Dentistry Uncensored with Howard Farran
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1044 Disruptive Technologies with Prof. Faleh Tamimi Marino : Dentistry Uncensored with Howard Farran

1044 Disruptive Technologies with Prof. Faleh Tamimi Marino : Dentistry Uncensored with Howard Farran

6/1/2018 12:36:22 PM   |   Comments: 0   |   Views: 185

1044 Disruptive Technologies with Prof. Faleh Tamimi Marino : Dentistry Uncensored with Howard Farran

Dr. Tamimi is a dentist who holds 2 clinical certificates, in Geriatric Dentistry, and in Implant-Prosthodontics, respectively, as well as a Ph.D. in Biomaterials and a  postdoctoral position at McGill University for two years. Currently he is a Canada Research Chair in Translational Craniofacial Research, and an Associate Professor at the Faculty of Dentistry of McGill University.

Dr. Tamimi’s research interests are in finding solutions to relevant clinical problems through the development and application of new biomaterials and pharmacological treatments.

He has published over 104 scientific articles in peer reviewed journals. And his publications have been highlighted in the public media (i.e. print, radio and television interviews in media such as Newsweek Magazine, The Wall Street Journal, Radio Canada, CTV, Global News).

Dr Tamimi is also involved in knowledge transfer activities. He along with a group of researchers and software developers created a web application (www.ebhnow.com) that is helping dentists from all over the world access scientific evidence to improve the treatment of their patients.

https://www.mcgill.ca/dentistry/



VIDEO - DUwHF #1044 - Faleh Tamimi Marino






AUDIO - DUwHF #1044 - Faleh Tamimi Marino



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1044 Disruptive Technologies with Prof. Faleh Tamimi Marino : Dentistry Uncensored with Howard Farran

Howard: It is just a huge honor for me today to be podcast interviewing Prof. Faleh Tamimi Marino. He is a dentist who holds two clinical certificates in geriatric dentistry and in implant prosthetics, respectively, as well as a PhD in biomaterials and a postdoctoral position at McGill University for two years. Currently, he has a Canada research chair in Translational Craniofacial Research and an associate professor at the faculty of dentistry of McGill. Dr. Tamimi's research interests are in finding solutions to relevant clinical problems through the development and application of new biomaterials and pharmacological treatments. He has published over one hundred and four scientific articles in peer-reviewed journals, and these publications have been highlighted in the public media, print, radio, television interviews in media such as Newsweek magazine, The Wall Street Journal, Radio Canada, CTV Global News. Dr. Tamimi is also involved in knowledge transfer activities. He, along with a group of researchers and software developers, created a web application, www.ebhnow.com, that is helping dentists from all over the world access scientific evidence to improve the treatment of their patients. My gosh, it’s not everyday someone with two doctorates comes on the show. Thank you so much for coming on the show today.

Dr. Tamimi: Thank you for having me.

Howard: The honor is all mine. You talked about so many things. I don't even know where to start. You want to start with osseointegration pharmacology.

Dr. Tamimi: Thank you. So a few years ago we were doing some studies on the success rate of dental implants. Looking at records of patients, we start to find some patterns in the implants that were failing in our patients and the implants that were not failing. So we started to see that there was a tendency that some patients that were taking certain drugs, they had the higher rates of failure than usual, and some patients that were taking other drugs had the opposite, had lower rates of failure than what’s the norm. So then we start to dig more thoroughly and we started to actually discover that in fact there are drugs that are high risk of implant failure, and there are medications that are shown to be the opposite, with low risk of implant failure. So we started to investigate the literature [inaudible 02:35]. We found so far there are around thirty known medications that could influence osseointegration and implant failure.

Howard: So there's thirty prescription medications that could lower the success rate of an implant that you're placing.

Dr. Tamimi: Exactly.


Howard: Do you have that list?

Dr. Tamimi: Yeah.

Howard: Could you post that list on Dentaltown under -- there's fifty forums and one of them is implants. Would you mind posting that list on Dentaltown?

Dr. Tamimi: Yeah, we could.

Howard: If you have it in front of you, can you read them off?

Dr. Tamimi: Yeah, I'm going to mention some of them are good, some of them are bad. Parathyroid hormone, calcitonin, strontium, vitamin D -- those are like the good ones.

Howard: Okay, those are the good ones. Say the good ones again. Let's start off with just the good… Vitamin D?

Dr. Tamimi: Vitamin D, parathyroid hormone, vitamin D analogs, strontium. Bisphosphonates have improved osseointegration… beta-blockers, antihypertensive drugs in general, including beta-blockers. Cannabinoids as prescription drugs have been found to increase osseointegration. Melatonin, it increases osseointegration also. Statins like for cholesterol have also been shown to improve osseointegration. And then lithium chloride also has been shown to improve osseointegration. Caffeine also, so there are studies on caffeine. There are studies on local anesthesia [inaudible 04:30] that have improved osseointegration. So those are, in a nutshell, the good ones that we have found.

