|
Howard:
|
Greetings. It is an honor to be in Johor Bahru, Malaysia.
|
|
Dr. Phun:
|
Correct.
|
|
Howard:
|
Which if you leave the island of Singapore, when you drive across the bridge and enter Malaysia, this is the first city on the other side of the bridge in Malaysia. You told me it would take probably what, six hours to drive to Kuala Lumpur, six hours or …
|
|
Dr. Liang:
|
Three hour …
|
|
Howard:
|
Just three to four hours. It would take 24 hours to drive all the way to the next country of Bangkok, Thailand.
|
|
Dr. Ling:
|
Yes.
|
|
Howard:
|
You said what, eight …
|
|
Dr. Liang:
|
The borders, 10 hours or 12 hours …
|
|
Howard:
|
10 hours to the Bangkok, to Thailand?
|
|
Dr. Liang:
|
Borders … [crosstalk 00:00:46]
|
|
Howard:
|
I want you three to introduce yourselves. Tell everyone your name and tell us about yourself.
|
|
Dr. Phun:
|
My name is Dr. Stephen Phun. I'm practicing in this clinic in Johor Bahru for the past 26 years. I'm not that young anymore.
|
|
Howard:
|
I'm one year older than him.
|
|
Dr. Phun:
|
Can't tell you how old we are. I've been having a small clinic of three chairs and it's been a very busy clinic and it's very fruitful clinic. May I introduce to you, Dr. Saw, she just joined us about two years back and she's got a lot of things to tell you.
|
|
Dr. Ling:
|
A lot of thing … Okay, my name is Dr. Saw, Saw Woon Ling and then I stay in Singapore so every day, I will cross the causeway to work in Johor Bahru. Then I've been a GP for about eight years. I do everything in my practice except implant and I think that's all.
|
|
Howard:
|
You live in Singapore and work in Malaysia?
|
|
Dr. Ling:
|
Yeah.
|
|
Howard:
|
Wouldn't that take a lot of time to cross the bridge every day? Why don’t you live here?
|
|
Dr. Ling:
|
Because actually, my family all settled down in Singapore and then it only takes me about 40 minutes to come from Singapore to this clinic if there is no jam. There are certain times like during December where there's a school holiday and then the jam is quite bad. Usually, it's three hours.
|
|
Howard:
|
Just asking in Malaysia, what percentage of the dentists are girls versus boys? Right here, there are two boys, one girl. Are the girls a third, a half? What percent of the dentists are girls?
|
|
Dr. Ling:
|
What percent I think …
|
|
Dr. Phun:
|
More on girls … [crosstalk 00:02:36]
|
|
Dr. Ling:
|
It should be more, there should be more …
|
|
Dr. Phun:
|
I would say about, at least about 65 o 35 now?
|
|
Howard:
|
65% girls?
|
|
Dr. Phun:
|
Yeah.
|
|
Howard:
|
Is that common in all of south East Asia? More girls than boys?
|
|
Dr. Phun:
|
I think that's the trend worldwide if I'm not wrong actually.
|
|
Howard:
|
Two thirds of the dentists are girls in Malaysia. What would it be for Laos, Cambodia, Thailand, Vietnam, Indonesia? Because I know you've lectured in all those countries.
|
|
Dr. Phun:
|
I think in developed countries like Thailand and Indonesia, I think the situation is about the same or slightly better, about 55, 45. In country like Cambodia, Vietnam, maybe in Burma, probably still male dominated profession, you're talking about dentistry. One of the reason is that there are more ladies in our dentistry probably because sometimes the guy says that I want to do something else like engineering and others. They all diverted to the other side. The girls, they will say no, dentistry is a good thing because it can be a part-time job when you finished.
|
|
Howard:
|
You know how I can tell that you're old? Because you said Burma instead of Myanmar. Are you going to say Peking instead of Beijing?
|
|
Dr. Phun:
|
That is to a Peking duck, it's not a Beijing duck okay, so that's for sure. It's I think that's what's happening now in the world because if you go to any developed countries, or developing countries, if you go to the university, you see that I'm sorry to say, I think the girls rules. If I'm not wrong.
|
|
Howard:
|
I would rather go to a girl.
|
|
Dr. Liang:
|
Hi, I'm Dr. Ron Ng, I just joined this practice not long ago, like maybe months? A few months ago. This is my third year of practice.
|
|
Howard:
|
It's your what?
|
|
Dr. Liang:
|
Third year, third year of practice.
|
|
Howard:
|
You guys have three operatories and three dentists which is very Asian. In America, usually one dentist will work two chairs or more. In Asia, you usually see one dentist per each room. You guys probably do your own cleanings too right?
|
|
Dr. Phun:
|
You mean cleaning the dental chairs and everything.
|
|
Howard:
|
No, cleaning the patient's teeth instead of a hygienist.
