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Speaker 1:
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We are live at Las Vegas. The last day, day three of the Townie Meeting 2016. This is our 14th annual Townie Meeting is it? I am here with my idol, my role model. I've got tell you a story about John Kanca. When I started Dental Town in '98, not even one percent of the dentists had internet connection. I would go in the lecture room and say, "How many of you guys have internet?" There'd be 100 dentists in the room. One guy would raise. I'd say, "What is your email address?" He wouldn't even know. I'd say, "Why did you get the internet?" He'd say, "The kid's teacher said we needed to get it for homework assignments to do term papers on planet mars, or whatever."
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'94 to 2004 Dental Town couldn't really grow very well because we were waiting for dentists to get on the internet. When they started getting on the internet it seems like everywhere I went, the top 10 most famous speakers in the world, John Kanca was the only one on there. So many times I would hear dentists talk and they say, "I heard these idiots arguing or whatever. I heard it's a dumb forum." Someone else would say, "Dude, John Kanca's on that forum." They'd say, "Really? John Kancas' on that forum?" You were the guy who validated Dental Town for the first day. I say from 1998 to at least 2005 you were the single validation to Dental Town. I'll always be forever grateful for that.
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Speaker 2:
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Happy to be able to help Howard.
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Speaker 1:
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You're posting, my god. What do you have? What do you have 40,000 posts?
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Speaker 2:
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44,382 I think it was as of yesterday.
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Speaker 1:
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Tell these young kids ... The bottom line is only five percent of Americans have ever listened to a podcast, you're probably talking to about 8,000 dentists right now. The truth is, most of them are juniors and seniors. I'd say 20% are juniors and seniors in dental school. The other 79% are probably within five years out. For every guy that sends me an email at howard@dentaltown.com and says, "I just want you to know there's an old guy like me listening to your show." The next 100 will be young kids. For young kids, tell them ... You were very historically important in dentistry. You were the one before any of us ever ... We heard it first from you that you could sketch dentin. Your email is, I don't want to give away your email address. It was webbonder@something. Tell the kids your historical relation with bonding.
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Speaker 2:
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I was coming out of practice. I spent a few years just in private practice solo.
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Speaker 1:
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What year did you get out of school?
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Speaker 2:
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'78.
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Speaker 1:
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1978. Where was that?
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Speaker 2:
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Yukon.
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Speaker 1:
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1978 Yukon.
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Speaker 2:
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After about four years I just had a hankering to do more professionally. I started reading the literature and taking a part in some of the meetings. I wanted to have my on a paper in the literature. I tried to figure out some mechanism for that to happen. I ended up buying a hardness tester and evaluating hardnesses of composites and published that paper in 1983 in Quintessence. I published a series of papers along that line, evaluating the hardnesses of composite as they were light polymerized. Back then lights were much weaker and composites didn't polymerize as thoroughly. You had to polymerize a two millimeter layer of composite for 40 seconds. That give you an idea of how far things have come since then.
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I started going to research meetings and I ran into Bertillati. I'm seeing him talking about etching Dentin. He's had been to Japan and knew a professor from Siamba. I saw him talking about it. I, belonging to the current crowd, said, "No, you can't do that." What I determined to do was to go prove he was wrong. That you couldn't-
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Speaker 1:
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Fusayama?
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Speaker 2:
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That they were all wrong.
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Speaker 1:
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Wrong about what?
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Speaker 2:
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Etching dentin. That you couldn't do it.
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Speaker 1:
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That you couldn't do it.
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Speaker 2:
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Then I started asking myself questions. For instance, the liquid in zinc-phosphate cement is phosphoric acid. In fact it's 85% phosphoric acid. Somehow he could mix that into a little zinc-oxide, put that on a tooth, and leave it there for thirty years. Putting 37% on for 20 seconds was really really bad. What I did was, I read every bio-compatibility paper written since 1945. I had my two boys, who were young at the time. They were playing with their G.I. Joes and I'm reading the papers. All of a sudden one day in the Yukon library it hit me. I had a revelation. I literally had a revelation. I erupted out with a rather nasty expletive. I realized in that moment what was wrong. I knew what was happening, what should have happened, and what had gone wrong with everybody's thinking.
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Then I also knew you could etch dentin and it was fine. I started to do that. I actually joined forces with John Gwinnett early on. He provided me with some invaluable information about interface relationships with composite resins and tooth structure. We worked together for many many years. It taught me what was going on. I had all my ducks lined up. I had my literature, I had my research, everything lined up. One day at the Academy of Cosmetic Dentistry in 1989 at Frenchman's Reef I was doing a lecture. I'm a founding member of the Academy of Cosmetic Dentistry. I said out loud to the audience, "I wasn't going to tell you this." If you ever want a room, you probably know this, full of people to stop what they're doing and get quiet and turn around and look at you, you just say, "I wasn't going to tell you this."
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I went on to talk about etching dentin. The place just exploded. My name was on everywhere. My face was everywhere. This is the guy who's going to destroy dentistry. This is the guy who's going to kill dentistry. This is the guy who's going to kill patients. In one of the tabloids someone said, "I want to practice next to his office." That's kind of how, professionally, I was received. Nobody ever asked me questions about is this really the right thing? What have you done? I got hammered. The summer of '89 was a very difficult year for me professionally. I was getting pounded from all sides. I realized then you just had to wait it out. Then just accept that this was going to happen. It happened with etching dentin. Then soon after that I discovered wet bonding.
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As I was doing research for that I kept doing samples. I would get a certain bond strength and a certain standard deviation. As I thought, I've got some high numbers and I've got some low numbers, how did I get those high numbers? What I did was tried drying it more. The numbers where actually started to drop and my standard deviation went up. I did it more and the number dropped further and the standard deviation went higher. You kind of intuitively go, I'm going the wrong way. Even though that didn't make sense. What I started to do was not dry it as much. All of a sudden the numbers started creeping up. I left it a little more moist and the numbers jumped up. Then I just shook off the water and put the adhesive and the numbers skyrocketed.
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They were bond strength numbers nobody had ever seen before. The standard deviation was really tight. I presented that at the research meeting IADR and other meetings. Again people said, "You're full of crap. That's not going to work. You can't do that. You're wrong." I had another one of those things that I had to sit out and wait. I take pleasure in knowing that dentistry changed courses twice because of things that I discovered. I'm grateful for that. It didn't make me personally wealthy but ...
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Speaker 1:
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Repeat the two things.
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Speaker 2:
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Validation of dentin etching and the explanation for why people thought that you couldn't do it. I explained why you could and the factors for ... Let me give you an example. There were etched teeth. They put acid on animal teeth and then they put a control material in. Two weeks later there would be a burn in the pulp. Two weeks. I'm thinking, why two weeks? I saw an article by Gunnar Bergenholtz in 1978 who had taken bi-alkalized bacteria, put it on a smear layer and got abscesses in the pulp within 30 hours. I realized that the pulp could react very very quickly. Why would a phosphoric acid take two weeks to cause a reaction?
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Then I started looking at the controlled material. I saw the controlled material. When you put the controlled material into different cell cultures all of the cells in a culture die. A controlled material was zinc-oxide eugenol. That control material was what people had always called bland and non-irritating and kind to the teeth. It is anything but. What was happening back then is they would etch the dentin tubules be opened up. They'd put this noxious material in there and over two weeks it would diffuse into the pulp and cause a chemical burn. That's why. They attributed that to the acid, but it was always the control material. That's kind of how I solved it at that point. Like I said, it took reading all of the literature to understand that.
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Speaker 1:
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John, a lot of those are confused because there are so many generations of bonding. What generation are we on now, eight?
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Speaker 2:
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Yeah thereabouts.
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Speaker 1:
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Can you explain what was generation one, two, three, four, five, six, seven, eight.
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Speaker 2:
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You'll have a little bit of different opinion on this. The first dental adhesive restorative was severaton.
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Speaker 1:
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Severaton?
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Speaker 2:
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Severaton, and that appeared in 1948.
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Speaker 1:
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Oh okay. I was going to say, "How did I miss that one?" I wasn't born then. Severaton? Are you kidding me? Who made that?
