B. Jin Chang, PhD is the President and Chief Scientist of SurgiTel, a division of General Scientific Corporation since 1992. From the late 1970s to the late 1980s, Dr. Chang led the development of advanced heads-up display systems for fighter jets such as the F15E, A10, and F4. Over the last 25 years he has been extending the ergonomic principles used for military display systems to clinical vision systems. This has led to SurgiTel’s family of ergonomic loupes and illumination systems which prevent chronic neck and back pains and protect eyes from the hazards of LED blue light. Also he led the development of touch-free LED light to prevent cross contamination and loupe-mounted video cameras which can be displayed with smart phones or tablets.
Karl has been with SurgiTel for five years, during which he has met many clinicians with avoidable working pain. He is working hard to spread the news to clinicians that working in pain and risking injury is not part of the job!
VIDEO - DUwHF #1011 - SurgiTel
AUDIO - DUwHF #1011 - SurgiTel
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Howard: We are at Townie Meeting, 2018. I am with Dr. Jin Chang, who is...
Jin: (unclear 0:00:12) nice meeting you.
Howard: ...the Ph.D., founder of SurgiTel. For how many years now?
Jin: About Twenty-seven years.
Howard: Twenty-seven years. My Gosh! And he is with Karl Schwartz...
Karl: Thank you.
Howard:...and they're arguing because one is University of Michigan Wolverine and he's Michigan State and they...
Howard:...just don't, they just, he's a Spartan. They don't see eye to eye. Which one was the better school?
Karl: I'll give it up. Dr. Chang got a doctorate.
Jin: I give both of them...
Karl: (unclear 0:00:43)...
Jin: ...good school.
Howard: But this is an amazing background, he has a Ph.D. He's the President and Chief Scientist of SurgiTel, a division of General Scientific Corporation since 1992. From the late seventies to the late eighties, Dr. Chang led the development of advanced heads-up display systems for fighter jets, such as the F-15E, the A-10, the F-4. Over the last twenty-five years, he has been extending the ergonomic principles used for military display systems to clinical vision systems. This has led to SurgiTel's family of ergonomic loupes and illumination systems which prevent chronic neck and back pains and protect eyes from the hazards of the LED blue light. Also, he has led the development of touch-free LED light to prevent cross-contamination and loupe mounted video cameras which can be displayed with smartphones or tablets. Numerous patents have been applied to designs of SurgiTel's loupes and illumination systems.
Karl Swartz has been with SurgiTel for five years, during which he has met many clinicians with avoidable working pain. He is working hard to spread the news that clinicians, that working in pain and risk and injury is not part of the job and I have to sit here and tell you, first of all, my story is this. So my story is from 1984 for twenty years, I just liked to go like this and I liked direct vision and all these older people told me, don't do that, sit up straight, quit doing that. You're young and you do all that stuff. It got to the point where even when I switched to loupes, I was trashed. I do this for the rest of my life. It got to the point where when I was changing lanes, when I would look over my shoulder, I'd get an electrical shock and I was living with, I never took any pills for it because it's not sustainable, you can't live on Ibuprofen or Aspirin or Tylenol the rest of your life and it was actually, I got to give a shout out, it was to a lady named Sharon Mattern, who's married to a friend of mine, a dentist Tom Mattern. One day, me and Tom were in the garage doing P90X, she said, Howard just do, just try hot Bikram Yoga. So I go, alright, I got nothing to lose. So I went to hot Bikram Yoga and that was the only thing that started to unwind it and I went to hot Bikram Yoga, probably every day for six months and I, to get to the point where I could change lanes without that shock. So if I don’t do, and the neat thing about Yoga, if you do it a long time, you don't have to go to Yoga class to do Yoga stretches, like if you're in the kitchen you throw your leg up on the counter and, I'm always doing it, but don't do what I did. My God! Just don't, the best thing about a microscope is that you're looking at a periscope. The best thing about loupes do it once, do it right because you're a human, you're a monkey without a tail and you've got this s curved spine and this is a ten-pound bowling ball and you lean that ten-pound bowling ball over, remember, when you look at injuries, very seldom is it the acute injury, a car crash, a fall down the stairs, an acute injury. Usually, it's a small movement that you do all day, every day, you have a bad bed, you have a bad pillow, you have a bad posture. I'll shut up. This is your business, you talk about it, but I would give a $1,000,000 to go back in time to get my neck back, to this day, it ain't right. So is this, do you, you obviously, I'm not the first story you've ever heard of this?
Jin: Oh yeah, we have all kinds of stories heard from clinicians who have been experiencing the serious neck pain. When I started SurgiTel, our mission was trying to help clinician practice safely. That's why we designed the first ergonomic loupes, which is adjustable. Since then we designed ergonomic frames and improved manufacturing technology to make custom ergonomic loupes. Today we can make ergonomic loupes even with fixed loupes called TTL (through-the-lens) loupes for anyone. We are able to ergonomically fit loupes to any facial feature, any people. A lot of people believe that loupes help clinicians work with ergonomically correct postures, but actually more than 80% loupes have non-ergonomic loupes, resulting in the development of chronic neck pain and injuries. I think that most major brand traditional custom loupes force clinicians to excessively tilt their head and these loupes actually create the neck problem. Wearing any loupe helps eliminate the lower back problem because they can help you sit right up better but most traditional custom loupes make users to tilt your head excessively. That's why today non-ergonomic loupes are a main cause for the development of neck pain. Majority of patients (clinicians) coming to us due to the neck pain have used very well-known brand custom loupes. Some people like hygienists, for example, after five years using non-ergonomic loupes they cannot practice due to serious neck pain. We have so many examples (testimonials).