|
|
Dr. Phun:
|
Yes, actually, what happened is that we are not allowed for hygienist. Not because that you don’t want them, it's because we haven't reached a stage that we allow hygienist to practice dentistry. Probably the law is in a process of changing, but if I'm not wrong, in about next five years, you'll see the category under the dental practice, there will be a hygienist, and there will be dental nurses and therapists coming in. We're a bit about I think 20, 15 years behind the States but we're catching up. One of the reason is probably the dental cost has gone up and the population is getting older and you have to think about cause and effect the other generations.
|
|
Howard:
|
What is your definition of older?
|
|
Dr. Phun:
|
Life starts at 60.
|
|
Howard:
|
Life starts at 60.
|
|
Dr. Phun:
|
Okay, fine, my friend. All the time, the moment you say this is too old for me, that’s one pin down and just like paying bowling, one pin down at one time and then slowly you notice that as you admit it, you're gone.
|
|
Howard:
|
I think one area, Asia is very far ahead of the United States is I look at your hours. You guys are open Tuesday to Saturday 9:00 to 5:00, Sunday 9:00 to 1:00 and then you're closed Monday. Obviously, consumers, customers, patients, it's easier to go to the dentist on a weekend and you're closed Monday. You work 44 hours a week. In the United States, the dentists seem to work 32 hours a week and they're always closed weekends. You almost never find a dentist open on Friday, Saturday, or Sunday.
|
|
|
I have to applaud you that … I would say the average Asian works 12 to 16 hours a week more than a lazy American. I can say that because I'm an American. [Crosstalk 00:07:09] They always say to me, I need more money, I've got to pay out my bills, I need to ... The last thing they'll ever think about is why don’t you just work six days a week? That's the last thing that will ever cross their mind. That's the last thing they want to hear. You guys all do orthodontics, right? You've been teaching for PSortho …
|
|
Dr. Phun:
|
POS …
|
|
Howard:
|
Progressive orthodontics which teaches really solid fundamental orthodontics all around the world and that was started out of California. What was … Don McGann out of California. Tell us about your journey with POSortho and you've taught that in Beijing or Peking, Bangkok, Bandon, Indonesia, Singapore, Kuala Lumpur. Talk about your journey with POSortho.
|
|
Dr. Phun:
|
Put it this way, when I first graduate, it took me about two years to get bored with general practice. I was looking for something to upgrade myself and by chance, there's an orthodontic hospital [hired 00:08:24] practitioners GPs available in Singapore so I signed myself in and that's the progressive orthodontic course. When I first started, they conduct the course by using videos. If you still can remember the cassettes that we have, they conduct by videos and they will … I'm that old, but it's still pass through the thing because the one that they want you to learn is basically the knowledge.
|
|
|
You just have to look at it, learn from it and then try it, solve the problem along the ways and slowly you'll get used to it. I've been practicing since 1992 until the year 2007 and Don was in Singapore I think at that time. He says, how long have you been practicing. I say around 20 years. He says, you look like a decent chap, would you like to teach orthodontics? I says, in my mind, I was thinking, that's a good way to retire. I said, okay, yes, so he dragged me in. Don is a very generous person. When he says he want to train you, he really train you out. He pay for everything and then the only thing that you need to do for him is to help him to teach the other GPs about orthodontics.
|
|
|
There's a catch. He didn’t tell you for how long so you owe him not a debt of money but a debt of gratitude. I'm still paying his debt. It's not bad because working for people like Don, he treat you well. The student treat you well, you travel the world, just like you, doing your job and travel the world. The only drawback is that you're not in a clinic all the time and as you can see, some of our patient is saying that, where have you been, you're supposed to treat me. I says no, I'm sorry, I have to teach the other doctors to teach you.
|
|
Howard:
|
Talk about the difference between fixed wire brackets and braces like POS [orthotics 00:10:28] versus removable clear aligner like Invisalign because Invisalign is a significant lab bill and that significantly changes the price of ortho. In Malaysia, do you do more removable clear liner Invisalign or do you do more fixed band and bracket hardwire ortho?
|
|
Dr. Phun:
|
I think most of the orthodontic treatment in Malaysia is still brackets and bands but I think Invisalign and the clear aligners are coming slowly. Cost is one thing but the demand of the patient is another one. The one that worries us the most is that probably be cost. If a GP is trying to learn orthodontics and if you go for simple course and you don’t have a basic knowledge of how the teeth move, how the bone affect the movement of the teeth and how you set it up, sometimes, you don’t know how to troubleshoot. If you use Invisalign, you are basically depends on the person that diagnose it for you. The complication is that he is not in the country that you're working in. Legally …
|
|
Howard:
|
What country are they in?
|
|
Dr. Phun:
|
Most of the time, I think they send it to the States to get it diagnosed and send back for the aligners.