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Speaker 2:
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Oh god, who made that? I think it was DeTrey if I'm not mistaken?
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Speaker 1:
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Who?
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Speaker 2:
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DeTrey.
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Speaker 1:
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I've never even heard of that one.
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Speaker 2:
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It's D-e-T-r-e-y.
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Speaker 1:
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Are they still around.
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Speaker 2:
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No they're not. I think they got taken up by Denstsply if I'm not mistaken. That was 1948. It appears in the literature in 1952. In the British Dental Journal. Kramer and McClain wrote a paper about it. What was really interesting about that paper was that Kramer and McClain describe what they call an aniline die. What they call a blue staining layer. That blue staining layer, that same layer, 29 years later was finally called a hybrid layer by Nobuo Nakabyashi. They were actually the first ones to see a hybrid layer. That was fascinating.
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That was really the first one. Then came about 1977 Kuraray put out New Bond. They had New Bond which is a phosphate esther-based material. In 1981 3M presented Scotchbond. The original Scotchbond, which was also a phosphate esther. These materials were the second generation. You would etch the enamel only. As if anybody could do that.
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Speaker 1:
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What was generation one?
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Speaker 2:
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Generation one was Severaton.
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Speaker 1:
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All right and what was-
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Speaker 2:
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Generation two was New Bond and Scotchbond.
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Speaker 1:
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New Bond and Scotchbond. Okay.
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Speaker 2:
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That one you would treat the enamel with phosphoric acid and then you would mix these two materials up, put them on a dentin, and go. These initially were self-curing materials.
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Speaker 1:
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New Bond was Kurray? K-U-R-R-A-Y
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Speaker 2:
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Kuraray. K-U-R-A-R-A-R-Y.
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Speaker 1:
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Okay, K-U-R-A-R-A-R-Y.
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Speaker 2:
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Kuraray. These were just self-curing materials. You'd mix them, two parts. Mix them and put them on the dentin in the enamel that you'd etched. You'd have to wait for them to set. They're meeker, but at least it was a start. The third generation materials were materials in which you would etch the enamel and then you had a primer that you placed on a dentin. You would acid etch the enamel and then place a primer on the dentin. Then you had a bonding resin. Now you have three parts. There are three parts to the story. There's the phosphoric acid etching of enamel, primer on the dentin, and then a bonding resin on top of that. Those were okay. The dirty secret here ...
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This is about the time now when people were worrying about etching dentin, getting acid on dentin. Because that's a no-no. As you sit there and watch these materials that had these primers, the secret was these primers were becoming more and more acidic. Because to make anything stick to a tooth you have to acid treat the tooth. One way or the other you have to acidify the surface. In order for these resins to stick. They were putting other materials that were acidic ... It seemed that as long as it wasn't phosphoric acid then it was okay to put on dentin. It could be nitric acid. It could be sulfuric acid. As long as it wasn't' phosphoric acid then we're okay. That's kind of what was going on. That was the third generation.
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The fourth generation is the generation I created. Then became total etch. Once we broke through that barrier we could create materials to just put phosphoric acid on dentin and enamel without ... It's hard. I don't know who thinks they can really put phosphoric acid on enamel only. I think that's a stupid thing, to be honest with you. How can you this? This stuff is slopping in especially in the bottom of boxes. You have thin little layers of enamel. How are you going to get ... It's absurd. Now we were free to phosphoric acid on dentin and enamel.
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Then there were primers. Primers could be in one bottle, or primers could be in an A or B type primer. You had primers to put on enamel and dentin and then a bonding resin. The difference the third and fourth was total etch. That's where you went total etch.
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Speaker 1:
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Does your license plate on your Porsche say total etch?
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Speaker 2:
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It should say that but it shouldn't say that. It says Dr. John.
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Speaker 1:
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Dr. John? Why didn't you go with total etch, or wet bonder?
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Speaker 2:
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I like Dr. John. I've had Dr. John license plates since 1976.
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Speaker 1:
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It is a Porsche isn't it?
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Speaker 2:
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9-11 yeah. This is right about the time when wet bonding was discovered. Let me step back just a sec. I had this concept for a fourth generation system. Which was phosphoric acid. I took tenure A and B, and I had Scotchbond two resin for light cure. I had dual cure Scotchbond for bonding on crowns. I kind of created the concept of bonding on crowns. I wrote the first article on this. It was in Ron Jordan's book. One of the aesthetics books. I have a chapter in there on how to bond on crowns, it's 1989.
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We went from there, right about this time we started talking about wet bonding. That's where wet bonding came in, that fourth generation. I took this concept that I had, the phosphoric acid, tenure A and B, and Scotchbond and I went to 3M with it. They didn't want anything to do with it, because you're putting acid on dentin patient's going to die. You're going to go to Hell. Then I took it to Kur. They said patient's going to die. You're going to go to Hell. They didn't want anything to do with it. The only company that would listen to that was Bisco. They hedged bets, but this system that I created is the system that became All-Bond.
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Speaker 1:
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With Byung Sung out of Korea.
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Speaker 2:
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Byung Sung yeah.
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Speaker 1:
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He was born in Seoul and then he moved to Chicago?
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Speaker 2:
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He was born outside of Seoul in a small town. Then he immigrated to the states. He was working for another company then he decided to form his own company.
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Speaker 1:
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What's the name of that city outside of Chicago? Chavanaugh?
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Speaker 2:
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Schaumburg is where the-
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Speaker 1:
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Schaumburg, Illinois.
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Speaker 2:
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That's where the company is.
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Speaker 1:
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Were you guys collaborators on All-Bond? You took it to him?
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Speaker 2:
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The concept of the acid etch, A and B, and resin that was what I had. He had a couple other monomers to work with. This little NTGMA in primer A. He had his own monomer in part B which was called BPM.
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Speaker 1:
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He was a chemical engineer?
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Speaker 2:
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He was an organic chemist. He had a background in that as well. First he offered a partial etch of dentin then finally wen't full blown into full total etch. That's where All-Bond came from.
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Speaker 1:
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All-Bond was a game changer.
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Speaker 2:
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Oh boy it was a game changer. Absolutely. The funny thing ... I don't have really tons of regrets in my life. I should have asked for a piece of the action and I didn't. This is one piece of advice I do have for people. At this time I was thinking history. I'm going to make history, and I did. I changed dentistry two or three times. I changed it completely. That's great, but that doesn't put your kids through college. I'm thinking history, I'm going to be in history, yes. I should have been thinking tuition, tuition, tuition. My advice is if you have choice between rich and famous, take rich. You can buy famous.
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Speaker 1:
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You're two boys that you put through school are lawyers. You're really a dental lawyer. You read that literature ... Most people just look at the summary box and say what do I need to know. How do I do it? You always read that literature like-
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Speaker 2:
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I'm an investigator.
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Speaker 1:
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Yeah. You remind me of some Baptist minister quoting the old testament. You just know all the quotes. You just know all the research.
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Speaker 2:
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I appreciate that.
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Speaker 1:
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You can quote that off the top of your head.
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Speaker 2:
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I have a capacity for remembering things like that. Now we're back. We're at fourth generation. The fifth generation now begins the pursuit of expediency and mediocrity.
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Speaker 1:
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What do you mean by expediency and mediocrity?
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Speaker 2:
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We're going to try to shorten the number of steps. We're going to take the steps down from three parts. We're going to now have a phosphoric acid. Now we take the primer and the bonding resin and combine them into one bottle. That's the fifth generation. Using things like one step, like prime and bond. This kind of thing. This is your fifth generation material.
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The sixth generation material is further effort at expediency. Sixth generation materials don't have any phosphoric acid around and in them. They depend on acidic monomers to attach to teeth. For the most part though, they do not etch enamel as well as phosphoric or as well as other things. You've given up something when you're using this sixth generation material. Those have it, did it in two parts. Either you put part one and part two, or you mix the two together and put it on. Sixth generation were two parts, but no phosphoric acid, no resin.
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Then we jump to the seventh generation. Which is now, again, the great leap into mediocrity. We try to do everything in one bottle. All you have is one bottle. Again, you're depending on acidic nature-
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Speaker 1:
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What are those brands?