Howard: So, you're saying people wearing other brands of loupes are harming their necks...
Jin: Yes. Non-ergonomic loupes are actually harming necks. Without using loupes we bend lower backs, creating lower back problems. The use of loupes help clinicians with the better back postures, eliminating lower back pain. But non-ergonomic loupes force more neck tilt, creating serious neck pain. The back pain without the use of loupes has transferred to the neck problem with the use of non-ergonomic loupes. As many clinicians have been using non-ergonomic loupes, the loupe neck problem has been becoming a global epidemic. I think that DentalTown’s role is very important. You can help many people by providing right information to clinicians. What you are doing can save many people’s career.
Howard:...and why is that? What you are saying is that SurgiTel’s difference is steep angle and sit more head up?
Jin: Yes, Right.
Karl: Right, because with loupes that have, like from the old days when they first started being adapted, they are flatter angle and you're forced to look through your loupes, you can't get the magnification by looking underneath them. If you don't have loupes, in theory, you can still work upright but if you have loupes where you have to look at this direction, then you have to tilt your head to make it happen. Your head tilt comes from where your subject is, plus the angle of the loupes and this is where you are. You were forced to look through it. So, it takes a lot of technology, Dr. Chang, like Dr. Chang said, we've been working on this technology for a long time and it's not easy to get these to sit low, to sit at a good angle, to be right where the clinician needs them to be and to have good vision at a good angle, it's not easy. So it's not often.
Howard: So, I have some friends in Phoenix, I have three where they now, their neck got so bad they have to do a 100% % of their work, they chose a microscope because with a microscope you could absolutely sit up and they can hold their back straight and that's the only way they can do work. Now it makes them go a lot slower but they would rather do slow Dentistry than stay at home and eat Ibuprofen all day. That's how bad their neck got.
Karl: Well, Dr. Chang reminds me of, in only the five years I've been here, I've met a bunch of people and we have a couple of people who were Hygienists in the past and they can only wear very steeply angled loupes, fully adjustable units, like you were saying, because they can't tilt their head because they've had injuries where they've had disc degeneration and now they have a bunch of metal back there, so they physically can't turn their head. The only way to do it, the only way to look at a subject beneath them is with really steep ergonomic loupes. Nobody wants to get there, nobody wants to get to the point where they have to treat their symptoms.
Howard: And you know what, the best medicine is no medicine at all. You don't want to smoke a pack a day and then hope they cure lung cancer when you're sixty-five. It’s just that shitload smarter just to not smoke and you don't want to end up, the first time you see a chiropractor, you need to say, why am I seeing a chiropractor? When you're going home at night and you're having your lover pop your back or, you got to ask yourself, just stop, just stop right there. Look at the older people that went before you, I'm thirty years down the road farther than you, don't end up with my neck. God! How many dentists have had their lower spine fused and then if they get their lower spine fused, it's an s curve, so within five years they're doing the upper neck deal. You just can't do a long-term chronic inflammation pain and have it turn out pretty. You got to nip it right in the bud. What are the, what do you think the initial warning signs are...
Jin: Strain or pain in the neck. Problem what I'm seeing is that people ignore these initial warnings. Today, a lot of Dental Schools is teaching ergonomics, but there is no clear guideline for selecting ergonomic loupes. Twenty-some years ago when I started teaching Ergonomics and ergonomic products, a lot of people say that with our profession, nobody can avoid a neck problem. But actually research proved that you can really avoid it if you use the right kind of ergonomic loupes. As a result of teaching Ergonomics, lots of people know that the head tilt is bad. The question is why still many people are practicing with the poor neck posture. The main reason is due to a lot of misleading information. Major loupe companies are still selling their loupes as ergonomic loupes because these loupes can eliminate a lower back problem, but it's not really helping neck problem. The other problem is young people will not feel the neck pain with the use of non-ergonomic loupes right away. It may take five to ten years. Five to ten years later they may feel a neck pain. But they may blame their pillow, saying “I maybe slept wrong last night.” They may look for new pillows rather than ergonomic loupes. Others may say that they hurt their neck by playing sports. Actually, that neck problems started ten years ago practicing with poor working posture, but they don't accept it, they are using excuses. They say to themselves, “I got ergonomic loupes (they think they have ergonomic loupes, but they do not) and my neck problem is because of my sports’ injuries or my bad pillows.” People are making excuses rather than searching for a real cause of their neck problem, poor working posture with non-ergonomic loupes. That's why Dentaltown's role is very important for educating clinicians, probably you can help many people. I think you have a right job to do.
Howard: You have your MBA, I have my MBA from Arizona State University and twenty years after my MBA, I disagree with some of the fundamental things they taught us. Like Adam Smith, efficient markets. If two people are efficiently trading, that doesn't figure into the fact that there's $1,000,000,000 a day spent on advertising and clouding that transaction. When Adam Smith was doing it, I knew I had four chickens and I wanted your pig, but Adam Smith, I don't know if he would believe half of what he says, if he saw all these advertisements to make me think that your pig was gluten-free and her, whatever, it’s just so much misinformation. The same thing when the internet came out. I thought when the internet came out, the whole world would have access to all information free, at zero cost. I'm only an expert in a couple little areas. One, I'd say it'd be water fluoridation and pretty damn good in dentistry. I've read every one of the five thousand articles on PubMed on water fluoridation. Yet, you Google water fluoridation on the internet, 99% of the sites are garbage, horror, it causes cancer and it's like if the consumer went on Google to learn about water fluoridation, there's no chance they'd read anything right. So then it makes me paranoid of learning about anything else on the internet, I have to go to a trusted site. There's so much misinformation. So how do you fight misinformation?