|
|
Howard:
|
See I thought if you take an impression, it usually goes to Mexico and the model work is done there and then it's diagnosed in Costa Rica, that's what I thought. That's … Is it United States?
|
|
Dr. Phun:
|
Actually, what happened is that if I'm not wrong, they send it to a centralized place. The person that diagnose it must be somebody that have used aligner before they experience with it. They did the diagnosis and then when they write it up, they just pass it back to the center to manufacture the aligner if I'm not wrong.
|
|
Howard:
|
You know, we have dental town, but we also have ortho town so dental town is about 210,000 dentists from around the world, ortho town is about … I think it's about 5,000 orthodontists. You have to be an orthodontist to get in ortho town. There seems to be a big complaint with short term ortho is what you're saying, the person didn’t get a complete diagnosis and treatment planning. With ortho, it's all in the diagnosing and treatment planning. You're telling me that POSortho really did a great job of learning the fundamentals of complete orthodontics.
|
|
Dr. Phun:
|
Yeah, I will say that that is the most important thing about POS is because they actually basically teach you from zero onwards. What they did is that they build up the foundation first and they really make sure that your foundation is good before you say I want to move that teeth.
|
|
Howard:
|
In your practice, what percent is orthodontics?
|
|
Dr. Phun:
|
Personally, I think half my patient are in orthodontics.
|
|
Howard:
|
What about you two?
|
|
Dr. Ling:
|
Actually, I'm quite new to this field, but we're about so far the ongoing case is probably 10 or slightly more than that. I'm still learning stage, that's why I'm only randomly pick some quite straightforward case. The more complicated one, we still refer to Dr. Stephen.
|
|
Dr. Phun:
|
This is a mentoring process that you have to do …
|
|
Howard:
|
Are you going to learn ortho or …
|
|
Dr. Liang:
|
I learned ortho together with her. We doing start together so still on the way of learning.
|
|
Howard:
|
Do you like it?
|
|
Dr. Liang:
|
Not too bad. I prefer orthodontics.
|
|
Howard:
|
You prefer endodontics. That is so neat. That's what I love the most about dentistry is there's so much … You couldn't even learn half of it if you tried. If you don’t like something like you were talking about earlier like pediatric dentistry, so you don’t care for pediatric, that’s what you said, but you love endodontics?
|
|
Dr. Liang:
|
Yes.
|
|
Howard:
|
You find so many dentists who can't stand endodontics. They like other things. That's what's so neat about dentistry, it's never a dull day and if you don’t like something, you don’t have to do it because there's so much other stuff you can do. Are all three of you doing implants, placing implants?
|
|
Dr. Phun:
|
I used to do a lot of implants, Megagen. The first one that I put in is what Nobel [straight 00:14:57]. That was really long ago and nowadays, I put in more of the mini implants because probably because after a while of conventional implants, we just want to try out some minis. What I discovered lately is that yes, it's good but sometimes, certain cases, conventional implant is much more superior. Sometimes, we have to wait it out because I don’t think there's a perfect system in the world. It depends on what your patients present with. Because if that case is suitable for certain implants, use that one.
|
|
|
Sometimes, it's a demand, sometimes, it's the case, dictate that you have to use that, and sometimes because you know your own preference. One thing for sure is that, implants has been going on for quite some time now. The problem is this, everybody claim that they have one that suits everybody. I don't think so. Just like orthodontics, you can't have one that suits everyone. Because certain cases like McGann teaches straight wires, sometimes, they individual prescription which is IP system that we are using is good.
|
|
|
Certain cases, it's [inaudible 00:16:11], certain cases, I can see that some of the old practitioners is using Becks and still come out with the good results. I think it depends on what works in our hand. Orthodontics, endodontics, the system that you use, ProTapers, Reciprocs, same thing, depends on what you're used to it and whether you can masters the system that you're using or not. Choose one, be good at it. Then only then you try the other one because you got one to fall back to.
|
|
Howard:
|
Is your favorite endodontics?
|
|
Dr. Liang:
|
Yes.
|
|
Howard:
|
What do you charge for a molar root canal in Malaysia?
|
|
Dr. Liang:
|
Charge for a molar, maybe 1,200 Ringgit?
|
|
Howard:
|
1,200 Ringgit.
|
|
Dr. Liang:
|
Yes, 1,200 Ringgit.
|
|
Howard:
|
What would that be in US dollars?
|
|
Dr. Phun:
|
400 US?
|
|
Dr. Liang:
|
300. 300 to 400.
|
|
Howard:
|
300 to 400 US? How much do you charge for braces, orthodontics?
|
|
Dr. Phun:
|
I charge about …
|
|
Dr. Liang:
|
2,000?
|
|
Dr. Phun:
|
8,000 to 10,000.
|
|
Howard:
|
8,000 to 10,000 Ringgit?