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Speaker 2:
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You have things like All-Bond Universal, 3M's adper adhesive universal, a number of those. We have one superb like that. In my opinion you should never use those without somehow conditioning the enamel first. They just don't etch in it. They'll stick pretty decently to dentin, because dentin is easier to work with. The key in adhesive dentistry, in long-term survival of restorations, is making sure you've done adequate preparation and etching of enamel. My advice is absolutely to make sure somehow you condition the enamel surface-
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Speaker 1:
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We're at eight now.
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Speaker 2:
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I would argue that what I created, the newest material Surpass, that we have. I would argue it's a newer generation, but it's kind of a combination of two generations. It's a little bit of the fourth and a little bit of the sixth. It's three bottles, but there's no rinsing. The nice part about Surpass is it emulates a fourth generation material, but there's no rinsing. There's no how wet is it, how dry is it? Everything is either all wet or all dry. Just a minute, let me make a point.
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The fourth generation has been called the gold standard. Today that's as good as you can do, other than Surpass. That's realistically as good as you can do. Nothing is better than, again I would argue that Surpass is better ... Pretty much nothing is better than the fourth generation of materials. People are seeking to doing things faster and faster willing sometimes to give up performance for that. What I tried to do was create something like a fourth generation material. It was just much easier to use. You didn't have to rinse anything. You didn't have to worry about how dry it was, how wet it was. I would argue that was a successor generation.
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Speaker 1:
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Where along this journey ... You did start your own bonding company.
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Speaker 2:
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Actually I didn't. I joined forces with a couple of my good friends, Scott Lamerand and Chris Kulton. Who formed their own company. They use to work for Bisco. They had left Bisco several, I think it was probably 20 years ago now, and formed their own company.
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Speaker 1:
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What are their names?
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Speaker 2:
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Scott Lamerand.
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Speaker 1:
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Scott Lamerand. How do you spell Lamerand?
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Speaker 2:
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E-R-A-N-D.
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Speaker 1:
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R-A-N-D.
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Speaker 2:
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Chris Kulton.
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Speaker 1:
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Chris
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Speaker 2:
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K-U-L-T-O-N
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Speaker 1:
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K-U-L-T-O-N
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Speaker 2:
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They had that company-
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Speaker 1:
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Apex?
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Speaker 2:
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Apex Dental Materials. They had formed it.
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Speaker 1:
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Why the Apex for the root? Why did they like that name?
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Speaker 2:
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They liked the Apex because of the height, the highest point in dentistry.
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Speaker 1:
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Oh the highest point in dentistry. I was thinking the Apex ... I was thinking endo. Okay, Apex. The highest point in dentistry.
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Speaker 2:
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We're trying to avoid endo.
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Speaker 1:
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They started Apex 20 years ago and you were part of that team? Just a consultant?
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Speaker 2:
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No, I was still a consultant for Bisco. We had, shall we say, a difference of opinion about things. About 2001 ... Let's just say that things didn't go the way I wanted them to go.
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Speaker 1:
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Product-wise? Financial-wise?
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Speaker 2:
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I discovered pulse activation. I created pulse activation in 1996. I published a paper on this. Bisco created a light called a VIP, variable intensity polymerizer. They had a booklet with it about pulse activation. There were seven references in there. I wasn't even in there. I would have never even got credit for ... I'm the guy who created the concept. I thought that was pretty unfair. I was ready to create another system. What happened, as I saw it, he got all the money and I was just hoping for credit. Then I saw the credit being taken away too.
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Speaker 1:
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Who were they giving the credit to?
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Speaker 2:
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Him, the president of the company, of Bisco.
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Speaker 1:
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Byung Sung?
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Speaker 2:
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Yeah. That's kind of how it went. I reached a breaking point with that. I wanted to do something, because I had a concept to create another bonding system. I departed, then I joined forces with ... Heard Scott was around and I called Scott. I said, "You want to work with me on something?" I had always liked Scott. We got along very very well. He said sure. From that point, right about 2001, we got together in 2001/2002. We started creating things. We created first Simplicity and then a few years later we created Surpass.
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Speaker 1:
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What year did Simplicity come out?
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Speaker 2:
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2002.
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Speaker 1:
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2002 was Simplicity?
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Speaker 2:
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Yep.
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Speaker 1:
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Surpass was what?
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Speaker 2:
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2006.
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Speaker 1:
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Which one of those do you like better?
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Speaker 2:
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Surpass.
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Speaker 1:
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Surpass?
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Speaker 2:
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Surpass is killer.
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Speaker 1:
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Did Surpass surpass simplicity?
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Speaker 2:
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Yes it did. yesterday I had a friend of mine in my private messages in Dental Town. I get a lot of those in Dental Town. Kids, especially younger ones looking for advice. They tell me, "The guy I work for won't let me buy the right materials and I'm supposed to use this. Can you tell me the best way to use this." I do try to help them out. He said that somebody sent me quote from a Bisco ad that says that All-Bond too is still unsurpassed. That's exactly why it was written like that.
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Speaker 1:
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You're not an owner of Apex then.
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Speaker 2:
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If you look in the corporate minutes I'm not. We have an understanding, basically it's a three-way ownership. By the letter of the law, I'm not. I am from the standpoint-
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Speaker 1:
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Could your two lawyer sons defend you if something went wrong?
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Speaker 2:
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Oh yes. Oh yeah. I own the patents ...
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Speaker 1:
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Oh you own the patents. Explain to these people ... Dentistry's kind of weird in the fact that when you go to a course they're always showing full-mouth rehabs, yet 96 out of 100 crowns sent to a lab are one unit. The bottom line is, what I do every single week the most is an MOD composite on a molar. Anybody can do an occlusal, but an MOD's tough. Especially you don't want post-op sensitivity. You don't want to contact. You don't want them packing food. Will you just detail how you would do an MOD composite on a first molar?
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Speaker 2:
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We premise that, we remove all of the decay properly.
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Speaker 1:
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Would you numb it up with septocaine, articaine?
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Speaker 2:
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Carbocaine is my go to.
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Speaker 1:
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Why is that?
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Speaker 2:
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I just like carbocaine. It's a fairly good anesthetic and it's a fairly short-term anesthetic. You can use it on anybody. You don't have to worry about systemic conditions at all. I've just been-
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Speaker 1:
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Really?
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Speaker 2:
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I've always enjoyed that for-
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Speaker 1:
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How long has that been your go-to?
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Speaker 2:
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About 30 years.
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Speaker 1:
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Why did you leave lidocaine? Why did you not join the setpocaine revolution?
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Speaker 2:
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It just didn't do anything for me. I didn't see it as a necessity.
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Speaker 1:
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Carbocaine's supposed to be what just a half hour?
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Speaker 2:
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I get about an hour, hour and a half, out of it.
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Speaker 1:
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You get an hour, hour and a half?
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Speaker 2:
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Yeah, but it's not going to be as durable as lidocaine or epinephrine would be. Plus, like I said, you avoid systemic issues. You're not going to hurt anybody with tachycardia or atrial fibrillation. You're not running afoul of that at all.
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Speaker 1:
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You numb up with carbocaine.
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Speaker 2:
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Yep.
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Speaker 1:
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I remember back in the day with Dental Town '98 at another thing I give you credit for, that you didn't mention is no one used a rubber dam back then. The joke that you practice under a rubber dam? Yeah I mounted one on the wall so that I'm always practicing under a rubber dam. What do you think about isolation? Do you like rubber dams? Do you like isolite?
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Speaker 2:
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Isolation is absolutely critical. Isolite is a marvelous way to gain isolation as well. Now you have a number of opportunities to get isolation. A rubber dam is absolutely a great way to do it, and is a necessity.
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Speaker 1:
|
Not to detour off on a tangent, but one of the reasons I get upset about the way dentists talk about almagam. I've seen this is three different countries in Africa and Asia. Ryan when we go to foreign countries when we're traveling around, when we see a dental office we hit the brakes. We jump out of the car. We knock on their door. I watched this dentist in Africa. The person sitting in a chair like this. He's all excited. He numbs it up and he's showing me, so excited. There's a cavity and it's on a canine buckle.