Jin: That's why we started publishing ErgoPractice News about five years ago. I'm writing articles every month about lighting, posture and learning process, safety from LED light. I think that today young dentist are probably facing two most critical risks. The first one is neck problem and the other one is to protect their eyes from LED lights. Today most dental LED headlights use cool LED chips which have a strong blue light content. It is like that they are probably watching curing lights all day long. When you are using curing light, what do you do? You will use orange filters which are protecting your eyes from the blue curing light, right? Today lot of the LED light have really strong blue light content. The Clinician’s Report (publication of CR Foundation) evaluated LED headlights available today, they actually measured the color temperature of those lights. The color temperature of some of them is about ten thousand Kelvin temperature; that means that the blue light spectrum is very strong. Today many people are using those LED lights without knowing the potential risk they are facing. That’s a reason we started to publish ErgoPractice News, still, very limited number of clincians may read per month. I don't know how many really, I'm hoping that many readers may share information published with their peers.
Howard: How do they read Ergo Practice News?
Karl: If you go to SurgiTel.com/news, you can just enter your email at the top and you'll get new information about this field....
Howard: ... take a picture of us and then we'll send this out on Twitter and tag @surgitel. So if you're on Twitter, he's @surgitel. I love Twitter, because Facebook, I have three hundred thousand followers on Facebook but when you make a post on Facebook, they won't show it to your followers unless you boost the post with money. Instagram, Twitter, and LinkedIn, I got twenty-five thousand followers on Twitter, so if I make a tweet, they all get it instantly. I got thirty-six thousand followers on LinkedIn, I make a post, they all get instantly. The same with a Pinterest, but Facebook is pay to play. Mark Cuban's the one who pointed it out to me, he paid all this money building his fan page to one million followers. So he thought if you made a post, a million people would see it, no way. To make a post on my own Facebook page for all three hundred thousand of my followers, if I give them a $1000 only, they'll only put it out to two hundred thousand of them.
So you, and our current president is only the president because of Twitter because what he figured out is that prime time news on CNN, there's only a million people watching, Fox News there's only three million watching, now that's four million. He had fifteen million followers on Twitter, so he could make a tweet that was reaching four times more than if he's on all the news stations and now he's up to fifty million. So, the mainstream media can't even catch that guy. So (unclear 0:19:00).
Karl: Well, I think they'll find a lot. I think that's a main source. A lot of stuff, we'll talk about our products and what not, but if you want to learn about ergonomics, if you want to get something that has references, that's not just marketing stuff, that's what Dr. Chang has been writing. To follow up on a few things we've been talking about. You showed me, we were talking about students leaving school, but you were showing me your tilt, like this. I've been collecting, I've been reading, looking through the dental magazines since I started working there and everywhere are these postures and last month the student graduated from school. I took her to look at his loupes, very low angle and he's doing the tilt and there's a picture taken of it and the faculty and university allowed that to be distributed because nobody's slapping them on the wrist with a ruler because he's doing it wrong.
So, I was talking to a student from a local school and he was saying yes, they had been talking to me about ergonomics and I said, well, OK, I'm thinking this is great. So what did you learn? And he said, well, I guess it's bad to not be Ergonomic, but they didn't give them any numbers, they didn't give them any clues, they didn't tell them how to know what a neutral posture is like, no real hard data.
I recently gave a presentation to a number of Hygienists and I tried to compensate that by giving them hard data. In preparation, I read a book by Bethany Valachi and I will recommend this to everybody too, everybody buy one of these for your office. I'm not making a dime off this by the way, but it has diagrams in there on how, what a neutral posture looks like and how far you can move out of that posture and what's a good range to be in because we're not going to be static all the time, we're going to move but how far is it good to move, and even if you move out of that range, you'll know to minimize that movement. For head tilt...
Howard: ...what was her name?
Karl: ...Bethany Valachi, she's a physical therapist.
Howard: We did a podcast with her, episode 304, right on. We're one step ahead of you.
Karl: Oh, that’s good.
Howard: Imagine that.
Jin: Oh, actually you did it with her?
Howard: Yeah, episode 304.
Karl: She is really smart and she recognized her husband shouldn't be coming home with all these issues, so she went to see him at the office and she went to see her husband at the office and said, oh my gosh! What's going on here? And she got research together, did research, wrote a whole book on what dentists should be doing and that was in 2008. So, this information has been out for a while on your neck tilt. Indicating that you should not tilt your head forward more than twenty to twenty-five degrees. The reason there's a range there is because everybody's different, everybody's body is different. You might have an issue faster than somebody else and somebody else might have.
Howard: So, when I was little, in Wichita, Kansas, my neighbor, Dr. Kenny Anderson sat down. The other dentist at St. Francis Church, Dr., oh my gosh. Dr., God, I'm so old, he stood up. What was his name? Dr., he was the one with the big bushy eyebrows, anyway his daughter was in my class too, her dad stood up and another girl in my class, Dr. Pamela Knutson, her dad, Dr. David Knutson sat down and I remember sitting in the cafeteria at Bishop Carroll High School asking Pam, why does your dad sit down to do general dentistry? And Dr. Proppard, asking his daughter, why does your dad stand up? And she said, Dr., I think it's Proppard, that was 1976, I'm having this conversation and she said, well, my dad has to stand up because his back, he can't sit down, it kills his back and then Pam said, well my dad sits down, he's never mentioned it. Do you think that we need to revisit sitting down and maybe we should be standing up or maybe the average dental stool that we sit on is part of the problem too?
Jin: I think that today a lot of stools designed properly exist. You can select one right away and use right away. I think that the sitting is probably better than standing up...
