapore. Estimate.

 

Howard:

You have 70 locations and I notice that you have several dentists from the United States. Right now, 3 out of 4 people listening to this podcast are from the United States. Why are these Americans here? Did they come here for retirement? Do they want to travel? What's the story with all these Americans in your office?

 

Raymond:

QandM, we are kind of like a mini United Nations. First of all, the most important thing, Singapore is a relatively liberal society. We have quite liberal policies with regards to dentist registration. I think that's the most important thing. If you want to practice dentistry anywhere else in Asia, it's not so simple to get your license.

 

 

You've got to take a board exam and all these things. In Thailand, the board exam is in Thai which makes it almost impossible. Where Singapore, as long as you are from a list of approved universities, I'm sitting on the dental council so I can tell you there's a list of approved universities from America, from Canada, from UK, Australia, New Zealand.

 

Howard:

I would love to have that list. Can I have that?

 

Raymond:

It's on the website. It's on the Singapore Dental Council website.

 

Howard:

Ryan, can you find that for me? I want to see which US dental schools made the list.

 

Raymond:

I think everybody. (laughs) I think almost everybody. As long as you're on the list, you can have direct registration in Singapore. That makes a big difference.

 

 

Your first 2 years here will be under conditional registration which means that you cannot be practicing alone. There has to be somebody else in the same practice, but it is a liberal society in the sense that you do not need to take the exam.

 

 

Number 2, I think Singapore is "Asia Light". If you want to explore Asia, Singapore is easy. The transport's good, the safety's good, people speak English. The food is great as you know during lunch we had really nice food. I think that it's a good opportunity for people around the world to actually work in Singapore if they want to.

 

Howard:

I'm going to ask you a really weird question. One of the 2 greatest societies I've ever seen are Hong Kong and Singapore. What, in your words, would be the advantage or disadvantage of Hong Kong versus Singapore? How do you see these cities?

 

Raymond:

I don't want to risk antagonizing any Hong Kong listeners. I know what you mean.

 

Howard:

They're both an island, about the same size. I think Singapore's what, 5.5 million and Hong Kong is 7 million. They're about the same size. Totally beautiful, awesome, amazing. How do you view them, Hong Kong versus Singapore.

 

Raymond:

I think Hong Kong has a lot of advantages. One of the big advantages is the proximity to China. In a way they have a hinterland. Hong Kong has it's advantages.

 

 

I think one of the big advantages of Singapore is in the sense that we are right smack in the middle of Southeast Asia. Everybody passes by here. Our economy is doing reasonably well. Transportation, public safety, English, openness, multi lingual, multicultural society. These are some of the advantages of Singaporeans.

 

 

Hong Kong might be a bit insular, but Singapore is a lot more open and welcoming I guess.

 

Howard:

I'd tell anybody listening to this, if you ever have a chance in your entire life to visit Hong Kong or Singapore, it's going to be the time of your life. It's absolutely amazing.

 

 

I want to ask you a question that is very different in Singapore. To practice in Singapore versus the United States, you're not allowed to advertise. You're not allowed to market. To me, if I opened up a practice in Singapore, I think the only way I'd be able to grow my business is word of mouth referral.

 

 

For you, a publicly traded, corporate dental office, is it hard for you to grow your business without being able to advertise?

 

Raymond:

You are actually 100% right. You hit the nail right on the head. I'm surprise you know about our Singapore very strict advertising guidelines. They call it guidelines, but it's actually a law from the ministry of health.

 

 

You are right, it makes it hard to advertise. What we do, we go for locations. Every time we go to a city center, a mall, a suburban location. We always try to get the best location available. We put our sign boards out, we run our practice 7 days a week. Even on weekends, even on nights. If you see it enough, you know that there is a dental clinic there. If you see that sign enough, you know there is a dental clinic there.

 

 

A patient would be accessible. Accessibility is one of our strong competing points. Location, good will. That's what we're trying to use to win successfully without overly advertising.

 

Howard:

As far as the business of dentistry goes, what products and services do your dental offices provide that you sing Singaporean people really want? They have to get out of pain. They have to come in if they have a toothache. What do they want to buy at a dental office?

 

Raymond:

At the moment, one huge growing item is orthodontics. Braces is a big thing here in Singapore. The young kids, if their friends have it, they want it. Now they come in nice multi colors. They love it.

 

 

You've got to flaunt it. At the moment we have 11 orthodontists in our group. We are also developing in conjunction with braces we are starting to expand into pediatric dentistry which I think has another good growth potential.

 

 

The usual suspects would be aesthetic dentistry and implant dentistry. Aside from these kind of things, I think braces together with pediatrics is growth in Singapore.