|
|
Dr. Phun:
|
Two, three? I think it's about 2,500 to 3,500. 2,500 to 3,500 US dollars.
|
|
Howard:
|
2,500 …
|
|
Dr. Phun:
|
2,500 to 3,500 depends on what you use.
|
|
Howard:
|
Being close, just you cross the bridge here in Singapore.
|
|
Dr. Phun:
|
Yeah.
|
|
Howard:
|
Do you get a lot of Singapore people coming to Malaysia because it would be less expensive than in Singapore?
|
|
Dr. Phun:
|
That is a myth but there are some truth in the myth. What happened is that they do come over to seek treatment because of cost. What I notice is that if they do come over because of cost, they will try to bargain with you and they will what we call clinic hopping to find the cheapest cost. That's other patients, sometimes, you spend about 5 minutes to educate to them says, what we want is cost, yes, but get the right treatment done. Don’t cut corners on that. Then when they say, yeah, I want this treatment, then you tell them, for good quality work comes with good price. Simple as that. Everything is like that. Yes, it's cheaper, even pound for pound, the same treatment, same quality it might be cheaper in Malaysia.
|
|
Howard:
|
How much cheaper?
|
|
Dr. Liang:
|
Two times, three times?
|
|
Dr. Phun:
|
Not three times, I would say about 30% cheaper. The problem is that the hassle is that you have to cross the causeway, you need a passport to cross over. You need a transport to come over here. After you finish, you have to go back. The thing is this, certain treatments or implants, you know that is not the one stop thing. You have to come back all the time, so is orthodontics.
|
|
Howard:
|
She comes every day.
|
|
Dr. Phun:
|
She come and earn money every day, it's okay. You come for treatment once in a while, then it's different, you know what I mean. She's okay because you see, one of the reason that she's working here, yes, it's because of money but the other one is that, I run a mentorship program in this clinic. They are my 11 or 12 students that I coach all the ways. I've been coaching some students since what, '97, '98, so they take turns coming in and then we share knowledge.
|
|
|
By the time in two years time when they learn whatever I want to teach them, they graduate. What happen is that once they move forward, there's somebody else who come in to replace them. Because at that time, I don’t have [inaudible 00:19:40], I only have two so I can train one at a time. Yes, Yoda and what's his name again? If you watch Star Trek or Star Wars, yeah, you know what I mean, one at a time. That's how you make sure that they learn all the thing correctly.
|
|
Howard:
|
Was it Star Trek or Star wars?
|
|
Dr. Phun:
|
Star Wars. Yoda and someone else. I can't remember what's the name.
|
|
Howard:
|
I hope I don’t remind you of Yoda.
|
|
Dr. Phun:
|
No, we are one year apart, that's it.
|
|
Howard:
|
You guys are also, you're looking into mini implants. Tell us about that part of your journey.
|
|
Dr. Phun:
|
That one I bumped into it by accident because one of my patient says, I need to get my dentures fixed and it's loose. I says fine, I'll try to figure out how to do mini implants for you. The first few mini implants I got from MDI which is 3M, it worked pretty well. You know people are very adventurous and they try to fix it ... fix a crown on it and it fail miserably. I says, okay if I don’t do it. Back in 2009, I was invited back in Singapore.
|
|
|
One of my job is to be a mentorship backup for some of my students in Singapore. Since I went in there once a day, I'm quite free so they toss me some cases that failed mini implants, asked me to look into it, asked me why it failed and how it failed and see if you can find a way to solve the problem. I was looking at multiple case of failed implants, mini implants, conventional implant and what I try to figure out is that why it failed. What I feel is that for conventional implants, there are a lot of smarter people than me that try to figure it out and I'm sure that they got the solution right.
|
|
|
For mini implants, it's an abandoned child. Nobody is interested in it. Once the mini implant fail, they say yeah, this system is no good. When I looked into it, there's not much wrong with the system but it's the way that you put in. It's the operator's issues that you have to look at. It has its role. It has its role, it's just that, when are you going to use it and how are you going to use it to maximize your success rate. That is important. That is still an ongoing project for me.
|
|
Howard:
|
What system are you using now?
|
|
Dr. Phun:
|
I learning from Todd Shatkin which is MDL interlock system. It's from the States but …
|
|
Howard:
|
That's www.intra-lock.com.
|
|
Dr. Phun:
|
Correct. He's good enough to share his experience with us and share his pain with us too because no matter who you are …
|
|
Howard:
|
[Crosstalk 00:22:18] you mentioned 3M was the MDI that was invented Dr. Max Sendax.
|
|
Dr. Phun:
|
I think the two pioneers in mini implants is Sendax and Shatkins. What happens is that along the way, Dr. Sendax decide to sell half the company to 3M and they maintained the name by MDI. Todd actually come up by himself. He says I'm going to develop it …
|
|
Howard:
|
You need to go … Yeah, that's fine. You've got to go to work, that's fine.