And now the bad ones are a few more like estrogens, estrogen-replacing therapies. No, sorry. Estrogen-replacing are good.  Proton pump inhibitors cause problems. Cyclosporins like immunosuppressants.  Because it's a long list, I don’t know these by heart. Nonsteroidal anti-inflammatories, so patients taking ibuprofen chronically, they’re at high risk. Patients taking antidepressants like serotonin uptake inhibitors, alcohol. Some medications that are used to treat glaucoma like Ranibizumab or Lucentis, it's an antibody that they use to treat glaucoma, and it's also used as chemotherapy. Anti-VEGF also impairs osseointegration. Thyroid hormone, so thyroid deficiency could increase implant failure also. Warfarin, so patients taking anticoagulants also have problems with osseointegration and implant success. And oxytocin also impairs implant osseointegration. Those are the nutshell.

Howard: Yeah, but you could post that list under implants?

Dr. Tamimi: Yeah, we can.

Howard: So the health history is very important on a presurgical obviously.

Dr. Tamimi: Yeah, that's what we have found. We came up with the concept of osseointegration in pharmacology because there are many drugs that seems to influence osseointegration.

Howard: You also talk a lot about rapid prototyping and 3D printing.

Dr. Tamimi: Yeah. I started to work on 3D printing technologies now for over a decade. Initially I did some research on craniofacial reconstruction. Let's say you want to reconstruct the jaws. With extensive research on printing ceramics for vertical bone augmentation, we obtained promising results. We were able to augment bone with ceramics and later on place implants on those bones. That was it on that end. It's challenging to bring that technology to the clinic though for regulatory constriction. Printing a material that is going to be implanted in the body is still a bit tricky in terms of FDA approval. There's not many options available nowadays to that. I hope in the future it will become easier to do that.

So I moved to other 3D printing technologies like laser sintering. Laser sintering is a technique to print metal. I started to work with a company a few years ago on a project. This company is called 3DRPD. It’s a Canadian-American company and they print dentures. They fabricate partial dentures. So I start to collaborate with--

Howard: Wait, what is the website of this company?

Dr. Tamimi: It's called 3DRPD.

Howard: Wait, 3D Art?

Dr. Tamimi: R, like--

Howard: Oh, 3DR…

Dr. Tamimi: 3DRPD... So it’s 3D removable partial denture, kind of.

Howard: So 3DRPD.

Dr. Tamimi: Yeah, 3DRPD.com. We have a collaborative project between McGill University and this company to develop partial dentures, but instead of being casted like in the traditional method, the metal frameworks are printed with laser sintering technology. What we discovered is that printing the metal frameworks this way, it eliminates a lot of inconsistencies that happen when the frameworks are made manually. The metal comes out with better quality. It's more resistant to deformation.

And then when we tried them in a clinical trial on patients, we found that the patients were happier with these dentures. We give the patients two treatments like a denture that was made through the traditional method, so it was made manually by casting the metal, and then the same denture but printed with laser sintering. We assessed how happy and satisfied the patients were with their treatments for a period of a month. And then at the end of the clinical trial, we asked them, “Which denture you would like to keep? You can only keep one.” 80% of the time, the patients selected the printed denture.

And when we dig into the data to find out what was going on, there were like two main things that made the difference. One, the fitting was more precise. The fitting was better. The other thing is that the retention was better also. The retention of dentures was better especially over time. We've found that the casted metal that they use for partial dentures, it's more prone to  deformation over time than the laser sinter method. So laser sinter method is more stiff and is less likely to deform. It maintains the retention of their partial denture.

Howard: Are you still researching it or is it ready for prime time? Is it taking off?

Dr. Tamimi: Yes. Now this product has been made available in the US. I think the military, they're using it for their patients in the US. This company now fabricates around one hundred and eighty frameworks per day.

Howard: A lab does it?

Dr. Tamimi: What happens is that the printing facility fabricates the frameworks and then they ship them to the dental labs, and the dental labs they got the teeth.

Howard: So you're making a hundred and eighty a day now?

Dr. Tamimi: Yeah, they're making a hundred and eighty.

Howard: In Montreal, Canada?

Dr. Tamimi: Well, actually the manufacturing facility is in Plattsburgh, New York.

Howard: Plattsburgh, New York?

Dr. Tamimi: Plattsburgh, New York, yeah.