 

Howard:

Is braces in Singapore something more Mom and Dad buy for their kid, is it more something more for girls? Do adults get it? Adults your and my age. Do you see 50 year old men coming and getting braces.

 

Raymond:

Maybe not 50, but 30, 40 there is a possibility. Maybe not 50. If we're talking about the 20s, the 30s. I think there's growth in that.

 

 

The difference would be the older people want to hide it. They like things like invisilign, or aligners. Which are not so visible or they go for ceramic brackets whereas the younger people want to flaunt it, so they want the bright color and the metal. They are going for the same thing, but they view it differently.

 

Howard:

Yes, those little girls care more about the color of their rubber bands.

 

Raymond:

That's right. What other bright colors do you have?

 

Howard:

You would say the three big things would be invisible braces, implants and CAD/CAM.

 

Raymond:

I would say braces a big thing, implants a big thing. CAD/CAM dentistry is a big thing. For QandM on our patient database we have about 600,000 patients. Bearing in mind Singapore's population, it's about 5.5 million. Quite a large portion of Singaporeans have walked through our doors.

 

 

On average we see about 250, 300,000 patients year. That is quite a large number by any account for a private dental group in Singapore. In total, Singapore has about 1,700 dentists. QandM we have about 220 dentists. We can kind of see the trend of dentistry in Singapore.

 

Howard:

What is that trend?

 

Raymond:

More and more people... the bread and butter work is still there. It will be there. Even times of economy recession, the bread and butter will still be there. People are asking for more. Instead of dentures is it possible to have something fixed. So implants start to come in.

 

 

Instead of extracting a tooth, can you save it? You already have the root canal, the post core, the crowns. Maybe a ceramic crown, maybe a CAD/CAM crown. Things like that. I think that's important.

 

 

Of course patients are starting to look for specialist dental services, rather than just cheapy. That's another thing that we focus on. We actually sponsor post graduate studies for young promising dentists. We pay for them to go study post graduate so that when they graduate they're specialists. They would be bonded to us for certain years. I think that's important to develop a specialist group.

 

Howard:

I think I could do America a great service if I could unload 1,000 US dentists onto Singapore. That's why I'm doing this podcast with you.

 

 

Are you looking to hire dentists right now? From America?

 

Raymond:

We've always been open to dentists from America or from UK or from Australia or from New Zealand...

 

Howard:

Try to do all of your hiring just from the United States. We'll all have less competition when I go back home.

 

Raymond:

Come to Singapore, you can work and enjoy a holiday at the same time.

 

Howard:

It's one degree north of the equator. There's no winter, spring, fall it's just beautiful weather day.

 

Raymond:

Beautiful weather, you can go shopping, you can go scuba diving anything.

 

Howard:

On the implants, does this big publicly traded company prefer a type of system, a type of implants, or is it more agnostic, doesn't care.

 

Raymond:

I think in a way, QandM is quite democratic. The dentist calls the shots. We do not control which lab they send their cases to. Even though we have our own lab, we give them the option to choose themselves. In the same way, we do not control the type of implants that they use. As long as it's from an established company.

 

 

Based on our protocols, we have what is called approved vendor lists. So it has to be one of the systems that we all recognize. It should not be some system that's coming from the right field that nobody knows about it. As long as it's on the approved vendor list you can use any of the usual systems that's available all over the world.

 

 

We give our dentists the professional freedom to use whatever implant system they like, whatever labs they like, whatever composites they like. Filling materials, composites. There's so many.

 

 

It's important the dentist makes the clinical choice. We ask company or administrators or what, we should respect their professional integrity.

 

Howard:

I also found it very interesting that your business model in China wasn't going after the expatriate international businessman. It wasn't going after the lifestyles of the rich and famous. Your dental business in China was going after the middle class.

 

Raymond:

That's right because China has a huge, huge, huge middle class. This middle class is more and more willing to spend money. When we started in China, bearing in mind we went public in 2009, but in 2008 we were already exploring the China market. Initially we made some investments into dental centers in places like Beijing, Shanghai, all the places that every father, mother, son is at.

 

 

Americans are there, Taiwanese are there, the Hong Kongers are there, the Japanese are there. Everybody is there is chasing after that 10%. The rich, the expatriates, the so called perceived people who can pay.

 

 

It's only later on that we discovered this concept of private dental hospitals. We found that in [Shan Yung 00:27:25] which is the largest city in the north eastern part of China, it's the capital city. It's got a population of 10 million.

 

 

Over there we realized that there are actually private dental hospitals and are doing fabulously well. To the typical Chinese cities and to the middle class, the hospitals are good. They like big. It's hard to get a hospital license. They know the government enforcement in hospitals is stricter. As compared to some of the clinics.