|
|
Dr. Phun:
|
Yeah. Okay.
|
|
Howard:
|
Thank you for joining us in our meeting.
|
|
Dr. Ling:
|
Thanks.
|
|
Dr. Phun:
|
What happened is that I think there is a split between them. Sendax retired. There's not much movement after being sold to 3M. What Shatkin did is that he looked into it. He says … I mean, he's the younger of the two partners. He says I still got a career to do. If I'm not wrong, he got some investor in to support his company and he developed it after that. He come up with attachment and everything and not perfect but we're refining it slowly. Because if I'm not wrong, the path that we are taking now for mini implant is the same path that we took for conventional implant back in 70s where you have quite a few features and we tried to figure out how it failed so that we can correct them up to a certain stage that when you have about 95% success rate then you say yes, we are done.
|
|
Howard:
|
What do you think is going on when they do fail?
|
|
Dr. Phun:
|
One of the thing that they keep telling you is that you put the mini implant in until the bone had stick out from the gums. That's where the failure is because you don’t know where the bone is. If you don’t have enough bone to … what do you call that, the bone engagement, of course, it fail. If you've got a thicker gum, do something about it. When you put in your mini implant, make sure that it's stable and put it all the way, all the [inaudible 00:24:12] inside the bone. Don’t leave it outside. Simple as that.
|
|
Howard:
|
You go to school in 1990 and this is 2016, so 26 years. My question to you is we hear different things, we hear things that in Asia, that today children drink a lot more Coke or Pepsi or soda. I want to ask you going back to 1990, 26 years to today, today, do children in Malaysia have more cavities, the same number of cavities or less cavities than when you started a quarter of a century a go?
|
|
Dr. Phun:
|
I will say that the DMFT council children around this region has actually dropped compared to about maybe about 20-25 years ago. 20-25 years ago, I mean you look at children, they still have bad teeth. Nowadays, DMFT, I think, it's three? Three is low. Compared to about maybe about 10, 12, 25 years ago.
|
|
Howard:
|
Do you think that what's more important is the dental IQ going up of more dentists brushing and flossing, that's more important than the dietary sugar going up?
|
|
Dr. Phun:
|
I think the public education part is very important because dental hygiene behaviors have changed and one of the things that they did is actually teaching the women how to brush properly and that makes sense too because women rules at home. I haven't seen a dad teaching the kids how to brush the teeth. I don’t know about you but most of the teaching done at home is done by mom. If you teach the mom the proper technique, chances are they'll get it right for the next generations.
|
|
Howard:
|
Do you see much baby bottle tooth decay in Malaysia?
|
|
Dr. Phun:
|
Once in a while … Not that much anymore.
|
|
Howard:
|
Not much, so the mothers know. The mothers have been educated more today than they were 25 years ago.
|
|
Dr. Phun:
|
One other thing too, you can get baby bottle caries with breast milk so they have been encouraging breast-feeding in this part of the world for quite some time now. I presume that that helps too in a way.
|
|
Howard:
|
Do you think water fluoridation has had an effect on … How common is water fluoridation in Malaysia and do you think that's had an effect on bringing down decay?
|
|
Dr. Phun:
|
I think we got it in 19- ... It depends on where you are. I think 1960 something, in most of the major town they have water fluoridations. This minor town, probably up to the 80s and then we get the whole country fluoridated. How important it is, I think that's one of the major factor that the DMFT [inaudible 00:27:02] actually.
|
|
Howard:
|
Water fluoridation …
|
|
Dr. Phun:
|
Yes, because they don’t prescribe anymore fluoride pellets, tablets or anything for pregnant ladies anymore, so you get it from the water. Simple as that.
|
|
Howard:
|
Is water fluoridation common in south East Asia. Is it common in Vietnam, Laos, Cambodia, Thailand?
|
|
Dr. Phun:
|
I think it is because at this moment, I haven’t heard anything, didn't hear any activities for the anti-fluoridation campaign in south East Asia. I don’t think they have any campaign at all. If you look at the scientific facts, I think it still works. That is the best way to prevent decay is water fluoridations. I mean of course, you get it right, we do have [inaudible 00:27:49] cases like flourosis and others. That's because probably at one time, the supervisor gets slack and then this sort of thing do happens. It's human error rather than the mistake of the chemicals.
|
|
Howard:
|
I'm going to ask you a controversial question. Which lasts longer? The most common tooth to have the cavity is the first molar. The most common tooth to be pulled is the first molar. The most common tooth to be relapse by an implant is the first molar. The most common tooth to be replaced with a bridge is first molar. If somebody came in here and had an MOD filling, what do you think would last longer, an amalgam or a composite?
|
|
Dr. Phun:
|
I'll let the young one step first.