Howard: Sitting is better than standing. Why is that?
Jin: Sitting will minimize the head tilt than standing.
Howard: So you recommend sitting. When you go through all the different specialties, all your oral surgeons stand.
Jin: Oral surgeons are imitating surgeons – (Standing may be easier for the surgery). You may know why they do it. They may want to be like surgeons. But 20% of surgeons today had neck surgeries.
Howard: 20% of surgeons have has neck surgeries?
Jin: Yes. Neck surgeries.
Howard: Oh, my God, that's horrible.
Jin: Many of them may take opioid and other drugs. They’re smart people, right? They may not want to show up their weakness, they may be trying to hide their pain. When I started to talk with surgeons many years ago, I found that they are reluctant to communicating each other about their personal matters such as neck pain. Finally about three years ago, American College of Surgeons meeting had an Ergonomic Forum. They shared their pain and American College of Surgeons’ newsletter published survey data: 92.6% have neck problem, 20% had already neck surgeries.
Howard: ...92% of surgeons have neck problems and 20% have had surgery. You're a baby, you're under thirty, don't be that guy, don't do that. I finally found, the first time in my whole life I've finally met one surgeon because remember when you have real back pain, you want to look through a microscope because it's like a submarine periscope, where you've got to sit up straight. He is, he does prostate cancer and what he does for prostate cancer, bleeding is a big issue. So, he finally thought to himself, why are all my men just laying there on the table bleeding like a sieve. So, now those ankle (unclear 0:26:22), where you can stretch your back, he lifts them up and he lifts it up until the prostrate’s right in front of him. So, now all the blood has rushed down below the prostate, so now he's looking straight, you're all swollen with blood underneath, he has a fraction of the bleeding and he's like.
It reminds me of this, this is the craziest thing in the human history. They came out with the silent film in 1891 and they had the phonograph and the record. It took forty years before one human said, why don't we add the sound to that movie and then the chocolate and peanut butter story's even sadder. It took a millennium for them to figure that out but it's like, how many surgeons did prostate surgery for how many, what a century? Before one guy thought, why is he laying flat on a bed? Why don't we hang him up on a gurney?
Karl: And that's amazing because those patients, there's a couple of things about ergonomics that are important. It's where you put your arms and your hands are important too and OK if I'm going to lean over. If you're leaning over, if your arms are really low, if you're stretching, sometimes it's patient positioning. The surgeon should be less concerned about the patients because they're asleep but also, from what I understand and from who I talk to, some dentists are afraid to move the patient in a certain way and the patient's only going to be there for an hour or couple of hours, whatnot. You're going to be doing this all day, every day. Move your patient, if they absolutely resist it, OK. Work out of bounds for a little while, but move your patient first, move the patient where you need to because that's your career and if you can't work any longer, it doesn't matter how comfortable the patient was.
Howard: So I just want to finish up with the chair. There's a couple, any chairs you recommend. I noticed some chairs now, you kneel into them. Is there any chair that you like for, more than others?
Jin: Saddle chairs without the back supoort.
Howard: Is that in your catalog?
Karl: ...yeah we partner with RGP, they're the experts. If we're.the experts on loupes, but we let them be the experts on seating.
Howard: So who, so it's RGP brand...
Jin: Long Island.
Howard: Long Island?
Jin: No, not Long, Rhode Island.
Howard: Rhode Island. Ryan, find RGP brand seating out of Rhode Island, do you know the CEO?
Howard: Well, why don't you tell him to come on the podcast and we'll release him after you.
Howard: So it could be a category
Jin: Yeah, OK.
Karl: It'd be good.
Howard: Then I also want to switch gears completely now. I think the light has to do with it, maybe we're bending over closer because we can't see and maybe magnification is part of it, but maybe just. Well, we're working in a dark hole. How much do you think the lighting has to do and I love your lighting system because, well, number one, the assistants, this is, I'm going to say this, this is politically incorrect and rude, but whenever you ask any assistant on earth, give me more light with the overhead, what she hears is to first take all the light away and then bring it back. And I always say to my assistants, I said, I didn't say take all the light away and then trying to aim it better. I just said I need more light. But their first reflex is always to take it away and then bring it back. But do you think that we're contorting our neck?
Karl: Oh yeah.
Howard: Because of magnification or light or both?
Jin: Light. Loupes control the head tilt. Loupes not designed correctly force too much head tilt. Beyond that, you're twisting your body because the light is not a coaxial with the direction of your vision. So you want to be aligned yourself with the direction of the light. That's why overhead lighting is not a good illumination. The head-mounted light should be an essential part of the vision system.
Howard: And then the headlight, then a battery pack.
Jin: Yeah, battery pack.
Howard: And how long is the battery pack lasting?
Jin: About eight hours. Whole day use.
Howard: Do you want to know what made me get mine? I was doing a missionary dental trip.
Howard: I realized it's really hard to do dentistry in your best friend's dental office, let alone on a lawn chair in Mexico or on the Tanzania, Africa and so it was that. I want to say one other thing that's bizarre. The dentist will wear the loupes and magnification and then he'll get mad at his hygienist because she missed this tartar and calculus and the assistant, he's not happy with a temporary. Well, they're not wearing loupes but all wet hands. If your hand gets wet in a mouth, it's loupes and a headlight, end of story. The fastest way to increase quality is not to get a bunch of initials after your last name. Its magnification, loupes for all wet hands. Endodontists will tell you the fastest way for them to quality, is a microscope and usually they just use it for the final check, right before the (unclear 0:32:10) tray, they're looking at (unclear 0:32:12) and about one time a day, maybe they do, work eight hours a day, eight molars a day, eight hours right before they (unclear 0:32:19) trau, one tooth they actually see a miscanal, they see a little bleeding point, or they see a bunch of slop on one side of the walls on one of the canals but the fastest way to increase the quality of your dental office is magnification for all wet hands. Now upfront dry hands on deck, they don't need it, but all wet hands need magnification and if you miss all wet hands, magnification, headlights, so they can see, if they don't have that, then you're running a Stevie Wonder operation. Every time Stevie wonder sends me a text, it's just like a bunch of random alphabetic numbers and letters, it doesn't make any sense. That's what you're doing when you can't see. Everyone needs to see.