 

 

We started to do very well once we expanded into dental hospitals. We acquired this group that runs 3 dental hospitals and 3 poly clinics in China.

 

Howard:

Tell me, who's winning the race? In the last 30, 40 years, on the one hand Asians and the whole world is getting better. Fluoridated toothpaste, better toothbrushes, electric toothbrushes, better knowledge, education, all that. But on the other hand, the diet is going from fruit and vegetable and fish, to packaged sugars and carbohydrates.

 

 

The Asians are getting more knowledge and technology and tooth brush and prevention dental offices. While their diet is kind of going off a cliff into sugar and carbs... so who's winning? Are Asian teeth better in 2016 than they were 50 years ago? Or is the bad diet offsetting the gains in dental technology?

 

Raymond:

Maybe? Who's winning? I would say the dentists are winning. (laughs) It's a good place to be. It's the awareness thing. The awareness is winning.

 

 

Generally, yes, diet all these processed foods makes a difference, but if you do see your dentist every 4 to 6 months, you can't go that far off. Things will be fixed.

 

Howard:

In my practice in Phoenix, this is what I always see with the Asians. The grandma and grandpa come in eating the traditional diet, and they've never had a cavity.

 

 

Then they bring in the 6 year old grandson who's got a McDonald's cup in his hand and a happy meal and he has 6 cavities. His grandma is 65 and she's never had a cavity.

 

 

Do you see that?

 

Raymond:

Yes. It is there. If you remember I mentioned we are looking at pediatric dentistry. It does go hand in hand with things like braces. You are right, there is a trend in that, but I think what we are trying to promote here in Singapore is awareness.

 

 

As long as you see your dentist every 4 to 6 months, even if it's just for regular clean and polish, you can't go very far wrong. It will not cost you that much to fix the problem, even if there's a problem.

 

 

Of course I think the awareness here is to promote the patients to visit a dentist on a regular basis.

 

 

There was a survey done by the health promotion board in Singapore which says that about 40% of the Singaporeans visit dentists once a year. It's not bad, but can be better.

 

Howard:

I want to go back to not advertising. It's something you see in Hong Kong too, it's something you see in China. I don't understand.

 

 

Here's the way I see it. When HIV was in the height of it's plague and was growing in double digit growths and some countries were literally losing the battle in South Africa or whatever. The health care community turned to all advertising. Television, radio, billboards. It was only through mass advertising about this horrific virus that stopped the growth and then started the plummet and got it in checks and balances.

 

 

What I don't understand, if countries say you can't advertise that means Coca Cola wins. That means McDonald s wins. Shouldn't in Singapore and Hong Kong and China, shouldn't the doctor be allowed to advertise to beat the disease?

 

 

If the physicians were not allowed to advertise to beat HIV in Africa, in parts of Asia, in Thailand, the disease would've won.

 

 

I think when you take an advertising tool away from a doctor, you're giving the advantage to the disease. Do you agree or disagree?

 

Raymond:

I do agree with you. It would be wonderful if you run our Singapore Ministry of Health advertising...

 

Howard:

Send them this podcast.

 

Raymond:

They are very strict about things like before and after photos. Very very strict. You can't even put it up, a before and after photo on your website. That's the extent of it. You go to any American website and you see before and after photos. Before and after photos, left, right, center.

 

 

They're very strict about using words. Words like, "promotion", "special" things like that. What it means is that if it's really very generic you can put it up. These are the stuff you can just Google anyway. They're kind of against you telling people that you're better than others, or encouraging people to come and see you ahead of others. It makes it a little bit tough.

 

 

If you look at our websites, it's very generic. General knowledge information that you're allowed to put up. We've started looking at other avenues. Things like Facebook and things like that which are quite interesting.

 

Howard:

I want to switch gears. Some countries like the United States, the United Kingdom, the dental industry is very insurance driven. Almost everything has to do with can they get their insurance to pay for it. There's basically no insurance in Singapore.

 

Raymond:

There's no big insurance place in Singapore.

 

Howard:

Do you like that more, or do you wish there was insurance?

 

Raymond:

Basically, about 90% of our patients are private, fee paying patients. That is it. Insurance wise, it's a double edged sword in my opinion. A lot of times the insurance company things like capitation comes in. They dictate how much you can charge for various procedures, they dictate who you can... Managed health care.

 

 

In medical site, we run the medical business in QandM, we have a small medical arm. They dictate what kind of drugs you can do, what kind of methods you can give, how many times you can send to this labs and this like that. It makes it a little bit difficult. Insurance is a double edged sword.