Howard: So do you think that's going to scale? I mean a hundred and eighty a day, that’s no small number. How long do you think it'll be to 10x that to go from a hundred and eighty a day to eighteen hundred a day?

Dr. Tamimi: Well, that I wouldn’t know. That will be the business people in those companies that would know that [inaudible 11:54].

Howard: You have two doctorates. That’s not your department, huh?

Dr. Tamimi: Yeah. It's been a very interesting experience to see how a procedure that was not manual and could take a dental technician maybe a week to complete -- like to make a partial framework. It's very labor intensive. Now a printer is working 24/7 printing dozens of these frameworks per cycle. It’s a disruptive technology. It’s a game changer, right?

Howard: You’re talking about it's higher quality. It's more precision. The patients liked it more, but what about costs in comparison to traditional.

Dr. Tamimi: So in theory it should become cheaper. Right now, I think they are being sold at a slightly lower price than what would have been a casted framework, but I'm sure that eventually it will become much lower than traditional frameworks. As the market starts picking up on these technologies, the prices are going to go very low because the manufacturing costs are actually very low. The only expensive thing here is the printer itself. But as the values of the printer start to go down, I think it's going to change the way these procedures are done.

Howard: What is the price of the printer nowadays?

Dr. Tamimi: That I wouldn’t know.

Howard: Interesting. You also talk about clinical decision making.

Dr. Tamimi: Yeah. So one thing about devoting my whole life to research and to try to improve knowledge on dentistry in general, when I went back to teach in the dental clinic after I finished my PhD, I started to realize that in the clinic most of the decisions that we take as clinicians are not based on scientific evidence. Most of the time we use intuition, we use our experience. We don't use scientific evidence. This was bugging me because I was taught in a way in my PhD that the best way to treat patients is using the scientific evidence. So there is a ton of scientific evidence there like on the Internet, on the scientific literature -- it's huge.

But it seems there is a huge barrier between what we know as scientists and what is being done in the clinical practice. So I think there is a need for new products, new technologies to break that barrier. Your podcast is one example. This endeavor that you're taking with Dentaltown, it helps break those kinds of barriers. So what we've done was something slightly different. It was creating a website in which systematic reviews and clinical practice guidelines are made easily accessible to dentists through web applications.

Howard: Now is this your website you're talking about, ebhnow.com?

Dr. Tamimi: That's correct.

Howard: What does ebhnow.com stands for?

Dr. Tamimi: It stands for evidence-based healthcare now.

Howard: Nice. When did you launch the app?


Dr. Tamimi: We launched it a year ago. It was between me and a friend of mine. We didn’t put much. We didn't put any investment into it. It was just at first like an experiment to see if there is really a need for this kind of products. Within the first year, we have over a hundred thousand visits.

Howard: Nice. Explain to my homies what your goal is. How does it work?

Dr. Tamimi: I'll give you an example. Let's say a patient comes to the clinic, and the patient has some decay on a tooth. Maybe there is a periapical lesion. They might need to a root canal. And then the patient asks you, “What would the best treatment?” So you have many options. You could say, “I can do a filling and a root canal. I can do a root canal and a crown. I can extract the tooth altogether and put an implant. I can do a bridge.” So how do you make the decision? How do you make the right call? It's very subjective.

So what we do in our app is that you place the condition of your patients and then the app pulls out the literature on the success rate of an implant, of a crown, of a filling, or a root canal in that particular scenario. So then you have data that you can use to make the decision. In that particular case, you will see that maybe the implant has the best success rate or the bridge is the best option. So you will have some data to make a better decision. Of course, this doesn't eliminate the intuition and experience of the dentist. It’s just a tool that can help support your decisions.

Howard: Are dentists liking it? Is it helping them?

Dr. Tamimi: Yeah, all the feedback I have had from people using it is very positive. Some dental schools are starting to incorporate it in their curriculum, and McGill University now is part of the resources used by the Library of McGill. But we wanted to make it bigger. Keep it going.

Howard: Well, we'll try to do that with the show, try to keep it going. Now you went to dental school. Tell them where you went to dental school.

Dr. Tamimi: I went to dental school in Jordan in the Middle East.

Howard: Because you're in Quebec right now, right?

Dr. Tamimi: That’s correct, yeah.

Howard: Because Lebanon was a French colony at one time. Is that where you learned how to speak French?

Dr. Tamimi: No, it's more complicated.


Howard: Because the French, they colonized the remnants of the Ottoman Empire -- Syria, Lebanon. Was your native tongue Arabic or French or both?

Dr. Tamimi: Actually my native tongue is Spanish.

Howard: Spanish?  Because then you went to another dental school. You went to dental school in Lebanon, then you went to dental school in Spain?