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He's drilling and drilling and drilling it. Gets a pulp exposure. I don't think he's aware of it. I know he's not. She keeps sitting up spitting water. Spitting in a five gallon. Then he gets out this nice bonding kit, which I notice he paid about 1/10th about what I paid for it in Africa. He puts on the etch. She didn't like the taste so she swishes, spits it out. Then he paints on the resin. She didn't like that taste. She rinses, spits out.
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Then he cures it. Then he puts on the composite. Then he light cures it. Then he spends like 20 minutes polishing it for a whole beauty. When it was all over, I thought to myself, "There's no isolation." There's two million dentists and I think about 500,000 practice like U.S., Canada, Western Europe, Australia, New Zealand. Then there's a million in the middle. There's 500,000 John that they don't have the mechanics for isolation. Anything they read, everybody's bad mouthing amalgam. I want to ask you this, if you can't get isolation, would amalgam be a better material?
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Speaker 2:
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Oh it sure would. If you really can't-
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Speaker 1:
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Dental Town people think if you're doing amalgam you're a communist, Nazi, Stalin, Idi Amin.
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Speaker 2:
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I gave up amalgams 30 years ago. It wasn't because anything wrong with it. It was just a decision I made. I do think that would be a great place for amalgam, because it will survive in unfortunate, or undesirable, circumstances.
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Speaker 1:
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If you can't get isolation and you can't get moisture control, amalgam's a better restoration.
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Speaker 2:
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I would argue that that's a really good choice. Something like a high-density glass ionomer.
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Speaker 1:
|
What would you say to these dentists who, I hear them, you see them post that mercury amalgam is toxic. It's probably causing autism. It probably caused my hair loss. Seriously, I had all my hair. I went to Creighton freshman year. I went to dental school. Got my first eight occlusal amalgams. All my fissures where stained. They did occlusal amalgams. That year all my hair fell out. Can we say, for a fact, that my eight mercury fillings caused my hair loss?
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Speaker 2:
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No I think it might have been going to Creighton.
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Speaker 1:
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It was just going to Creighton? What do you say ... You hear the mercury haters.
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Speaker 2:
|
I think that's nonsense. It's just nonsense. There really isn't any evidence. Actually, I had one patient in my life. I remember one patient who had contact sensitivity to amalgam. I actually saw that. Each place to get class-5 buckle amalgam where the amalgam would touch his, he'd have a rash. He'd have an eruption in that spot. I took them out and it went away. It was the only thing I've ever seen like it. I've never seen anything like it since. That could have been anything.
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Speaker 1:
|
What did you think of that whole Hal Huggins revolution that we went through?
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Speaker 2:
|
I give it no credibility at all.
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Speaker 1:
|
They're charging people that live in trailer parks $30,000 to remove all their mercury, all this evacuation. They're wearing that NASA suit on the moon. What do you think of all that?
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Speaker 2:
|
I think it's absurd, frankly.
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Speaker 1:
|
You're a literature freak.
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Speaker 2:
|
Yeah, I think it's absurd.
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Speaker 1:
|
You're not seeing anything in the literature that would warrant some poor lady in a trailer paying $30,000 to have all of her mercury toxic things removed?
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Speaker 2:
|
You're going to know how many amalgams there are in people's teeth in the United States right? Do you have an idea?
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Speaker 1:
|
What billions?
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Speaker 2:
|
If it was going to show up, it would show up. If these patterns were real it would show up. You'd know it. You would know it. It's just not there. It's not there. It doesn't make sense. I give it no credibility at all.
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Speaker 1:
|
Just staying on mercury a little bit. Some people say that drilling out old amalgams to ... Some dentists say, "I don't place amalgams." But I'm drilling it out. I'm smelling mercury vapor all day. Is that harming me, my assistant, my staff?
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Speaker 2:
|
It is true that if you cut an amalgam dry you're going to generate more mercury vapor than if you cut it wet. If an amalgam is being cut, it should be cut wet, not dry. Then you should have a high volume suction near it also. I know of absolutely no examples in the literature of anybody suffering for having an amalgam removed.
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Speaker 1:
|
Wouldn't a sample size of 150 ... There's 125,000 dentists who work full time. There's 30,000 specialists. There's actually 211,000 people in America who are alive that have a dental degree, if you can't everyone who has retired and hasn't died. Wouldn't that be a big enough sample to show-
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Speaker 2:
|
Wouldn't you see it in the providers?
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|
Speaker 1:
|
Would you?
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Speaker 2:
|
Yeah, you sure would.
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Speaker 1:
|
You absolutely would.
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Speaker 2:
|
Because they're the ones who are totally exposed to it all the time, placing it, removing it. Again, there's no pattern in that. It just doesn't exist.
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Speaker 1:
|
These guys all have money, access to healthcare. They're in the system. There's no research for that?
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|
Speaker 2:
|
No.
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Speaker 1:
|
You would use carbocaine. That surprised me that you said that. You'd use a rubber dam or an isolite. What do you use? What personally do you ...
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|
Speaker 2:
|
It's both. It depends on how I'm approaching this. Isolite is great but you can't get it for everybody. Not everybody will accept it. That's okay. Then you use a rubber. We'll just kind of get that in place, then start removing whatever we need to remove out of the tooth. If it's an MOD, now I'm going to secure my matrices. I'm going to use a V3 ring from Triodent.
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|
Speaker 1:
|
That's out of Australia?
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|
Speaker 2:
|
Yeah.
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|
Speaker 1:
|
New Zealand.
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|
Speaker 2:
|
Out of New Zealand. I actually met Simon McDonnell. I think it was 2004/2005 when he had the original ni-ti prototype. I saw the original prototype.
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|
Speaker 1:
|
Were you in Auckland, New Zealand at the time?
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Speaker 2:
|
Yeah I was in Auckland.
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|
Speaker 1:
|
That's where he is?
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|
Speaker 2:
|
Yeah. That's where I ran ... He came up to me and said, "What do you think of this?" I looked at it and-
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|
Speaker 1:
|
Didn't he sell that company?
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|
Speaker 2:
|
I think he did.
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|
Speaker 1:
|
To Dentsply.
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|
Speaker 2:
|
To Dentsply, yeah. When I saw that prototype, I knew immediately this was going to work. I said, "I'm going to use this one." I never liked any of the other rings. They didn't really do much, but this was going to work.
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|
Speaker 1:
|
He had another buddy with him, Marshall White.
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|
Speaker 2:
|
Yes.
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|
Speaker 1:
|
You're his god. Marshall loves the literature. I can't talk to Marshall for five minutes without your name coming up three times.
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|
Speaker 2:
|
I really appreciate that. Marshall's a great guy. He's a really good guy. I would use the V3 rings, their tab matrices, fix the rings. After I get the rings in I'm going to use the wedges. I do like the wedges. Their what we originally called wave wedges. We put them in-
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|
Speaker 1:
|
Stop there. There's low-cost wooden wedges that some people say when they get wet they shrink.
|
|
Speaker 2:
|
When they get wet they expand, not shrink. They get weaker. When they absorb water, they swell.
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|
Speaker 1:
|
Wouldn't that be a good thing?
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|
Speaker 2:
|
It gets softer.
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|
Speaker 1:
|
It expands, but then it gets soft?
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|
Speaker 2:
|
Yeah. It's like a piece of wood lying in a river for a long time.
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|
Speaker 1:
|
You like wood or plastic?
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|
Speaker 2:
|
I like the plastic ones.
|
|
Speaker 1:
|
Why?
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|
Speaker 2:
|
They'll stay where you put them. They're shape is preferable to the wooden ones. I either use the flexi-wedges or the wave wedges. Those are my two choices. I like them.
|
|
Speaker 1:
|
Flexi or wave? Who makes flexi and wave?
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|
Speaker 2:
|
Common Sense Dental does I believe.
|
|
Speaker 1:
|
Common Sense Dental does them both?
|
|
Speaker 2:
|
Makes the flexi. The wave wedges come from Triodent. This is all inserted. Once I've got my cavity preparation complete. I have the matrix and I have it all set to go. Then I'm going to pick up my Clean and Boost. This is a product we make. It's an acid-based ... It has acids and alcohols in it. You use it to clean the cavity preparation. Just clean it up.
