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Howard:
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It is a huge honor to be in Tokyo, Nippon, which Americans call Japan, in the doctor's office of Dr. Shinya Minami. How do you say it?
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Shinya:
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Shinya Minami.
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Howard:
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Thank you very much for letting us in your dental office. He went to school in Soa University, Department of Dentistry, in Tokyo, Nippon in 2004. He was telling me that dental school is 6 years long. He was the only one in his class that married a girl in his class. Right on, congratulations. After dental school, she went on an additional 7 years to become an orthodontist. Seven more years after dental school. So, dental school is 6 years and then they do a 1 year residency. So, his wife went to dental school 6 years, and then did 7 more years to become an orthodontist. Wow.
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They have a beautiful office. Most of Asia dental offices, 1 dentist, 1 operatory, 1 staff member, but in Japan, they have bigger offices. This is 4 operatories, and he works in here with his wife who's an orthodontist.
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Joya:
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That's right.
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Howard:
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What would you like to tell ... what are you passionate about in dentistry?
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Joya:
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His passion for the ... he does not want to damage the teeth. So he's, how do you say, he is interested in minimal intervention.
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Howard:
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Minimal intervention.
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Joya:
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Yeah, that's right.
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Howard:
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Yes, minimally invasive dentistry.
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Joya:
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That's right. Minimal invasive dentistry.
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Howard:
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What is his practice like? Is it mostly children? Adults? Is it fillings, crowns, root canals? What do you like to do, mostly?
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Joya:
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Mindy, the dental hygienist in his clinic, they do their work. He does not do many crowns or root canal. Many people come here to maintenance.
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Howard:
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You mostly, in here, it's mostly hygienists doing cleanings and your wife doing orthodontics? So, you like to prevent disease. What do you mostly do, yourself? If the hygienists are cleaning teeth, your wife's doing orthodontics, what do you like to do?
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Joya:
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Of course, if the patient come for the first time, he will check and do something the patient needed. If he has cavities he will make it treat. He will treat, but mainly, he is managing the staffs, and his main work it to manage the dental office. Not directly doing the work, practice.
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Howard:
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So, you're more a businessman than a dentist? Would you say more a businessman than a dentist?
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Joya:
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No, he's not businessman. He is more of a dentist, but there are many staffs in his office to help him.
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Howard:
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Does he have other dentists working for him?
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Joya:
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There are 3 dentists.
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Howard:
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Oh, okay. So, he's managing the 3 dentists.
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Joya:
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That's right.
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Howard:
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How many hygienists?
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Joya:
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Four.
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Howard:
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Four hygienists, three dentists, and one orthodontist? Are there any other specialties?
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Joya:
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There are dental assistant, and receptionist, 3. Three dental assistant.
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Howard:
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Does the 3 dentist that work for, do any of those do root canals, endodontics, or extractions, or what procedures do they like to do?
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Joya:
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Of course they do.
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Howard:
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They do?
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Joya:
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They do extraction, root canal treatment, root canal filling. In his definition, management meaning educating the young doctors to make them professional. It's his main work.
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Howard:
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The fees, like in America, for a root canal is $1,000 U.S. The fees for a root canal in Japan are like $100. How can you afford to do a root canal for only $100. Do the fees the Japanese insurance company pay, can you really afford to do root canals?
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Joya:
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For his clinic, the main earning comes from orthodontics.
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Howard:
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That's because the government doesn't set the price of ortho, right? You can raise the price of ortho, but you can't raise the price of a root canal.
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Joya:
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That's right. It's because of the insurance, right?
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Howard:
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Because insurance? Yeah. So, do any of the dentists in Japan ever just stop taking the insurance so that they could raise the price of a root canal from 100 to 200 or $1,000?
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Joya:
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Of course, the patients can get the root canal without insurance, but many people think if they can use insurance, they want to use insurance. They don't really care how the quality of the root canal. They can't understand. They think even if they pay more money, the quality is same. They think, the practice with insurance, practice without insurance, they think it's same.
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Howard:
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Do any of the dental offices not take insurance? Or do they all take insurance?
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Joya:
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Of course there is clinics that do not cover the insurance.
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Howard:
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There are clinics that do not take insurance?
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Joya:
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There are, yeah.
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Howard:
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Do they have higher fees?
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Joya:
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Yeah. I know.
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Howard:
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Do they make more money?
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Joya:
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Compared with the clinics covered with insurance, the clinics without insurance do not have many patients. A few patients for one day. So, comparing earning, it almost same.
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Howard:
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So, how many patients a day does the average Japanese dentist see a day? What are your hours?
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Joya:
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9 am to 7 pm.
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Howard:
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The hours are what? From what time?
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Joya:
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9 am.
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Howard:
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9 am to?
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Joya:
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7 pm.
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Howard:
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To 7 pm?
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Joya:
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With one and a half hour break.
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Howard:
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How many days a week are those hours? Monday through?
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Joya:
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Monday through Saturday.
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Howard:
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Monday through Saturday? So, is Monday through Saturday?
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Joya:
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Tuesday and Sunday is holiday.