Dr. Tamimi: Yeah, I was born in Spain actually because my mom is Spanish. I was born in Spain, and then my parents moved to Jordan in the Middle East. And then in Jordan, I stayed there for ten years. I did my dental school there. And then when I finished dental school, I decided to go back to Spain. So I spent in Spain the next seven years doing my master's and my PhD, and then that's when I moved to Canada.

Howard: And then pick up French.

Dr. Tamimi: Yeah, a little bit. It's not easy -- French.

Howard: Because you're in Montreal right now. So you speak Arabic, Spanish and French and English?

Dr. Tamimi: Yes.

Howard: That's just amazing. I mean I can barely speak English and I've lived in Phoenix for thirty years. 25% of my patients speak Spanish. I tried so hard, but I just tip my hat. Man, you must be about eight times smarter than me to be able to speak four languages. Which language do you dream in?

Dr. Tamimi: I think I don't dream in any language now.

Howard: What language are you most comfortable with?

Dr. Tamimi: I’m most comfortable in Spanish. Spanish is my mother language.

Howard: I had a good buddy who was a dentist and she was born in, I think Czechoslovakia. Her mother was Czechoslovakian, her dad was Russian, and they were born, I think, in some other country. Anyway, long story short, she’d always say, “I speak five languages, none of them well.” And I'd say, “What is your native tongue?” She goes, “I don't know. I talked to my mom in this language, dad in this language.” They moved in a different country then moved to America. I just thought that was just crazy not to have a fallback foundational language. For that, I tip my hat to you.

And you've lived in several different places. How is dentistry different in Syria, Lebanon, and Canada?

Dr. Tamimi: There's some important differences. Like in dental school where I went to, the teaching was very much focused, very much technique-driven.

Howard: In Lebanon or Spain?

Dr. Tamimi: In Jordan. It was technique driven, so you learn how to perform a technique and everything was organized in that way. In Spain, it was a bit different. In my program there, it was more driven about the management of the case. It's not about the technique as much. You learn the technique, but it's more about the holistic care of the patient. In McGill, it’s all about the holistic care of the patient. Basically the patient comes in faculty here in McGill and you need to treat him as a whole. It's not about doing requirements of how many fillings or how many crowns you do. You need to complete the case.

So here in McGill, there is a lot of emphasis on treatment planning, which I think is very important because the technicalities you learn over the time. But what makes us special as human beings is our ability to reason. Technical skills can be replaced by machines in the future. But our ability to reason is what makes us special. So I think that's the most important thing in a dentist is our ability to think.

Howard: It’s so amazing because when I was in dental school thirty years ago, to graduate we had all these numbers. I had to do fifty extractions, fifteen root canals, fifteen units of dentures. I had to do fifty fillings. You're saying that that's mechanized and that you had more holistic. How many patients did you have to manage at McGill to graduate in dental school? Was it a number of patients that you had to manage them?

Dr. Tamimi: We have a certain amount of requirement. There's some minimum requirements. They still have to do a certain number of procedures, but the priority is that the student has to complete the patient as a whole. So the patient arrives in the clinic and he has to do everything the patient needs. He cannot dismiss a patient until everything is completed, like a perio, prostho, restorative -- anything has to be done. So it's about completing a case or patient, which is more similar to what happens later on in real life in the clinical practice. A patient comes to your clinic, you need to fix everything. It's not that you do a filling and then you send them home.

Howard: So is it about the same number of units? I mean we're doing fifty extractions, fifty fillings, and then fifteen root canals and fifteen units of denture.

Dr. Tamimi: Probably it's much lower. I think the requirements now here are lower than that. That also creates an issue because some of our students here, technically they are not very strong. They require some more training, so later on they go into general residency programs to compensate for that.

Howard: I find on clinical decision making -- God, I wish I have saved the study, but it was about a decade ago. They were talking about the US military, the submarines. I think they have eight hundred people on there. So they don't have enough people. They have a full-time physician, and they don't have the space like they do on a big aircraft carrier. I've been on several aircraft carriers and there's two full-time dentists on there. But for a submarine, they submerge, they might not come up for six months. So they had this really advanced software where if one of those eight hundred people got sick, there is no doctor, they don't want to surface and give away their position, so they would enter their symptoms on this computer and they had a mess kit. And the research is showing that the computer was better than any emergency room in America. The computer had like a 94% success rate, and your emergency room doctor didn't. So that's kind of what you're talking about on clinical decision making.

Dr. Tamimi: Exactly, yeah. It's changing. Things are changing so quickly. We're living through something they call the fourth industrial revolution, and it's driven by all these software, decision support systems, artificial intelligence, and we need to adapt to it. Many of the tasks that we do today as professionals might be replaced by by machines or computers, and they might even do a better job. So I need to find out what is our space in the future.