|
|
Howard:
|
He's going to defer. You know it's controversial when he won't even answer the question, he hands it to you to get you …
|
|
Dr. Liang:
|
This is a very tricky question. I believe amalgam lasts very long. It's 20 years but the carbon composite which is the [inaudible 00:28:46], I believe lasts very long also for the research. Depends how you use it. If you want to use a composite, definitely you need a very good isolations to make it success, that's the only problem with the composites. The strength of this thing, I believe for the current composite is strong enough to withstand the …
|
|
Howard:
|
For the 9,000 dentists in Malaysia, what percent of fillings on molars, just morals … Obviously, the front teeth would be more composite but on molars, what do you think done today in 2016 are amalgam versus composite?
|
|
Dr. Liang:
|
Depends which sector you mean. If let's say, you're saying the public sector, government sector, for the posterior, I believe they're not using amalgam also. They're using GIC.
|
|
Howard:
|
GIC, glass ionomer?
|
|
Dr. Liang:
|
Glass ionomer.
|
|
Howard:
|
Made by who?
|
|
Dr. Liang:
|
Made by who, GC, maybe GC? Mostly because of the time issues, they need to do a lot of patients in a day. They rush, they're using glass ionomer then ...
|
|
Howard:
|
They would not use amalgam.
|
|
Dr. Liang:
|
Depends on the practice. [Crosstalk 00:29:58] I indeed used amalgam, I did use amalgam in the government, slowly, I changed into composites. I still using two but I prefer using composites nowadays.
|
|
Howard:
|
Why do you prefer a composite over a glass ionomer or an amalgam?
|
|
Dr. Liang:
|
First of all, talk about glass ionomer, it doesn’t stay long.
|
|
Howard:
|
It doesn’t last long.
|
|
Dr. Liang:
|
It doesn’t last long. Because it's easy to wear off, one of the reasons. The contact point is not that good. Then because you start all this thing and caries. Then amalgam and composite is both giving a good result. I wouldn’t say that one is better or one is not that god. It's good results. Just certain time in amalgam, [cause crack 00:30:40] expansions, cause crack or [we highly do 00:30:44] hold the amalgam, then I will choose composites. [Crosstalk 00:30:51] For aesthetic reason maybe.
|
|
Howard:
|
Does this office right here offer both or just …
|
|
Dr. Liang:
|
We offer both.
|
|
Howard:
|
Is one lower cost, is one higher cost? Are they the same cost?
|
|
Dr. Liang:
|
Definitely, higher cost.
|
|
Howard:
|
How much would an MOD amalgam cost on a lower first molar, how much would an MOD composite cost on a lower first molar?
|
|
Dr. Phun:
|
I think about two and a half times more expensive [crosstalk 00:30:51]
|
|
Howard:
|
The composite is two and a half times more …
|
|
Dr. Phun:
|
One thing about amalgam …
|
|
Howard:
|
How much would that be?
|
|
Dr. Phun:
|
Composites is about 250 dollars to 300 Ringgit and above. Amalgam probably about 100 to 150.
|
|
Howard:
|
What would 150 Ringgit be in US?
|
|
Dr. Phun:
|
It's about 40 to 50?
|
|
Howard:
|
$30-$40? You offer …
|
|
Dr. Phun:
|
Actually, one of the question is about amalgam and composite is depend on who you ask. Because if you ask a practitioner that is my age, you say you want me to do composite, it's over my dead body. Because you need to relearn the thing that they've been taught in the university and redo it again. If you ask a youngsters like him, then you say over my young body because I'm not going to go back to your OH amalgam. Sometimes there's a generation gap in our training too. Because you and I are trained up in amalgam and if you want to do composites, you have to retrain again and I don’t know about you, in my point of view, it's slightly different and it takes longer time and it takes more effort. If you have MOD in the sixth, I'll ask you to do a crown.
|
|
Howard:
|
When I was in school, we filled the teeth with dinosaur bones. Tell me another thing we're seeing all around the world. It doesn’t matter if you're in Brazil or India or United States, in the last 10 years, Malaysia's gone from four dental schools to 18 dental schools. What do you think about ... what is it like to have four to eight to 12 to 16, that's an explosion in dental schools. What are your thoughts on that, is it a good thing, a bad thing? How is that going to change dentistry in Malaysia?
|
|
Dr. Phun:
|
Put it this way, if I tell you the truth, we have a law that's called internal security act, I might end up in jail.
|
|
Howard:
|
Seriously?
|
|
Dr. Phun:
|
Yes. Of course. These sort of things are official secrets. The truth is this. If you're talking about a population of 24 million back in 2006 and we have only about 5,000 dentists, what's the patient to … What's the doctor to population ratio, it's way too high.
|
|
Howard:
|
Okay, let's see the math of that. You're saying in 2006, there were …
|
|
Dr. Phun:
|
You've got 5,000 dentists and 24 million patients.