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|
Speaker 1:
|
What's it called?
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|
Speaker 2:
|
Clean and Boost.
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|
Speaker 1:
|
Clean and Boost.
|
|
Speaker 2:
|
Yep.
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|
Speaker 1:
|
Okay.
|
|
Speaker 2:
|
Clean and Boost leaves a pristine tooth surface. You have something in there that will clean the organics. Something in there that will clean the inorganic and remove all the junk that's in a cavity prep. I put that on there for about 10 seconds and rinse it out. Then I would dry the tooth. The way I'm doing it, I dry the tooth severely. Then we apply Surpass. Surpass 1 is a mixture of acids, but it's mostly water. It's going to re-hydrate the tooth and etch the tooth at the same time. We put the Surpass 1 on. It stays on for 10/12 seconds. Three coats of Surpass 2 are applied directly onto that. Surpass 1 is not dried.
|
|
Speaker 1:
|
Are you putting it in with a dropper, or are you scrubbing it-
|
|
Speaker 2:
|
No, brushes. They're color coded brushes.
|
|
Speaker 1:
|
Are you just painting it? Are you burnishing and scrubbing it?
|
|
Speaker 2:
|
Surpass 1 is agitated. You kind of agitate the thing around it to kind of rub it into the tooth a bit. If you leave it wet and then just three brush-fulls of Surpass. They don't have to be rubbed in, just applied. Just wick them in and go. Once the three brush-fulls are in, you dry it. You dry that severely. The more dry you make the Surpass 2, the better bond you're going to have. This is what I love about this stuff. You dry it as much as you possible can. Then you put Surpass 3 on, and thin that out as much as you can. After all three parts are in, light activate it 10 seconds. The nice part about Surpass is that it's either all wet or all dry. There is nothing between.
|
|
|
The same technique that is used in a class one or a class two is used in a class four, class five, bonding on crowns. There is one technique no matter what you're doing. It can be used under anything. That's what it was for. It's supposed to be a true universal material. It sticks to anything self-cure, dual-cure, light-cure. Everything sticks to it. Anyway, I have my cavity prep. Now I have my adhesive in, I've light activated it. The next thing I'm going to do is put a little flowable in the bottom of that cavity prep. All along the line angles. Carrying out to the cavosurface-
|
|
Speaker 1:
|
What brand?
|
|
Speaker 2:
|
Titan. Titan is ours.
|
|
Speaker 1:
|
Apex makes Titan.
|
|
Speaker 2:
|
Yeah, Titan.
|
|
Speaker 1:
|
Is that a dual-cure?
|
|
Speaker 2:
|
No it's light activated.
|
|
Speaker 1:
|
I mean is it a ... What type of composite is it?
|
|
Speaker 2:
|
Flowable composite.
|
|
Speaker 1:
|
Flowable composite?
|
|
Speaker 2:
|
Yeah. I like that because you can place flowable composite in the bottom. You can see if there's any problems. See if there's any defects, or if there's any bubbles or voids. You can see it. That's a very very critical spot. The bottom of that cavosurface margin, in that box. That's where teeth die. That's where restorations die. You have to be really really careful about making sure that it stays secure and properly constructed. You get the flowable in there. That's light activated for 10 seconds. Then we incrementally start to add another composite that we, Exquisite Restoration which is again from Apex. That goes in. We fill that up and then light activate the segments. Then, off comes the matrix and the rubber dam. We do the adjustments and polish and all that.
|
|
Speaker 1:
|
By the way, you talk about putting your kids through college. Why isn't that an online CE course John? I've been begging you since 19 ... We started online CE in 2004. Now they're on the iPhone. They're on the Android, the Samsung, the iPad. Here's where you hit it on the phone. We put up 350 courses. They've been viewed over 550,000 times. You'd be selling Surpass and Titan, and all that in countries, well you could find them on a map. A lot of our listeners couldn't find some of these. That's a big procedure. The thing that these young kids are doing with their iPhone is, instead of going to a course like you and I had to always go to conventions. We had to get on a plane, stay in a hotel for the convention. These guys, since it's Apple, they get the Apple TV. Have you heard of the Apple TV?
|
|
Speaker 2:
|
I've heard of it.
|
|
Speaker 1:
|
Yeah, it's just a little thing the size of an iPhone. They pull this up on their iPhone and then they hit their big screen, or bedroom, or front room, whatever TV's on.
|
|
Speaker 2:
|
Cast it?
|
|
Speaker 1:
|
Now they're watching it on their 60 inch big screen and surround sound. They tell me that once you take a course in your own living room rocking chair, on your own surround sound where you can pause it if you need to go to the bathroom or get a beer. They just never want to sit in a convention again. That would just be ... See, there's one by Restorative Dentistry. The top one is Nicholas Cante. Why isn't that John Kanca, with 40,000 posts on Dental Town.
|
|
Speaker 2:
|
We're going to have to do that.
|
|
Speaker 1:
|
I wish you would. It would be the best damn marketing you ever did for your company. What I like about it is, you're a legend. You're the real deal. The other thing I like about you the most is ... The thing I respected you the most about, not just your contribution to dentistry, but why did O.J. not take the witness stand? Because he killed his wife and her boyfriend. They can't put him on the witness stand. So many of these ... There's 210,000 dentists on Dental Town, but who is conspicuously missing? People out there are lecturing. Saying shit that they couldn't say in a message board room where guys like you would just start quoting research. Saying, "Dude, you're full of shit." They can't take the witness stand. Dammit, you have been on the witness stand since 1998. No matter what anybody throws at you, you're there. You're laughing. You're answering it and you won over the whole damn community.
|
|
Speaker 2:
|
Again, I appreciate the kind words.
|
|
Speaker 1:
|
You have. What I want to do is make this message faster, easier, higher-quality/lower cost. That's an online CE course on their iPhone. When they're laying in their bed watching TV and there's nothing on, they just ... If you think about this. If you look at your big screen TV and you think it's really big, put your iPhone in front of it then move it back to where you can't see your big screen TV and you're about right here.
|
|
Speaker 2:
|
Yep.
|
|
Speaker 1:
|
That's what they do. They put in their headphones. I had a woman tell me this. My husband's laying next to me asleep and I've got my iPhone on. It's leaning next to his pillow and I've got my headphones in. I'm watching online CE. They're getting credit for ... It's a game changer.
|
|
Speaker 2:
|
Yeah.
|
|
Speaker 1:
|
We need to make all your information faster, easier, higher quality/lower cost available to the masses. That should be a game changer for your company.
|
|
Speaker 2:
|
That would be a nice thing.
|
|
Speaker 1:
|
Now you take out the rubber dam. Is polishing cosmetic, or is that real? Some people talk about when you're done with a composite you should acid etch the margins and reapply flowable-
|
|
Speaker 2:
|
Yeah, I like doing that. I like sealing restorations. I typically will go back and seal restorations.
|
|
Speaker 1:
|
At the time it's done?
|
|
Speaker 2:
|
At the time it's done.
|
|
Speaker 1:
|
Talk about that.
|
|
Speaker 2:
|
Polishing is a necessity.
|
|
Speaker 1:
|
It is a necessity.
|
|
Speaker 2:
|
You don't want to have rough surfaces. Rough surfaces will attract plaque. You definitely want to have a smooth surface. You want to have thick pits in there. You don't want to have stuff accumulating in it to stain it. It's a mess. Yes, you do want to polish restorations. I don't think you have to go crazy putting all kinds of tertiary anatomy in stains and putting decay back in the teeth. I find that folly. I do need to create good occlusion, a functional occlusion. If all you do is make sure they're properly an occlusion, both in centric and para-functional movements, then you've done something well. I do like to go back and seal them, just in case. There's always potential for little defects along the margins. I like to go back and seal those things. That's important to me.
|
|
Speaker 1:
|
Do you agree or disagree with this statement. We start out in college and we learn math, and then applied math. Math is just math. It's one plus one equals two. There's no philosophy.