Howard: How long do you think it will be before the CBCT actually reads the x- ray?

Dr. Tamimi: Well, it's already happening. Like in radiology, there is a big project that is driven by IBM to use artificial intelligence to diagnose pathologies from radiographs. They have surpassed by far the accuracy and the precision of radiologists. There is a high risk that the radiologist as professionals, they might become obsolete in five to ten years. So anything that is digitalized like images from optical scanners, the analysis of those images, it's very easy to get it automated by computers.

Howard: Yeah, I liked the fourth industrial revolution. The first industrial revolution saw the creation of the first trade union and environmental laws. The second industrial revolution saw the dawn of electricity and mass production. The third industrial revolution was the digital age, and the fourth industrial revolution is the internet of things and artificial intelligence. You do a lot of work with artificial intelligence, machine learning. What are your thoughts on that? You think the machine learning and artificial intelligence are going to start helping with the diagnosis and treatment plan and the reading of x-rays?

Dr. Tamimi: Absolutely. They’re going to replace many of the things that we're doing today in terms of diagnosis, analysis, design, for example -- design of a crown, of a denture,  of an implant treatment because it can be automated with those technologies. What it cannot replace though is the common sense. So artificial intelligence doesn't have common sense.

Howard: But common sense was never common to begin with.

Dr. Tamimi: That’s right.

Howard: So if the machine learning has no common sense, it'll still be better than humans. I’m down here in Phoenix and this is where Google is testing their driverless car, the Waymo, and I see him every day. I mean they're all around here and I talked to many of them when they stop or they're at the store or a restaurant. We had one fatality in Tempe a few weeks ago and it was funny how emotionally everybody freaked out about this one person dying. Do you not know that a hundred Americans are killed by humans driving cars every single day? And then the one day they had one death, they panic. 

I think about thirty to forty thousand Americans are killed each year in a car. Even Warren Buffett was talking about how he was preparing his investors that over the next ten years, as we switched from humans driving to machines driving, he doesn't even know if there need to be insurance. He goes, “Our business is going to be killed because the cars have been getting safer for thirty years with Ralph Nader's bumper and airbags, and all these things like that.” But he said the human hasn’t gotten any better. In fact, the humans have gotten worse because they're so distracted by their smartphones. When I was little, the major distraction was drinking and driving, and they massively cracked down on that. Now that doesn't even make the top five.

But now the beer has been replaced by a smartphone and they're sitting there texting and calling and it's all distraction. The number of people in the car -- by the time you have four people in the car, your rates of mortality are really high. Eating -- I mean, I can tell you how many times I've been at a red light and you look over and some woman is putting on her lipstick and she's doing her makeup while she's holding a coffee and driving this three thousand pound piece of metal down the street. It's crazy. 

Do you think rapid prototyping and 3D printing is -- you're talking about sintering with partials. How close are we to crowns?

Dr. Tamimi: Oh, it’s already been done. Crowns are already there. Like metallic crowns. Laser sintering, [inaudible 30:25] to metal crowns are already there. The challenge is the porcelain. The only thing in a dental lab today that still the machines haven't been able to achieve at the same level as humans, I think, is the porcelain -- the cosmetic part of porcelain. Everything else can be done now with 3D printing technologies like from printing plastic, machining plastic, acrylic, metal, you name it. The last thing is the cosmetic porcelain.

Howard: So you're saying that right now the porcelain is only good enough for old bald guys with liver spots where it doesn't matter on the back teeth?

Dr. Tamimi: Yeah, the good ceramic stuff.

Howard: But how long between this is technically understood and bleeding edge versus leading edge and starts becoming mainstream where you might have 5-10% market penetration with this. How far away is that, do you think?

Dr. Tamimi: I think it’s going to be really quickly -- the penetration. It's already happening through the dental labs. If you went to a dental lab ten years ago or twenty years ago, it was the same thing as in the last century where we have [unclear 31:41] smelling everywhere, you have the wax, the Bunsen burner, people doing wax-ups. Now you go to a dental lab and it’s just a kid playing with a mouse on a computer and a whole bunch of printers printing the dentures, printing the crowns. It's already happening in the labs.

Howard: Yeah, I love visiting labs. I love visiting Van Hook. I’m right up street. They’re just so technical. Same thing with (inaudible: 32.16) laboratories. Yeah, you're right. When I was talking to Jim Glidewell, he was telling me something very interesting that back in the day -- thirty, forty years ago -- it would take a year to teach someone the full art of pouring up a model, trimming the dye, waxing, then taking that off in casting and then putting that on, and then stacking the porcelain and fire. He said it’s like zero to a year, and he had all kinds of money invested in all these VCR tapes, his own inhouse education. He said it'd take a year to take you from zero to good and then you can make five crowns a day. He said with a CAD/CAM, now that training instead of a year is five days, and after five days you're up to speed and now you can make fifty a day. I mean talk about amazing productivity.