Karl: Yeah, yes and I think that's, I think there's also an issue with magnification level because sometimes the doc, the doc will have a three and a half times magnification or four and a half times magnification and the clinician, the hygienists will all be on two and a half. We do two and a half to eight times magnification, our highest loupe overlaps a microscope.
Howard: So you have an eight times magnification, then you wouldn't need a microscope.
Karl: Some people go without it. Where there's a Canadian dentist who is always talking about us to all his associates because he's working on these really interesting cases. The tradeoff is once you get a higher magnification, your field decreases, but you still see the whole mouth, when you're at three and a half, there's no other issue and then at eight, you're working on more specialty type stuff, like one tooth at a time.
Howard: I also love my, I run a democracy. So, when I take an impression and I look at it under my loupes, my light, I look and I say it's good. I hand it to my assistant because it's going to go to a lab man that you're not going to be in the room with and we don't discuss it. If this isn't good enough for her crown on her tooth, she just throws it in the, she just drops it in the trash can, there's no word spoken and we do it again. What you do, is your assistant is not wearing loupes, your assistant doesn't have the freedom to call your own bullshit and throw away the impression. So, now the lab man has it, so then he's like, well, I don't want to call up and have you re-impress, you might get mad at me and drop your $6,000 a month account or maybe we can work around it or whatever. Your staff has to have the freedom.
I've been in so many dental offices where the dental assistant will ask the dentist a question, he says, well, you know what, go to Dental School. That is so rude. You're trying to sell dentistry to a patient and you can't even convince your own assistant or the hygienist. You know what I mean? If you can't sell your staff on what you're doing, why you're doing it, you probably don't even realize you only have a 30 % treatment plan acceptance rate. So the, it needs to be an equal playing field. They need to have loupes, they need to have their own light, they need to have the freedom of no fear, in fact, they're representatives of the patient, well, why are you doing this? Or they'll look down on your root canal and say, is that a fourth canal? Or just pull up your digital X-ray and say, should we go take a CBCT of that because on this mesial root, is that a hourglass root shape or is that an extra root? Because you're filing three canals, that looks funky. We've got a Carestream CBCT, do you want me to go take a three dimension of that molar? Open up the freedom, make your lab feel safe to talk to you. Make your assistants and hygienists feel safe to talk to you. If you don't have a safe working environment, your people can't bring you the information you need to do dentistry faster, easier, higher quality, lower costs, more profitable. A lot of you guys are shy and say, they know I'm a good guy, they know I'm safe. Your lab man doesn't know that your receptionist doesn't know. You have to tell people all the time.
Karl: Yeah and like you're talking about with the people who work there and making sure we're talking about the business side of it, making sure that everybody's doing their best, not only is that, we were talking about vision, but ergonomics as well. If you say to the hygienist and I'll, the hygienists are on a budget and some dentists will help the hygienist out, some won't and if they buy a cheap pair of loupes or a pair of loupes that also expensive and not ergonomic, they can do that too. Their career's going to be shorter, you're going to be out somebody who you just trained. It's a real hazard for, especially the hygienist who is working a lot of hours with those loupes on.
Howard: Yeah, I buy all of my staff their magnifications and their light and I think that's just standard operating procedure. You're the one that's going to have to eat all the remakes, you're the ones that are going to have more implants have perimplantitis because she didn't have loupes to see excess cement, missed calculus. Again, the fastest way to increase quality is be able to see and that means magnification and light. So back to magnification. You said the average dental assistant, hygienist two and a half magnification.
Jin: Yeah. But I think that two and half is not enough. Their hygienists are using higher power loupes.
Howard: Who is?
Jin: ...Japanese hygienists...
Howard: Yeah, Japanese hygienists.
Jin: With higher power loupes Hygienists can find dental problems such as cracks and caries before dentists see. Then they report dental problems to dentists. So they don't need to wait until the problem really become bad.
Howard: But what power in Japan? Three and a half?
Jin: Many hygienists use three and a half, and four and a half. Twenty years ago the working distance of most dentists was fourteen inches, surgeon working distance was sixteen to seventeen inches. But today, the working distance of dentists is eighteen to twenty inches. The increase of their working distance requires more magnification. At the fourteen inches, two-point-five is adequate for most procedures, but if the working distance increases to seventeen or eighteen inches, the increase of the working distance is 20%, 30%. By the same amount (20%, 30%) we have to increase the magnification power in order to see details with a two-point-five at the fourteen inches. So that's why today many dental schools recommend three-point-five magnification loupes to their students.
Howard: So how do my homies listening to you, how can they get, accurately measure? Do you have reps in the field?
Jin: Yes, we have over twenty sales reps, they can visit every dental office.
Howard: You have over twenty reps in the United States that can cover every city in the United States? No kidding. What've are they, on a flying carpet? Or how do you?
Karl: They're on the road a lot...
Howard: They're on the road a lot.
Howard: OK, so if I go to...
Karl: If you go to surgitel.com
Karl: …/myrep, all one word, you can type in your zip code, you'll find the contact of your person and they know a lot. We want to make sure, speaking of education, we want to make sure our reps aren't just out there slinging the product around...