|
|
Speaker 2:
|
Unless it's Common Core.
|
|
Speaker 1:
|
Unless it's what?
|
|
Speaker 2:
|
Common Core. Then three plus one could be 11.
|
|
Speaker 1:
|
What I was getting at, when I look at all there is in dentistry, there's seems to be a lot of math, and science, and physics, and chemistry, and biology, in a lot of the areas. A lot of times the research will win over the majority. It seems like the one camp, occlusion, seems to be closer to religion and philosophy than science and math. These young kids out here, one of the most common questions I get is, I want to take an occlusion course, but they're all expensive. Pankey's expensive. Dawson's expensive. LVI's expensive, but they need to know. One is, we're in Vegas right now, like LVI or the neuromuscular type camps. The others are like Dawson, Pankey, CR camps. They just need to know, I can't spend $5,000 at each camp. Does any of those camps make more sense to you?
|
|
Speaker 2:
|
I'm a Dawseon advocate. I am definitely a Dawson, Kois, Spear type advocate.
|
|
Speaker 1:
|
What would you call that camp, CR? What would you call that camp? If the other camp's called neuromuscular, what would you call the Pankey, Spear, Dawson ...
|
|
Speaker 2:
|
I don't want to mischaracterize what they think. I am adherent to that philosophy. It's not neuromuscular. I'm just not a fan of that.
|
|
Speaker 1:
|
You would tell the young kid, if you've got a limited budget and you're going to take an occlusion camp-
|
|
Speaker 2:
|
Either you go to Dawson, Spear, Kois. Something like that.
|
|
Speaker 1:
|
Okay. Lights, let's talk about lights. Some people say the the number one issue in the quality composite is they didn't have moisture control. The number two quality concern, I'm talking about the masses of all the fillings done, is that their light isn't strong enough or that they didn't use it ... It was light. It didn't get cured well enough. Do you agree with that?
|
|
Speaker 2:
|
I think that may be an argument. That may be a possible outcome. I like having a proper light. The light that I use is a Valo from Ultradent. I think that is the finest light on the market. It has a number of different outputs. It has a broad spectrum of a radiance that can activate in any kind of material. It's robust. You can crank it. You can drop it on the floor. You can do a lot of things with it.
|
|
Speaker 1:
|
The Valo from Ultradent?
|
|
Speaker 2:
|
Yep.
|
|
Speaker 1:
|
South Jordan, Utah, owned by Dan Fisher.
|
|
Speaker 2:
|
Yes sir.
|
|
Speaker 1:
|
Who always mentions you. I don't think I've ever heard a lecture of Dan Fisher where you're name didn't come up.
|
|
Speaker 2:
|
He's a terrific guy. He's a really good friend of mine. I have great respect for him. He's a whirlwind. He's kind of like you. He's a hyperactive guy, always doing something. Always keeping busy and trying to do the best he can. He's genuinely a very very kind person. He's just a great guy.
|
|
Speaker 1:
|
That would be an LED light?
|
|
Speaker 2:
|
Yeah, it's an LED light.
|
|
Speaker 1:
|
Some people are saying that these big bulb halogen lights, or some of these lasers cure composites better, or a big strong halogen light. What would you say to that?
|
|
Speaker 2:
|
I was given a laser to use a number of years ago to just investigate how lasers would polymerize resin composites. In fact, it was from another company out in Utah, I won't mention their name.
|
|
Speaker 1:
|
Who's that?
|
|
Speaker 2:
|
I'm not going to mention their name. It did light activate composite. Oh it light activated composite, but it was so strong, so powerful, the contraction force was so powerful that it caused the composite to rip apart in the process of polymerizing. The composite was bonded to the walls and actually tore apart. The composite ruptured and the tooth ruptured underneath it. I was just absolutely floored with that. When I saw that I just couldn't believe it. I said, "Okay. This is probably not a good idea." We went through halogen lights. Halogen lights are too susceptible. They were what they were at the time, but they're too susceptible to breaking the tips, the emitter tips. I don't it's where you want to be. I think you want to be in the LED arena.
|
|
Speaker 1:
|
What about those big halogen by Dentsply. No, not Dentsply, DenMat.
|
|
Speaker 2:
|
You mean the plasma lights?
|
|
Speaker 1:
|
The sapphire light, that's plasma.
|
|
Speaker 2:
|
The plasma arc lights. No.
|
|
Speaker 1:
|
You don't need that either?
|
|
Speaker 2:
|
No. Those things put out a tremendous amount of heat. You can do anything you want to do. If you wanted a plasma emulation mode the Valo has that. In a tiny little stick, rather than in a big box.
|
|
Speaker 1:
|
Some people say that when they go around ... One of the things that I like about the Valo, you're the expert on this not me, a lot of dentists are using a light that's 10 years old. It just slowly gets weaker and weaker and weaker. Is it true that Valo, if you turn it over and the lights are on, it's strong?
|
|
Speaker 2:
|
It's on. LED is pretty much their on. They're either on or they're not on.
|
|
Speaker 1:
|
It's working or it's not. It's not a slow fade away.
|
|
Speaker 2:
|
No, not really. They're either on or off. That's the nice part about them. They last a long long time.
|
|
Speaker 1:
|
Now I want to go to some political questions. For rich countries like the United State, Canada, Scandinavia should amalgams be banned?
|
|
Speaker 2:
|
No. That would deprive a lower socioeconomic group of people who have restorations. It's faster to place an amalgam, and you can place it at much lower cost than you can a resin composite. I think that would be a bad thing to do.
|
|
Speaker 1:
|
I agree. I've been asking all the questions. Is there anything else you want to talk about?
|
|
Speaker 2:
|
Things that pop into my mind are ... One of the things that we run into, that I find is a nuisance, no matter how you try to polymerize, some teeth end up with white lines along the margins. White lines are fractures of the enamel. Sometimes the tooth has taken such a pounding, the enamel in an area is just fragile no matter what you're doing. Unless you're going to cut it all the way, you try to bond to it and you're going to cause a little rupture along that interface. When you break that interface, over time that will stain and degrade and become a problem. One of the things I like to do with that, we have a product called Interface. Which is actually a ceramic primer. What I found was, you could use Interface. You can mix it up and after it's mixed, you can apply it to the margins and just let it sit there. Let it sit there and just kind of rub it in for a little while. It will make the white line go away. You can actually repair it. Which is just wonderful. Then you add a little adhesive on top of that and light activate that. It just is a great way to do things.
|
|
Speaker 1:
|
Is that a cosmetic treatment?
|
|
Speaker 2:
|
No, this is a functional repair. Like I said, a white line around a resin composite over time is going to turn into a brown line. Become an access point for bacteria, for stain, for loss of the restoration. This repairs that. It's relatively new. This is the repair. I think this is a valuable asset.
|
|
Speaker 1:
|
I see you as a father-figure leader in our industry. You've been at it a long time. You're a founding father of the ACDU. Changed course of the industry in research and bonding. These are a lot of young kids. I want to ask you this. From when you got out of Yukon in '78.
|
|
Speaker 2:
|
You can figure it out in Howard.
|
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Speaker 1:
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Today in 2016 is the profession of dentistry a better sovereign profession? Is it more sovereign? Is it more commercial? Is it going in the right direction? Is the dental playground better? Are you going to leave ... When you retire someday will you have left the dental playground better than you found it? As far as the macro, not what you did micro. Is dentistry headed in the right direction?
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Speaker 2:
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No.
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Speaker 1:
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No. What are you're thoughts?
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Speaker 2:
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I don't think so. I'm bothered by the mega-corporations buying up practices. Then it becomes, we're not concerned anymore with patient outcome, but simply getting things done. Then forcing the younger dentists into doing things they know they really shouldn't be doing. That worries me a great deal.
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Speaker 1:
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Do you hear that from kids in corporate dentistry?
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Speaker 2:
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Oh yeah.
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Speaker 1:
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Do you hear it a little or do you hear it a lot?
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Speaker 2:
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I'm hearing a fair amount of it. I'm getting, again, emails. I get private messages.