Dr. Tamimi: Yeah, it's crazy.

Howard: So then how long do you think it will be? The Chinese were the first ones that just had a robot place a titanium implant. I mean the robot did the whole thing. Did you see that? What did you think of that? Did it make you want to move to China and learn a fifth language?

Dr. Tamimi: Yeah, that was very impressive. But it's just a hint of what is ahead of us. The future is exciting.

Howard: So what advice would you give to these young kids listening to you? Because I got to tell young kids… I say, remember when I got out of dental school, nobody saw the ATM, the cell phone, the laptop, the iPad. I mean it’s like -- oh, my gosh. I tell my four boys all the time, “If you see the same increase of wow that your dad did, who could even imagine what's around the corner?” How does a young student prepare for the unknown like this? This is going to be a lot of extremely disruptive technology.

Dr. Tamimi: There’s a philosopher, his name is Zygmunt Bauman, a Polish British philosopher. He describes this phenomenon very well. He calls it the liquid reality.  He calls it the liquid reality because there is nothing solid that we can grasp on because everything is changing continuously at our feet. I tell the young students, I them them, “They need to be [inaudible 34:40] because everything that they learned today, it can become obsolete in the next five years. They need to keep adapting and learning, adapting to whatever new things are coming.” They need to learn the fundamentals. That's very important. But they also need to learn how to keep adapting and incorporating new technology [inaudible 35:05] at a tremendous pace.

Howard: How long do you think it'll be before there's a device that prepares the filling or the crown prep or the inlay or the onlay? Do you see any of that around the corner?

Dr. Tamimi: I think it might happen someday, but I think it’s a bit challenging. Like placing an implant with a robot is pretty straightforward compared to preparing a crown or a filling. It might come some day, but it’s not something that’s already around the corner. I haven’t seen it in labs or in research conferences yet.

Howard: Your website,  evidence-based healthcare now, when they sign up for that, what is the cost of that?

Dr. Tamimi: It's free. We decided to put it for free.

Howard: Wow. Have you posted about this on Dentaltown?

Dr. Tamimi: No. We could.

Howard: Yeah. You should start a thread because we have a… See, the scientist who invented the internet or the ones that invented the computerized bulletin board system which Dentaltown is on, and it's the only place in dentistry that's organized by fifty categories -- root canals, fillings, crowns. We have evidence-based dentistry, you should post that under. Your list of drugs will be under implantology.

I just never liked all the other. I started off probably in ‘94 with these email groups -- dentist yahoo group, dentists at compuserve -- and you open up your email and it just is crazy, unorganized barrage of crap. All social media has done to this day is just move it out of the inbox into Friendster and then Myspace and Facebook and Twitter and Instagram and Linkedin where it’s just unorganized, and I just don't like that at all. If I can go to Dentaltown and I want to look up somebody's implants, I'm going to go straight to implants and that's called the computerized bulletin board system. That was in 1970.

And so you can just go to Dentaltown, then go to the category, evidence-based dentistry, and then put your lists on the other stuff. What's neat about that is the way… well, I don't know -- I'm just organized. I think the reason that Dentaltown has grown a thousand new members a month ever since they've launched Facebook is because of that element.  

I saw research the other day that if your songs are being played in random, you actually secrete more dopamine and serotonin because you weren't expecting it. It's kind of neat to get on to Twitter and see just random stuff. It's very entertaining and it's very fun, but it's not a great way to learn how to do an implant. You know what I mean? So if it's something that requires a lot of deep knowledge, I just think the bulletin board system is better. And then the other thing, you post that there, it'll be so easy for the kids to find it a year from now.

Now McGill, is that the largest dental school? How many dental schools are in Canada? 

Dr. Tamimi:  There are ten dental schools in Canada.

Howard: And is Mcgill the largest?

Dr. Tamimi: No, it's the oldest.

Howard: So it’s the first one.

Dr. Tamimi: The first one, yeah. It’s the oldest one.

Howard: What year was that?

Dr. Tamimi: The beginning of the nineteenth century. I’m sorry, at the end of the nineteenth century.

Howard: Can I ask you one controversial question? I don't want to upset you guys. You guys were all over the news last year with a the big scandal?

Dr. Tamimi:  Well, a few.

Howard: It did not blow over and pass, no big deal, or is that still lingering on or...

Dr. Tamimi: Well, that's still around there. I think it's getting fixed.