|
|
Howard:
|
Okay, let's see that, 24 million.
|
|
Dr. Phun:
|
That is the need of dentistry.
|
|
Howard:
|
24 million divided by 5,000 would have given you of a dentist for every 4,800. In the United States, there's a dentist for every 1,800.
|
|
Dr. Phun:
|
That's bad.
|
|
Howard:
|
That was 2006.
|
|
Dr. Phun:
|
2006.
|
|
Howard:
|
Now, what is it in 2016?
|
|
Dr. Phun:
|
You're talking about …
|
|
Howard:
|
Now, you have about 30 million people.
|
|
Dr. Phun:
|
30 million. 8,000 dentists.
|
|
Howard:
|
Is it 8,000 or 9,000?
|
|
Dr. Phun:
|
They can change quite a lot because ... [Crosstalk 00:34:12]
|
|
Howard:
|
If it's 8,000, it's 3,750, so it's coming down.
|
|
Dr. Phun:
|
Yes. The thing is this, the thing is that the momentum is too high because you're talking about … you're producing about a thousand plus dentists a year.
|
|
Howard:
|
How many dentists here?
|
|
Dr. Phun:
|
About a thousand plus. That includes those that have been trained overseas and coming back. We're going to have a little bit of issue in terms of whether there's enough patient to do around, because the figure that you're talking about is 3,700 to one is the need of dentistry. If you and I would know, if you do what we call the human resource planning, you're looking at the demand. Question is this, how many percent of the populations demands dental services at any given time? I would say about 40?
|
|
Howard:
|
Let's go back to the Malaysia diet. You lived in Australia for [crosstalk 00:35:12] you went to dental school in … Where'd you go to dental school at Queensland?
|
|
Dr. Phun:
|
Yeah, Queensland University, Brisbane.
|
|
Howard:
|
You went to Brisbane in Queensland. Who eats more sugar, an Australian or a Malaysian?
|
|
Dr. Phun:
|
I would say both because it depends on where your sugar come from. We got sweeter drinks but we don’t eat a lot of sweet desserts or anything. It's not popular in Malaysia to have sweets dessert but sweet drinks, yes. Probably that's the evil …
|
|
Howard:
|
What are sweet drinks, like fruit drinks?
|
|
Dr. Phun:
|
Sodas, canned fruits, canned drinks and everything. Now, the problem is that sweet drinks, you can see the effects and not just in teeth. You can see the obesity coming in. In Australia, I think at one time they have … [crosstalk 00:36:01]
|
|
Howard:
|
Are you talking about me or are you talking about the Australians?
|
|
Dr. Phun:
|
… it's different, because they don’t consume a lot of canned drinks or anything. The evil is that they love sweet desserts. Cakes, everything.
|
|
Howard:
|
In Australia?
|
|
Dr. Phun:
|
Yeah. If you ask me, is it the sugar in the diet that counts. Yeah, part of it but I think the other is a nature of the food. Sticky foods stays longer in the mouth and that's why you get the decay.
|
|
Howard:
|
You know what I was surprised to see who eats the most sweets, cakes and cookies in my life? I would have never guessed. Do you know who it was that my …
|
|
Dr. Phun:
|
I think the Europeans.
|
|
Howard:
|
I think it's India.
|
|
Dr. Phun:
|
Yes.
|
|
Howard:
|
My god, I don’t think anybody eats more cakes and cookies and sweets than in India.
|
|
Dr. Phun:
|
Yeah.
|
|
Howard:
|
Every 100% of the time, you went to a dentist's house, they greeted you with a tray of cakes and cookies and everything had sprinkled sugar on it. My god, that was an awesome strip.
|
|
Dr. Phun:
|
That is what we call courtesy because they serve you the best food that they can have and then you just worry about your diet later on. That's how it goes. One thing true about this part of the world is that the sugar is more readily available, more refined, more sticky. We do not have a lot of Mars bars or Snickers but we're getting there slowly. I think the food is there.
|
|
Howard:
|
I want to ask you …
|
|
Dr. Phun:
|
The fluoride itself makes the difference.
|
|
Howard:
|
I want to ask you another question. How many dentists in Malaysia are not from Malaysia? Do many expatriates come here, do dentists come here from other countries, is it … Like if I wanted to be a dentist in a Malaysia, how hard would it be to get a license to practice in Malaysia?
|
|
Dr. Phun:
|
[Foreign language 00:37:56]
|
|
Howard:
|
What?
|
|
Dr. Phun:
|
See what I mean. He can't speak the language. That's the major problem.
|
|
Howard:
|
The test would be in Malaysian.
|
|
Dr. Phun:
|
Not really because one of the thing to practice good dentistry is your communication with your patients. If they can't tell you where the pain is, how are you going to treat them? That is the catch.