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Speaker 1:
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What are some of the things you're hearing? What are some of the things you hear that bother you?
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Speaker 2:
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One of the things I read just the other day, was that the owner of a larger practice said to one of the younger kids, "Why did you mark these as simple extractions when you could have marked them all as surgical extractions?" Which is an abuse of the system. There was another presentation where there was a picture of a tooth with an occlusal composite restoration, maybe a little crack in it somewhere. The patient was told that needs a crown. I'm looking, going I'm aghast at this. This is where you're seeing pressure from top for performance. In a solo environment you kind of tend to do what's best for the patient. If you're an employee in a big corporation, then that becomes ... The patient is a commodity now. An asset from which extract money. Not so concerned about the long-term ...
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Speaker 1:
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You hear hygienists saying in these big corporate chains that they feel they have to stick tetracycline chips perio chips in these pockets. They go to courses and they're not sold on the idea, but they have to. Have you ever heard that?
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Speaker 2:
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I've heard of it happening. I don't know of it personally, but I have heard of it.
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Speaker 1:
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Another big game changer, since I first heard you lecture, has been Cerec. Do you think Cerec is ... What are your thoughts on, not Cerec but CAD/CAM.
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Speaker 2:
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I think CAD/CAM can be used really well. I know it's abused. I know it is abused. You buy this monster machine with this big note that you have to carry. Then there's this software update every year. Then there's a hardware upgrade every year. There's all this stuff you have to ... You have to take courses. If you're using it in your office, you have to hire somebody else. These are giant financial burdens to be adding to somebody. It means you have to use it. You have to put it out there. What you're seeing is, again I go to the boards and I'm seeing look at these teeth that have amalgams.
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Now I replaced them with all inlays. I don't personally see any clinical indication for an inlay that is anything other than direct composite. I don't see it. I sometimes get in trouble by asking, why did you remove that amalgam. It had decay underneath it. How did you know it had decay underneath it? Because you took it out. There was another case where I just looked at one. This dentist invited a friend to come in and do some CAD/CAM inlays. The guy who was describing it said, these cavities were small. I'm thinking, "Why are you doing an MOD inlay on a CAD/CAM unit for a small cavity?" That's where I start getting angry.
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I read, I'm not sure which forum it was on, it was a woman dentist. I have no idea what her name is now. One woman said, "Some of these pieces are so small I'm having trouble handling them." I'm thinking, "Are you kidding me? You're having trouble handling it. They're so small you can't handle them and you're charging someone for an indirect restoration?" This kind of stuff. All I can think is, what are you going to do next, a pit and a fisher CAD/CAM?
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Speaker 1:
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I never thought of that. I'm going to be the first published person to do a buckled pit CAD/CAM inlay.
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Speaker 2:
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I see that. The potential, the financial pressure is so enormous that you basically everything becomes the nail for your hammer.
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Speaker 1:
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I want to have you weigh in on another huge debate that I know Dennis will agree on. How long is the average, I don't know what you want to call it the median, the mu, the mode, the mean. How long does the average amalgam last in America? How long the average direct composite in America? One is metal, the other one's plastic. One all the ingredients are kind of bacterial static: mercury, zinc, copper, tin, all the inlay. Stainless fluoride is tin. Amalgam is made of silver, silver nitrate. I want to come back to that. I have a question about silver nitrate under fillings. The other direct composite is an inert material that doesn't bother bugs at all. We spend our whole life worrying about these [inaudible 00:58:19] coming and eating all this. How long would a metal antibacterial silver-zinc-copper-mercury amalgam last. How long would an inert plastic resin last?
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Speaker 2:
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It's hard to give you a number exactly. It's going to say, who did it? That's going to come into my mind, is who did it. I have resin restorations going back 30 years, that have survived 30 years. They don't look as good as they used to. The materials they have today are way better. Amalgam could last a lifetime. There's not a question about it. It could last a lifetime.
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Speaker 1:
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All those variables went in. There's 330 million people with various home-cares and diets. There's 150,000 dentists, different skillsets. For the whole United States of America what would be that number?
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Speaker 2:
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The other thing you have to remember is that amalgam's been around for 200 years. Composite is new and still is evolving as a technology. I think as we develop materials further, that that difference will narrow. I think we're going to see that narrow. We're going to have better stuff that we work with. You're argument is leading to saying that amalgam is going to typically last longer. Typically it does, right now. I still see resin composite dentistry in it's early adolescence.
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Speaker 1:
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I'm a dentist and I've got four boys. You know what all of our restorations are in our mouth?
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Speaker 2:
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I have a guess.
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Speaker 1:
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They're all gold. This whole time we're talking, I've tried to look at your molars to see if I could see a molar. I have not seen a molar. I've been talking to you for one hour and one minute. You haven't seen my gold because you know. Do you still think gold is the gold standard? Is that a pun or is that ...
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Speaker 2:
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Gold is marvelous. You can't argue with gold at all.
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Speaker 1:
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If someone said, "What restoration on a molar lasts the longest?" What would you say? Would you say gold, amalgum, composite?
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Speaker 2:
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I'd say zirconia.
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Speaker 1:
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You'd say zircornia? Wow. I was not expecting you to say that.
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Speaker 2:
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I'd say zirconia. Because zirconia ... I have zirconia knees. Zirconia, I think, will be the new gold.
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Speaker 1:
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How did you get that? Was that a ...
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Speaker 2:
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I got sandwiched between two cars when I was working at a gas station at the age of 19. It was 10 minutes before I was supposed to go home. I'm standing in front a Pinto, the one that didn't catch fire. I'm putting gas and oil in it. A woman in a Skyler backed up into me. Hit me and put my knees in the radiator of the Pinto, 10 minutes before I was supposed to go home.
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Speaker 1:
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I am so sorry.
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Speaker 2:
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I didn't break anything. Caught me and my knees rode up on the bumper. I was actually pretty lucky, because it could have hit me. The bumpers were the same size and I don't have any legs. If the bumper was below me it would have snapped my legs in pieces. It was slightly higher. It hit me, and like I said, my knees went up and into the radiator. Nothing broke, because I was able to fold. I couldn't walk for a month. Over time that's it.
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Speaker 1:
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One thing I want to get you on then we'll switch over to the pediatric dentist. Silver nitrate seems to come in and out of the history of dentistry.
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Speaker 2:
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Right now the formulation of it would be silver diamine fluoride, not silver nitrate.
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Speaker 1:
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Okay, silver diamine fluoride. What's the brand on that?
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Speaker 2:
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I think it comes out of Australia. I'm trying to remember the name of the company.
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Speaker 1:
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What are your thoughts on silver diamine fluoride?
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Speaker 2:
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It's effective, but it turns everything black. It still does that.
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Speaker 1:
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Can you put it under a composite?
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Speaker 2:
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No no no. It would immediately stain it.
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Speaker 1:
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You can only put it underneath-
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Speaker 2:
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An amalgam.
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Speaker 1:
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An amalgam or ...
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Speaker 2:
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If aesthetics are not going to be an issue, you just want to preserve teeth, then you could put it anywhere.
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Speaker 1:
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Where are you seeing it used today that's a good idea.
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Speaker 2:
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I think in third world countries. If you could put this in and arrest decay process, even if you didn't get to do much else, that's a pretty good thing they're doing.
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Speaker 1:
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Now I'm going to have to ask you a really controversial question. Some of these dentists like caries indicators. It keeps staining. It keeps staining. It keeps staining. Then they got a pulp exposure.
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Speaker 2:
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Right.
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Speaker 1:
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Then some people talk about affected dentin, effected dentin. Other's are like if you don't have a microscope how do you know when you cross from one end to the other?
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Speaker 2:
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I can tell you. Caries affected dentin doesn't stain. Caries infected dentin does.
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Speaker 1:
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Is that right?
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Speaker 2:
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That's right. That goes back to fusuyama.
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Speaker 1:
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If that's infected with [inaudible 01:03:09] then it will stain.
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Speaker 2:
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It will stain.
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Speaker 1:
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what stain do you use? Do you use stain?
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Speaker 2:
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I use Seek from UltraDent.