Howard: It was kind of one of those things like Dr. Walter Palmer who shot Cecil the lion, he became massively famous overnight, but for all the wrong reasons. I don't think there's a dentist on earth that has not heard of McGill university. So it built a brand faster than any anybody can. So what's got you excited? How long have you been a professor at McGill?

Dr. Tamimi: Eight years now

Howard: What’s got you passionate about being a professor at McGill as opposed to going into private practice and seeing your own patients?

Dr. Tamimi: Well, it’s an intellectual challenge of learning new things every day. Then also, it’s gratifying when you make contributions that could help others improve their lives and improve their careers. And I also like teaching.

Howard: So it sounds like you're a big sharer. You like sharing. There's a lot of skill in sharing. I mean it's one thing if you sat down and do a filling. But if you taught all the dentists how to do a filling better, faster, easier, you're really motivated by finding these new digital technologies so dentistry can be done better and faster and higher quality.

And the one everybody forgets is they're always talking about better, faster, easier, higher quality, but they always forget miniaturization. Like when the steam engine came out, it was so damn big. Its only use in the United Kingdom was to pump water out of flooded mines, so they could go back and reactivate coal mines. But each generation of steam engines got smaller and smaller and smaller and eventually they fit on a ship, and then that was transatlantic shipping. And then when the ship got here, that turned into even smaller so they could go down canals. So I just wonder when these machines will get small enough that when someone needs an MOD filling, you will just put a device in their mouth and it will prep it instead of having a human holding a high-speed handpiece.

Dr. Tamimi: Yeah, exactly.

Howard: But you think that's going to be a lot further off. Of everything we talked about today, what do you think is the thing next that will start showing up in the private practice? Go from research lab to bleeding edge to actually getting 5% penetration.

Dr. Tamimi: Us dentists, we're not very quick in adopting new technologies. Dental labs are much quicker than a dentist in adopting new technologies. So usually the big changes are  [inaudible 41:37]. Many of the big changes, at least  [inaudible 41:43] dentists are coming from the labs and already there. The one that I'm most excited about is the arrival of artificial intelligence. So like you were saying automated x-ray diagnosis. I think that's very exciting.

The next big thing that I’m concerned about is about technologies that’s a bit scary for the person -- technologies that could overpass the dentist. So technologies that could be sold directly to the patient overpassing the dentist, those are a bit worrying for many reasons and they're also coming. So there are some exciting new things coming out. There are also some risks that are coming in the next few years.

Howard: Well, it's very profound. You said dental labs adopt technology faster than dentists. That is so true. Why do you think that is true?

Dr. Tamimi: Why? I think it could be an issue of personality. Also a dental lab doesn't face a patient. They’re just facing the machines and equipment and prescriptions, so they don't feel the risk of, “Okay, what if I try something new on my patient today and it doesn't work?” So they don't see that also. Bringing new technology to the lab, the regulatories are much simpler than bringing the technology to the clinic. So having a equipment in the lab doesn't need the same requirements as having something in  the clinic -- it's different. I think maybe that's also a reason.

Howard: Back to artificial intelligence, what do you think of some of the greatest men out there who think that artificial intelligence will eventually turn on humans? Basically the only thing a human was for was to create the artificial intelligence and then the artificial intelligence will no longer need us and kill us.

Dr. Tamimi: Well, like Terminator.

Howard: What’s that?

Dr. Tamimi: Like the movie Terminator.

Howard: Yeah. What do you think about that? Do you think that's probably real?

Dr. Tamimi: Well, I think some experts tells us -- they all mention that there is limits of how far off artificial intelligence can go. Like it can allow generating solutions for problems faster but to have a conscience of its own, and that's another story.

Howard: Yeah. Well, I mean, if we made a conscience, obviously someday your iPhone will have a conscience. I mean if it's been done before, it's probably possible. And it's not just the machines journey against humans with a conscience. 


I mean, what if there is a viral pandemic? They could survive that. What if there is a nuclear holocaust and a nuclear winter, climate change, bacteria, the way the dinosaurs? It's very likely that some iPhone droid with opposing thumb would survive. Right now when you look at the only things that have left our solar system, man-made, there's no humans on Voyager 1 and Voyager 2. So when you look at the fact that it takes ten million years for some of these journeys or a billion years for some of these journeys, you're not going to put a human in that deal.

I bet we will perfect droids and we’ll protect it all and it'll be so perfect, and then something will happen to our habitat. Either we’ll kill each other ourselves, a virus, a meteorite, and then all the droids that have been launched in the space will still be surviving while we won't. I don't see any way how they won’t. If we get to make it right, I don't think there's any way they won't make it.