 

 

In Singapore currently, insurance is not a big thing. Our patients are primarily fee paying patients. Good news is that the government has certain subsidies in Singapore called the pioneer generation and [trust 00:35:40]. These are targeted subsidies for people who need it. Pioneer generation is that if you're above 65 years old, you get quite a significant subsidy from the government. [Trust 00:35:52] if it's your combined income, your family income is below a certain amount there is a certain amount of subsidy from the government. Those do help the people who need help.

 

 

Insurance is not a big thing here.

 

Howard:

Are there any other differences that I'm not aware of about Singapore dentistry versus dentistry in Australia, United States, United Kingdom...

 

Raymond:

I think the trusts and pioneer generation thing is very useful because in a way it's better than UK system where everybody gets it regardless of whether you need it or not. These are very targeted. There's an element of means testing involved. If you're above 65 and you go and make a full denture, let's just say above full denture. Let's just say if a clinic charges $600 to $800 for a full denture, the subsidy from the government comes out to about $250. That's not too bad. They kind of waive about 30% of the price.

 

 

It is a help to the patients, so things like that...

 

Howard:

You got to run?

 

Raymond:

No, no, no, I just need to make sure I put it on silent.

 

Howard:

Is that your girlfriend or your stockbroker?

 

Raymond:

No, no, no, dentists. I've got lots of dentists calling me all the time.

 

 

In a sense it does help and it's a targeted help. Even things like scaling [inaudible 00:37:31] or obstruction, the government subsidy can amount to 30 or 40 percent of the bill.

 

Howard:

I notice that Singapore has community water fluoridation. How long has it been using...

 

Raymond:

Since I was a kid.

 

Howard:

Is it very common in other Southeast Asian cities that you're aware of.

 

Raymond:

They have it in certain places, but it's not that common. Singapore definitely fluoridation works in a sense that if you look at people's teeth now, aside from the very obvious cause that you highlight things like processed foods, sugars, fruits. Otherwise their teeth are generally in good condition.

 

 

I think there's an element of due to fluoridation in the water because sometimes we see patients from Malaysia, from areas which are not fluoridated. There is a significant difference.

 

Howard:

It is amazing how back in the United States and New Zealand and places like that it's still so controversial. Whereas when you read the literature, it's not controversial.

 

Raymond:

It works, number 1. Nobody has developed green skin or anything from fluoride in the water.

 

Howard:

It's almost the greatest fake controversy that's ever existed.

 

Raymond:

We've all studied in dental school as part of dental public health, when we were dental students, and we know it works. The research shows that it works.

 

Howard:

What's the number 1,2,3 selling toothpaste in Singapore. What's the most popular?

 

Raymond:

Let's hope the Colgate or toothpaste manufacturer's get upset with me. Not in any order of preference or in any order of merit. You're probably talking about things like Oral-B, Colgate, Sensodyne, all these. Pretty much all of them has element of fluoride.

 

Howard:

So Oral-B is a popular toothpaste?

 

Raymond:

I think Colgate is more popular.

 

Howard:

But Oral-B is very popular too?

 

 

Ryan let's get a picture of that, I don't ever remember seeing an Oral-B toothpaste at a store in the United States have you?

 

Raymond:

Colgate is probably more popular, Oral-B. Sensodyne, through their sensitive toothpaste line is actually popular.

 

Howard:

Last question, and then I'll let you go because I know you're a very busy man. I haven't seen the epidemiological research that I would like to see, but you hear lot of people say that periodontal disease is more prevalent in Asia than it is in Europe. True or false?

 

Raymond:

I do not have enough access to information to make a decision like that, but periodontal disease in Asia basically in my opinion, the prevalence increase as awareness increase.

 

 

Let's put it this way, my grandparents thought that it's natural to lose your teeth when you reach 60. They think it's part and parcel of growing old. They're not going to complain about it because they think it's just about growing older. Now we know that a lot of people are losing their teeth as they get older due to periodontal disease.

 

 

You can extract a tooth, totally no decay at all on it but there's no bone support. The tooth goes. Now we all know the damage caused by periodontal disease, and we are taking steps to fix it. We identify this problem, which here has been in existence for the longest time.

 

 

I think it's good we're taking steps to fix this problem because periodontal disease is something that's preventable, that's fixable. If we catch it early enough before the extensive bone loss takes place. I think that's a good place actually.

 

 

In comparison to Europe, I'm not so sure.

 

Howard:

Where I grew up, Kansas is in the very middle of the United States. When I was little, all my aunts and uncles, they had lost all of their teeth before they got out of high school. All of them. It's amazing.

 

 

I think you're a class act, your organization is amazing. The people here are all so happy and it looks fun. You're nothing but fun and thank you so much for taking me and my two boys to lunch and spending all afternoon with us.

 

 

I think you're amazing.

 

Raymond:

It's our pleasure. Really nice to meet you. It's a honor and a pleasure. Thank you very much.

 

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