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Speaker 1:
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Okay. Do you use it on all your restorations?
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Speaker 2:
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No. I'll use them when I'm getting fearful of death. I know where you're going with this. Yes. The answer is yes, it can. You're going to ask your question. The question is can you leave some stuff underneath. The answer is yes you can. Absolutely. The literature now is replete with study after study and meta-analyses after meta-analyses saying it does not harm ... If you want to arrest caries, you just seal it. There's a study by-
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Speaker 1:
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How much caries?
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Speaker 2:
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There's a study by Eva Mertz Fairhurst and a host of other authors, including Fred Rueggerberg. 10 year study, published in the American Dental Association 1998. 753 patients were followed for 10 years. 753, and all they did to take occlusal caries, bevel the enamel, frank cavitation, and just sealed it all in. Just sealed it. Just restored it, sealed it, plugged it up without removing anything. In 10 years there was no progression of lesions in any of those teeth. That's the 800 pound gorilla of studies.
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Speaker 1:
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Would you be telling me this, because if the tooth is asymptomatic and when you went in you didn't think-
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Speaker 2:
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That's the key. The key is asymptomatic and no radiographic evidence of anything wrong.
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Speaker 1:
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You didn't think you were going to do a root canal when you started. You saw no evidence. It wasn't bothering them-
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Speaker 2:
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Stop. When you start getting nervous. When you start getting worried about how deep you are, that's when you stop, leave it. Leave it and seal it in. The literature does absolutely indicate that if you seal that in you arrest the progression of caries. You arrest it. It either dies or stops.
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Speaker 1:
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What would you say to the other guy who says, I'd rather remove all the decay, and then do a pulp cap.
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Speaker 2:
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No. Carious exposures are precocious. They're unpredictable. They're success rate is not very high. Mechanical exposures you can take care of them very nicely, but carious exposures are unpredictable.
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Speaker 1:
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You'd be better without going to endo, doing a root canal if you got a carious exposure.
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Speaker 2:
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I would still try it.
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Speaker 1:
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You would still try?
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Speaker 2:
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I would still try it. It is again, asymptomatic, no evidence, none of the red flags. The best thing to do is don't get it. Don't get the exposure at any cost. You tell the patient, "I'm going to seal this in. It may or may not work. We'll see. We're going to give the tooth a chance to heal." I've never seen a single patient in my life whoever said, "No, just do the root canal now." If you can keep it vital for 18 or 20 years, they'll be very happy with that.
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Speaker 1:
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I've heard you speak so many times I couldn't count them. You also were one of the early pioneers on magnification.
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Speaker 2:
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Oh yeah.
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Speaker 1:
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You've been harping that since I first saw you in '87. When did you start lecturing?
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Speaker 2:
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'84 is when I started lecturing so probably somewhere-
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Speaker 1:
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I think I saw you first in '87. I personally didn't listen to that piece of advice for another five years. I just thought, "What, I can see." What do you say to a kid who says, "You're fat and 53 of course you need magnification. I'm a rockin hot 25 year old. I don't need magnification." What would you say to that?
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Speaker 2:
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I would say unequivocally you're nowhere near as good as you can be without magnification. You're not a good dentist without magnification. Flat out, you're just not a good dentist without magnification.
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Speaker 1:
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What magnification are you using?
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Speaker 2:
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Three and a half to four and a half. You get kind of an average thing, three and a half to four and a half depending on the-
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Speaker 1:
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Another thing I'm a big proponent of is, dentists get mad because the hygienist left [inaudible 01:07:07] so her assistant didn't clean off the cement right. The dentists use magnification but not their assistants. I make everyone in my office-
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Speaker 2:
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I make everyone in my office.
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Speaker 1:
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Every hygienist, assistant, if you work at Today's Dental you wear magnification.
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Speaker 2:
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I totally agree with that, as mine do.
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Speaker 1:
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Anything else that you're passionate about?
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Speaker 2:
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Golf.
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Speaker 1:
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Golf? If you're on Dental Town you might not know this. I think most people I talk to don't know this. On the today's active topics we have 51 categories: root canals, fillings, crowns, all that stuff. It's all on today's active topics. If you post on a thread it stays on today's active topics for exactly 24 hours. If you go to leisure, there's a forum called Politics. It says, "Easily offended do not enter." If you complain about whatever we're saying, it wasn't on today's active topics, you specifically went to leisure, you specifically went to politics and now you're whining to me that someone said something you didn't like. You have been the king of the political section for a long time. Everyone's out there wondering do you think it's going to come down to Trump and Hillary? If so, which one of them are you going to vote for?
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Speaker 2:
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I'm not going to vote for Hillary. Whether I vote for anybody else remains to be seen. I find this right now very distasteful. I find the whole process very distasteful. It's a disaster, on one hand. On the other hand it's pretty interesting. It is interesting to watch as you would watch if you were watching the Civil War from a balloon somewhere. It's tragic, but it's something you don't really get to see very often. I am interested to see what happens at a convention. Whether the nomination is seized away, wrestled away from Trump should he have enough delegates. I think that would be, on one hand, might be the best thing. It would be a terrible thing for democracy. You're nullifying all the people-
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Speaker 1:
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I think it's funny when people say ... My and Ryan just lectured a bunch of countries and people are saying, "Do you think Trump could be elected?" I'm like, Dude, Mussolini and Hitler were elected in democratically free elections, correct?
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Speaker 2:
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Yeah, they were. I don't think-
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Speaker 1:
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Anybody could be elected.
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Speaker 2:
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Anybody can be elected. Everybody's telling him what he's going to do, what he's not going to do. Politics is a funny animal. You do need to cooperate. You do need to make friends. You do have to do that. You can bully your way through a business, but you can't bully your way through a government. It just doesn't work like that. People just sit on their hands and go screw yourself, I'm not going to do this.
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Speaker 1:
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If you could pick your person-
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Speaker 2:
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Scott Walker.
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Speaker 1:
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Scott Walker?
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Speaker 2:
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If I could pick one guy-
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Speaker 1:
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I'm sorry, I don't even know who that is.
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Speaker 2:
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Governor of Wisconsin.
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Speaker 1:
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The Governor of Wisconsin? I'm not even aware of this guy.
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Speaker 2:
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He's, in my opinion, easily the most capable best candidate that's out there.
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Speaker 1:
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He's a republican?
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Speaker 2:
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Yeah.
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Speaker 1:
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Is he in the race?
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Speaker 2:
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He was, he got ousted pretty early. I still think he was the best candidate.
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Speaker 1:
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Why is Hillary a categorically no?
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Speaker 2:
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I don't liker her.
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Speaker 1:
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You just don't like her.
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Speaker 2:
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I've never liked her, as you well know. I find her dishonest. I find her untrustworthy.
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Speaker 1:
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The reason I went there is because people say to me, the biggest sport in America is the NFL. They do 11 billion dollars a year. I always say, you're not an American. The biggest sport in America is the election every four years. The Superbowl hype is for a couple of weeks. The election hype is for a flipping year. The money spent is crazy.
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Speaker 2:
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It's not for a year. It's almost non-stop now. It is almost non-stop. We were talking about this. The news item for the last three years almost, the next election.
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Speaker 1:
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The biggest sport in America is absolutely the presidential election. I think there's no doubt about it. John, anything else that you want to talk about.
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Speaker 2:
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Pretty good.
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Speaker 1:
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Pretty good? I just want to tell you profoundly from the bottom of my heart, thanks for being the first top 10 speakers in the world, top one tier that validated Dental Town. You were the saving grace of Dental Town for the first at least five, six, seven years. It was just people get on stage and say those are a bunch of idiots on there, they don't know what they're talking about it was always, dude John Kanca's on there. Then they'd say really? Then they'd want to look. Now that thing's got 210,000 members. I really want you to do the online CE course John. I'm so glad you did the podcast. I wanted you to be my first podcast. It's taken me a year to get you on. I want to turn you on to the next generation and I think that online CE it'll be watched on every single country on Earth the first month.
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Speaker 2:
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That'd be nice.
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Speaker 1:
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All right buddy. Thanks again.
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Speaker 2:
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Thank you.
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