Howard: OK, so...
Karl: ...we teach them everything...
Howard: ...video camera, clinical seating, eye protection, ergo-practice e-newsletter, specials, exhibitions, events, how to...
Karl: Like contact us...
Howard: So, why SurgiTel loupes? Headlights reviews, contact. OK, wait, I saw another one, I saw a contact your local rep...
Karl: ...that's the one.
Howard: OK, so I will type in, you type in your zip code. So I'll type in eight, five, zero, four, four submit. And my rep is Chris Reidy...
Karl: ...yeah Reidy...
Howard: ...Chris Reidy…
Howard: ...is that a boy or girl?
Karl: That is a guy.
Howard: And where does he live?
Jin: He lives in Dallas.
Howard: Dallas, right on. So then if they didn't have a loupes, so they would go to surgitel.com, contact local rep, type in their zip code, and then they would what? Come by and see if you're doing mostly crown and bridge versus surgery or would they measure your, and what...
Karl: They measure a whole bunch of stuff. They measure the horizontal of your eyes, the vertical of your eyes, the distance here and they'll also show you different kinds of angles and find the one that works for you that's going to keep you up. Because every, there is many custom loupes needed to be made, as many truly custom loupes need to be made for as many people as there are. We were talking about, another thing, we were talking about two and a half loupes for the, let's say the dentist is wearing two and a half loupes and he's a guy of six three or, yeah, and then let's say the hygienist is wearing two and a half loupes and she's five one. She is, that's the opposite of, the working distance effect comes in because she can see a lot more than the dentist sees. The rep who comes by will see how tall you are and make a recommendation on how far away you are from your subject and help you pick the right product, no matter what. Ergonomically, vision-wise, the whole thing.
Jin: Also when we select our frame, for example, Howard, we should consider a facial feature for the true custom-fit because there are different facial features. Caucasian guys have a very high nose and some Asian ladies have no nose bridges. So we cannot fit the same pair of loupes to both facial types. So, we have to select right frame and special nose pad type for different facial types. Also we measure head width for the custom-fit. Other companies make are making custom loupes, but they only customize interpupillary distance and working distance: these loupes are partially custom loupes. They don't make a specific declination angle and do not consider specific facial features. SurgiTel consider every aspect of your facial features and then work environment and everything.
Howard: I was always blown away when you think of the diversity of man when you think about me standing next to Shaq, or who was that famous wrestler, they just did a movie on, the big Wrestlemania guy...
Karl: Undertaker, I don't know.
Howard: Oh, it's, but anyway, he was that big.
Jin: Huge guys.
Howard: But the orthodontist, the variants between the two linguals of the maxillary second molars for all humans, it's only like three millimeters from the biggest. What's the variance of interpupil distance?
Jin: Interpupil distance difference is about twenty millimeters.
Howard: That's a big variance.
Jin: Yeah, big variance.
Howard: So twenty millimeters?
Howard: Would it just be the obvious, a really, a six foot six guy,
Jin: Even shorter people have wide interpupil distance. The military standard shows that the interpupil distance is between 55mm and 75mm.
Howard: Fifty-five to seventy-five...
Karl: Yeah and then where those oculars seem to be vertically, depends on your nose and that is very different between each individual. (There is about twenty millimeter difference between low nose and high nose)
Howard: Yeah it's huge in, the difference between Asia and Europe because in, when you have a big nose, you're getting a lot of botox and lip fillers that push your lip out. Then when you go to Asia where they have smaller, more dainty noses, the girls, it's really, beauty is so bizarre. In Asia, especially like Cambodia and Vietnam and Indonesia, they put their finger to their nose and their chin and if their lip touches their finger, they think their lips too big. So they go pull the two first bicuspids, to pull the teeth back because they want a space between their little nose and they want a space and what's sad about it is when I'm over there, there's not one man in Cambodia that ever looked at this darling little girl and said your lip needs to go back two millimeters and here she's extracting, she's mutilating two teeth and she's spending several thousand on Invisalign and she doesn't know there's not one man in Cambodia who doesn't think she's already adorable and beautiful. So beauty is so bizarre, but you're right as you get a bigger nose. I think of Italians...
Karl: Also Norwegian people.
Howard: Norwegian. So when they get a bigger nose, how does that, what does that doing to the angle of the glasses?
Karl: Well, it makes it more of a challenge. But we've developed some technologies where oculars can sit very low. In fact, we have one of the older limitations of designs as glasses that have a rim on the bottom. We've made a lot of rimless designs, we carry Oakley frames that have a rimless design, so the ocular can drop right up the edge or even below it a little bit and that'll help.
Howard: So, talk about the Oakley because that's fashion brand name. How did you get tied up with Oakley. What was that decision? What's the story on that?
Jin: Early days, I designed ergonomic FLM loupes. Then surgeons and everybody told me, Dr. Chang you're making good loupes, why don't you just make TTL loupes. I said, “I really cannot, I don't want to offer TTL loupes because I cannot make ergonomic TTL loupes. I do not want to make traditional TTL loupes which can hurt people.” When I started SurgiTel, my goal was to provide ergonomic vision products. At a previous company which I co-founded, I did a military system. I am a Christian. I was helping pilots fight better but I thought about God-given talent to use in a better way for more people. That's why I thought about how I use my talents. Then I sold my company stock and started SurgiTel. Then...
Howard: So you felt bad making military, stuff for military?
Jin: Yeah. (Making military stuff is ok, but I wanted to use my talents for more people who take care of patients)
Howard: Now that's very interesting.