And also, necessity is the mother of invention. Japan has a real problem where every single day they have less people than the day before. They have an ageing population. Their girls aren't making babies. A lot of people in economics say, “If they don't open up immigration and they don't start letting in a bunch of people...” which they don't want those people. I've lectured there. They liked their island. They like it like it is. They do not want to open it up to immigration. They like a closed society. But what's going to be their savior is artificial intelligence, machine learning, robotics. I mean if you're not going to make a two point four babies per family, and you're only going to have less than one, then you to have to make one point for robots for family and make up for the productivity. So I think Japan will be the one where they have to force this because they don't have a substitute in the marketplace, which is America, which was built on slave labor, cheap labor, immigrant labor. I mean it's always had a low cost labor advantage.

Hey, it's an honor that you came on the show today. It's not everyday that we get someone to come on with two doctorates. Is there anything else you wanted to talk about or is there any questions I was too dumb to ask?

Dr. Tamimi: I don’t know. I could keep talking forever.

Howard: So of all the countries you've lived in -- Lebanon, Spain, Montreal -- are you going to limit it to three or are you going to move to a fourth place? Which one did you like living in the most?

Dr. Tamimi: I never realized how good the weather was in Spain until I came to Canada. 

Howard:  Well, Lebanon was Mediterranean, too.


Dr. Tamimi:  Yeah, Lebanon is also good weather. I’d say hot. It’s hot.

Howard: So Lebanon was too hot. Spain was perfect.

Dr. Tamimi:  Yeah. Arizona is very hot also, right?

Howard:  Yeah, it's very hot. Today is May 9th and it's a hundred and four degrees.

Dr. Tamimi: Wow. I won’t complain. I wouldn’t complain.

Howard: So what's your favorite city in Spain? Is it Barcelona or Madrid?

Dr. Tamimi: I lived a long time in Madrid but my favorite place in Spain is the Canary Islands.

Howard: The Canary Islands?

Dr. Tamimi: Yeah, that’s my favorite.

Howard: Are those British?

Dr. Tamimi: No, they’re Spanish.

Howard: Oh, the Canary Islands are Spanish.

Dr. Tamimi: Yeah, it’s in the Atlantic Ocean. If you have the chance to go there, that's a beautiful place. It’s like the Hawaii of Europe, kind of.

Howard: How many people approximately live on the Canary Islands?

Dr. Tamimi: Maybe a million in all of them together. There are seven islands.

Howard: Seven islands and it's Spanish?

Dr. Tamimi: Yeah.

Howard: How many dentists do you think are on the Canary Islands?

Dr. Tamimi: Not many. They don't have a dental school there.

Howard:  The dentists that are there, what percent of the dentists could speak English?

Dr. Tamimi: Quite a few because there’s a big population of expatriates from northern Europe. I guess Swedish and Norwegian, British that they go and retire there.

Howard: Wow. There's two big huge dental companies in Costa Rica. One is Align Technology where they make all the Invisalign trays. The other one is Glidewell. And I tell you what, that Costa Rica, that is one country where... I think that's where I want to retire. Some day when it's a hundred and fifteen degrees here, I'm going to go down there.

But hey, seriously, thank you so much for coming on the show. It was a huge honor. His name is Faleh Tamimi Marino. His website is... Tell them the website again.

Dr. Tamimi:  ebhnow.com.

Howard:  ebhnow for evidence-based healthcare now.com. It's free, and you're going to post that. Because they're driving right now, they can't take notes, so you go to Dentaltown, you'll put your list of bad prescriptions for implant placement outcomes, the good ones, and then go to the other section, evidence-based dental care, and place your link to your app there.

Dr. Tamimi: Very good.

Howard: All right. I hope you have a rocking hot day, Faleh. Thank you so much again.

Dr. Tamimi: You too. Thank you very much.

My name is Faleh Tamimi. I'm an assistant professor at the faculty of dentistry. I have a bachelor degrees in dentistry from the University of Jordan in Jordan and a PhD, a masters in science and two specialty degrees from the University Complutense of Madrid in Spain, and a postdoctoral fellowship from McGill University. I do translational research in biomaterials and mineralized tissues. I work on developing new treatments for problems related to bone health and the health of the skull such as osteoporosis and bone fractures.

In my lab with my students, we work on developing new biomaterials and characterizing them, the physical properties and chemical properties, as well as developing new therapies for bone-related problems and bone diseases. We also test these new therapies in animal studies, and subsequently we also assess this new therapies in patients in clinical studies in our clinic. In our research program, we are developing new therapies for diseases such as osteoporosis and drugs to treat bone fractures. We have discovered so far a few of those and we're also developing new biomaterials that can help regenerate and heal bone in patients that are suffering from bone loss due to fractures or cancer or other types of diseases.




Category: Technology
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