|
|
Howard:
|
Would the government not give me a license because they would say I wouldn’t be able to talk to the patients?
|
|
Dr. Phun:
|
It depends on how qualified you are because if you work as a GP, you're meeting the public all the time, I think language is very important. If you are in a status now at the moment as a consultant, chances are the language, the local language might not be that important because English is the one that you teach the dentists.
|
|
Howard:
|
I noticed in Singapore, it's pretty easy to get a license because the first two years, you have to work under supervision. Then if you work under supervision up to two years, this guy says he's a good dentist and then you get your license. Is it not like that in Malaysia, you can't work under a supervision?
|
|
Dr. Liang:
|
You need to speak Malay. One of the criteria is you need to speak Malay. Second, you might need to be a PR residents or married someone who is resident. Then you need to work for government for two years. You need the language to …
|
|
Howard:
|
That's an advantage that you're not having a lot of supply of dentists coming from other places in the world like they are in Singapore.
|
|
Dr. Liang:
|
No.
|
|
Howard:
|
Australia. A bit part of the increase in the number of dentists in Australia has been because it's so easy like a thousand dentists in Australia migrated there from another country. It's very easy for them, for expatriates, expats to come to Australia and practice in Australia.
|
|
Dr. Phun:
|
Actually, there's a lot of dentists in Australia. It's just that they practice four days a week.
|
|
Howard:
|
Are you saying that Australians are lazy like Americans?
|
|
Dr. Phun:
|
No. They have a very sharp tax man. Which is true because I mean, in my course of teaching orthodontics, we have fellows, teachers from Australia, from New Zealand and from States and the first that they talk about after the … why don’t you work in your own clinic, you earn more. They said, what's the point because my tax bracket is one of the highest so that's why I says, I might as well come out and enjoy life.
|
|
|
That’s true in Australia because with a tax bracket of about 47%, when you're hitting about 300,000 which is for a dentist is nothing, what's the point of working harder. You might as well employ someone, give them a chance to work. Let them earn a living and while you have your monies, life is short, go and enjoy what nature can give you. Light up the barbecue go for sailings, probably drop a few line for fishing, this is life. That's what you choose. In Malaysia, it's different.
|
|
Howard:
|
Anything else that you're passionate about, anything else that you want to talk about? Anything you're passionate about or like to talk about in dentistry, anything got you excited in dentistry? What's got you excited in dentistry.
|
|
Dr. Liang:
|
To me, it's the challenge. Maybe something that other people cannot do, I would like to do. Challenges, maybe, yeah. Try to be the best and one of the best.
|
|
Howard:
|
Right now, you're doing braces on your girlfriend. Isn't that kind of dangerous? What if the braces don't turn out, you might lose your girlfriend? Do you think that's dangerous to work on your girlfriend?
|
|
Dr. Liang:
|
I have to do the best for her. I have no choice.
|
|
Howard:
|
Got a lot of pressure.
|
|
Dr. Liang:
|
Not really, I've got my mentor …
|
|
Dr. Phun:
|
Yes, it is, you know why, because anything go wrong, I got to step in. One thing for sure is that, what's our challenge, what's next for us in dentistry, you know what's our passions? Look, you and I, we are not old for sure but …
|
|
Howard:
|
You say we aren’t?
|
|
Dr. Phun:
|
No. Life starts at 60 so now the most important thing is that we've the experience that we gain. What are we supposed to do with it, because if you and I are not careful, we might bring it 6 feet down. My passion is that before we go, make sure that we write down whatever we learned and pass it to youngster like this because in a few years time, you and I will be opening our mouth and they are the one that gives us the treatment. We better train them well. I'm not joking about it because the population is getting older and older, the more challenge is it so better do something about it.
|
|
Howard:
|
One of the things I've been saying for at least 10 years is I've been in so many dental schools in so many different continents and I actually think the next generation of dentists are better than our generation.
|
|
Dr. Phun:
|
Better be.
|
|
Howard:
|
They are. I feel so amazingly awesome handing off the dental baton to the next generation because they just seem bright eyed, bushy tailed, giggling, laughing fun, wanting to learn everything, not knowing where to start. They just seem eager to learn and they just seem … I think they're … That's well put, we have to train them because someday you and I will need you to fix our own teeth.
|
|
Dr. Phun:
|
In the meantime, join them to have some fun.
|
|
Howard:
|
Any other parting words, any other thing, passion you want to talk about or any …
|
|
Dr. Phun:
|
I'll put it this way. If you come and interview me in about year's time, I'll tell you something else. Life evolve.
|
|
Howard:
|
Okay. Thank you so much for taking me and my boys to lunch, opening up your dental office, spending an hour with us today. I just think you guys are fantastic and thank you so much for letting us come in and give us some of your time.
|
|
Dr. Phun:
|
It's my pleasure.
|