Jin: And then I started the FLM loupes, they were very ergonomic one. I did a lot of surveying how surgeons are working. Then people asked me to make TTL loupes. But consciously I cannot make non-ergonomic traditional loupes. So I refused. Then I started to invent (ergonomic) frames with a proper pantoscopic angle. With these ergonomic frames we were able to mount loupes into glasses with a good looking-down angles which users do not need to tilt their head too much. But the bottom rim limits the mounting option. So we were looking for same kind of sports frame without the bottom rim and found that Oakley frames were exactly meeting my requirements. That's why I visited Oakley. Oakley frames were designed to protect eyes. The founder of Oakley was a mountain biker. That's why Oakley and we are tied together...
Howard: And where's Oakley? Where they out of? San Fran?
Jin: They located in California, southern California
Howard: Southern California. What city are they in?
Karl: Like Foothills
Howard: Foothills, OK.
Howard: I want to go back to your story. I think that's so romantic. You didn't want to participate in building the technology that kills people. Talk to us about that journey, how...
Jin: As a Christian, I wanted to do something helping people. Actually when I started this journey, making money is not the main goal. I was trying to help people based on my faith. My wife said, “You're really crazy. You want to leave the good company and start this new one here.” I said yeah and started. There were difficult times, but I never regret my decision. I think we have a lot of things to offer today. We have all the tools and are able to help all clinicians who want to prevent the neck problem.
Howard: That is a beautiful story. Way too many Americans do not practice self-examination on their own country's military. The end of World War Two was the war to end all wars and it wasn't even an hour and a half and they were in North Korea for ten years, then they were in Vietnam. They've been in Afghanistan for sixteen years, then Iraq, they leveled Libya. When I look around at all the actors and the world, I'm most frightened of my own country. I don't wake up at night worrying about all these other countries, I wake up at night worrying about our own damn military and I think that is absolutely amazing that you said enough is enough and walked away from that.
Karl: Dr. Chang said, when I started working for Dr. Chang, well I was just looking for work...
Howard: You were what?
Karl: I was just looking for work when I started looking for work. When I was, got out of my MBA and I ended up hooking up with SurgiTel but I never told you this Dr. Chang, but I'm thinking, OK, if they don't pay me enough in three years, I'll go somewhere else. It's been five years because I like the company mission, and you guys do pay me enough, don't worry about it.
Karl: It's because it's really interesting to work for a product that honestly, when I talk to people and, who have our product and have solved their issues and it's great, it's nice to come to an event like this event or any other event and talk about a product I know is going to help somebody. It's a lot easier to be in a marketing department in that company than any other.
Howard: And that's why I love dentistry. You're a different breed of cat who goes to college for eight years to help another human get out of pain with your hands. You live in a surgery, we're all surgeons. 80% of physicians just write prescriptions. We all do surgery in an operatory, we're all surgeons, but the type of person who goes to school for eight years. I don't care if I'm meeting them in Poland or Cambodia, they're a special breed of cat. I love my homies. Back to my question, what is the most common magnification in America? Is it different for general dentists versus implantologist? Or endodontist? What are you mostly selling? What magnification? What lighting system? How many different products do you have?
Jin: We have two-point-five to eight (magnification powers). I think that we have the most options available.
Howard: List them all. Two-point-five.
Jin: Two-point-five, three-point-zero and three-point-five, four-point-five, five-point- five, six-point-five, eight-point-zero.
Howard: So you have one, two, three, four, five, six, seven.
Karl: And a couple versions of each of those, some of those. So...
Howard: How would you have a couple versions?
Jin: Well there are a couple version: one of them, flip up style (FLM) and then the other one, the TTL style. FLM, front-lens mounted.
Howard: What percentage of loupes? Same FLM and TTL loupes?
Jin: TTL loupes are about 70% and FLM loupes about 30%. Today the three-point-five, still two-point-five loupes are getting popular, but we're selling a lot of two-point-five's.
Howard: So two-point-five is the most common. I always thought, tell me if I'm wrong. I always thought two-point-five was the most common because when you're getting them in Dental School and you're thirty, you have a really good functioning eyeball, but by the time you're fifty-five, obviously I can't see as good...
Jin: No, actually that’s not...
Howard: ...as I could at fifty-five as I could when I was twenty-five.
Jin: ...no, actually that's not the case.
Howard: That's not true.
Jin: Yeah, actually two-point-five was due to the wrong education.
Howard: Wrong education?
Jin: There are old generation teachers who used to working at a short working distance like this. Two-point-five enough for them. Now most dental students are working at longer working distance like this. Two-point-five loupes are not enough for those students because longer working distances require more magnification. Two-point-five loupes were good to old generation teachers whose working distance is short, but almost useless products to new generation dental students whose working distance is long. That's why some schools, like USC, recommend three-point-five now.
Howard: USC? And they changed their name, they're no longer USC.
Jin: What you call them now?
Howard: Oh it's, gosh what is it? I'll tell you...
Karl: Also two-point-five has been around the longest, so if they asked somebody before them or somebody next to them what you got, oh two-point-five, OK that sounds good.
Howard: ...they're now, it's no longer USC, it's the Herman Ostrow School of Dentistry.
Jin: Oh, OK.
Howard: HOS, Herman Ostrow Scholl. So USC which is one of the greatest Dental Schools in the world, they recommend three-point-five...
Jin: Three-point-five but a lot other Dental School doing the same way now because two-point-five is not enough. Because two-point-five here is OK, two-point-five here is not OK.
Howard: So you're saying your number one magnification is at three-point-five. 70% would be through the lens.
Jin: Still we selling lots of two-point-five
Jin: ...but three-point-five loupes rapidly increases...
Howard: Now what if you were an oral surgeon? Are they buying differently than general dentist?
Jin: No, not necessarily the same thing
Howard: So, is there any advantages or just, if you're purely wanting to go save the neck, is there any advantage or disadvantage of through the lens versus flip-up styles...
Jin: Yeah, there is something again. It depends on the facial feature. Someone who have a really high nose, flip up system sometimes limits, because loupe mounting parts may touch their noses.
Howard: What is my nose?
Jin: You are about average.
Howard: I have an average nose.
Jin: ...little higher than average, within the range of average. Someone who really have nose bridges of over two centimeter. That’s pretty high.
Howard: Oh, so it’s nose bridge, it's not the end of your nose…
Howard: ...when you have a big nose, it's just the nose bridge...
Jin: ...nose bridge yeah...
Howard: ...well, so does the nose bridge...bigger nose bridge usually have a bigger nose?
Karl: Yeah usually.
Jin: it's a mounting fixture touching the nose and that's why look-down angle may be limited. For low nose people FLM loupes offer enough angles but for high nose people TTL loupes are better. We can make better angle with TTL loupes. Actually right now we can offer any different angle to anyone. So it doesn't really matter.
Karl: ...and that's what the rep is for because Howard, you were asking about products. There's some micro versions of some of those oculars and there's different types of, we didn't even talk about frame options or frame nose pad options which are custom. It's, it took me a long time to catch up because there's a lot of different customizations for all these.
Howard: But what percent of the people, could you recommend, what percent of the people are buying a light with their magnification?
Jin: Oh yeah, almost everybody buys headlights
Howard: Almost everybody.
Jin: Almost everybody.
Howard: That's amazing. So, that was the fastest hour in the world.
Howard: Your Phoenix guy, Chris, tell him next time he's in Phoenix to, I have a home studio. Tell him to come by the home studio and tell us, I'd like to talk to him, what it's like in the field. Maybe he could also go through what he's measuring, how he's doing it, what that consultation would look like, but tell him next time he's in Phoenix to stop by the house. Ryan lives with me, so we can film him twenty-four/ seven. We've filmed them at two o'clock in the morning before, I don't want to say that it was after a long night of drinking, but let's just say it was two o'clock in the morning. Thank you so much for coming on the show. Thank you so much for coming to Townie Meeting 2018. Are you enjoying yourself at Townie?
Jin: Oh, yeah.
Howard: Thank you so much, this was so informative, I learned a lot and thank you so much.
Jin: Well, again, I want to say your role is very important for educating clinicians. All the government regulations focus on the patient care, nobody cares about professionals. OK. If dentists themselves do not protect themselves, they may end up a very sad life. You are doing great job in helping those people who are your fellow dental professionals. I think that your role is extremely rewarding for you and also very important. So I really thank you for inviting us, sharing idea. Any time you ever come to Michigan and drop in. I will show you what we do. We have two big CNC machines there and they are really automated.
Howard: In Chicago?
Jin: Ann Arbor, Michigan.
Howard: Oh in Ann Arbor, Michigan.
Karl: Our facility is in Ann Arbor, Michigan. We build and ship around the world.
Howard: Well, do me a favor. Get me your chair guy CEO. I'd like to talk about that and if you're ever visiting back in Seoul, Korea, I'll pay my own way, I'd give anything to lecture in Seoul. I've lectured in fifty countries. I have not lectured in Seoul. So what I want to do is...
Howard: What's that?
Jin: You didn't lecture in Seoul yet?
Howard: I've never been invited to Seoul. So, here's what I want you to do. I want you to send me an email email@example.com. I'll reply back to my other two Korean buddies, Dr. Park who has Megagen in Seoul and Dr. Byong Seo who has his company outside of Chicago. What city is that in?
Howard: And maybe between you three, maybe the three of you can get me a lecture Seoul, Korea at...
Jin: Seoul is a beautiful city and very vibrant city.
Howard: What I like the most about, well, a couple of interesting things I love most about Seoul. They also had a Dentaltown. They had their own message board community, but they did something wrong, they set up a database of what they call pain in the ass patients. So it said, this lady, so then they had this database where, OK, here's a troublemaker, she's been to seven, eight dentists and the local television station found out. So that was the end of that site. So they had a Dentaltown. It was very, it was a great Dentaltown. About the same time, we started our Dentaltown but the thing I like the most about the South Koreans is that their product cycle, we were talking about between when Megagen, Dr. Park has an example. What people don't realize that first, he was a massively successful dental, and he had a dental hospital, ten floors tall, he had a, one level was oral surgery, orthodontics, pediatrics, five floors of general dentistry. When he would get an idea, he would change his implant design, he'd mill out a hundred and his one hundred dentists would have them all placed by Friday. Compare that to the United States and Europe where a Dental School, like say Michigan. First, they talk about it for a year, then they apply to grants and then they get the grants and they'd spent a year designing the study and then they would set up for their grad students. So the time they had an idea, by the time they had the end results would be five years. The Koreans, five months. So when these shorten that and they do the same thing with bonding and bleaching and all their techniques. The experiment is usually done in ninety to a hundred days. So, since they have the shortest product cycle between idea, innovation, result, they're just leapfrogging the Europeans and the Americans. It's hard for a Nobel Biocare in old Europe to advance at the rate of the South Koreans, just because they've figured out the value of faster, easier, higher quality, lower cost experimentation. It's amazing, how fast they can innovate. So I want to go there and see it all. So send me an email firstname.lastname@example.org, I'll reply to (unclear 1:04:56), Dr. Park and then he fix me up with that ergonomic guy and thank you for all that you do for dentistry