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Howard:
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Okay, Monday, closed Tuesday and?
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Joya:
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Sunday.
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Howard:
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And Sunday.
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Joya:
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National holiday.
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Howard:
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So, you're open Monday ... And, how many patients do you see a day on those? How many does each dentist see per day, not the whole office, but how many patients does a dentist see? How long are the average appointments? When you see a patient, how long?
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Joya:
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Ten patients for each doctor.
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Howard:
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Ten a patients a day? Okay. How long are those appointments?
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Joya:
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About an hour, 60 minutes, about.
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Howard:
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You see 10 patients a day, for one hour each?
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Joya:
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About, depending on procedures.
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Howard:
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What procedures would you do in that one hour?
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Joya:
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Everything. Root canal extraction, canal filling.
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Howard:
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So that could be anything. When the hygienists see a patient, how long do they see a patient? How long are the hygienist appointments?
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Joya:
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Five patients.
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Howard:
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Five patients a day? And how long are their appointments?
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Joya:
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Sixty minutes, one hour.
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Howard:
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One hour too. One hour appointments too? When a patient has a cavity, do you fill it with glass ionomer or composite resin?
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Shinya:
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Composite resin.
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Joya:
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He will use composite resin.
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Howard:
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Composite resin? Because this is where Fuji was invented. Fuji GC glass ionomer, Fuji Ketac. Are GC products very popular in Japan? Because that's where they invented that? So is glass ionomer very popular, because this is where GC was started? Or not really.
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Joya:
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For the filling, he thinks it's not that popular.
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Howard:
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So, resins are more popular?
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Joya:
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Yeah, composite resin is more popular.
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Howard:
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What brand? Who makes them?
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Shinya:
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Kuraray.
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Howard:
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Kuraray?
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Joya:
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Kuraray.
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Howard:
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Do they make Panavia 21 too? Kuraray, Panavia 21? Nice.
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Joya:
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Are you talking about this? Cement?
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Howard:
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Cement, yeah.
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Joya:
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This is composite resin, right?
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Howard:
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Kuraray, yeah.
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Joya:
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Ah yeah, this one. For the composite resin, it's Kuraray, yeah.
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Howard:
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Glass ionomer. Made by GC? Or Kuraray?
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Shinya:
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GC.
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Howard:
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GC? Nice. I really like this. This is very nice.
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Joya:
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This for the patient information. Japanese doctor has to explain what they are doing to the patients. So, when they explain they will use such instrument. Because they can't understand dental jargon's, if the dentist explain what he did, what they did. So, they will show the pictures to make them more understand clearly.
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Howard:
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Do dental offices in Japan, do you advertise to get new patients?
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Joya:
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He doesn't advertise much. He has a homepage for his clinic, homepage, a webpage of his clinic. The patients see the webpage, then they will come.
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Howard:
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So, he doesn't mail a flier to their home?
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Joya:
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He doesn't.
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Howard:
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Does he have a Facebook page?
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Joya:
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He doesn't use Facebook page.
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Howard:
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Is Facebook very common for dentists in Japan?
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Joya:
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To communicate as a dentist is very famous, but not for advertisement.
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Howard:
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Not for advertisement.
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Joya:
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For the patients.
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Howard:
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So, the dentists talk to each other on Facebook.
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Joya:
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That's right.
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Howard:
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But not really talking to the patient. Not advertising.
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Joya:
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That's right, very few.
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Howard:
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Do you guys like any other social media, like Twitter or Instagram or Pinterest or LinkedIn?
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Joya:
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Do you know [inaudible 00:18:51]?
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Howard:
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What?
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Joya:
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L-I-N-E, Line?
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Howard:
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Oh, is that another one?
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Joya:
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Yeah, it's only in Asia, maybe?
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Howard:
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It's only what?
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Joya:
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In Asia.
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Howard:
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Oh, it's Asia, what's it called?
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Joya:
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L-I-N-E.
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Howard:
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L-I-E?
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Joya:
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L-I-N-E, Line.
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Howard:
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L-I-N-E?
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Joya:
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Yeah, Line. It's a communication tool.
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Howard:
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Oh wow, Line.
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Joya:
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It's like chat tool.
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Howard:
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Is that for you to talk to dentists or you to talk to patients?
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Joya:
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Patients.
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Howard:
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Patients. Line, huh. And it's common in Asia, or mostly Japan?
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Joya:
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Maybe only in Japan.
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Howard:
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Line's only in Japan?
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Joya:
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For the dentistry, maybe. Many people in Asia use Line, but for advertising, maybe Japanese dentists. Only Japanese dentists use Line to communicate with patients. He's not sure.
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Howard:
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So, introduce yourself. Who are you? You're his friend. What do you do? Tell them about yourself.
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Joya:
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I'm currently translator.
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Howard:
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You're a translator.
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Joya:
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Mostly I am a recruiting agent. I'm helping the dentists to recruit dental hygienists, dental technician, dental assistant, and, of course, doctors. I'm working for that company for 2 years. I and Dr. Minami met maybe last year. I was working for his clinic for about 6 month to help him manage the doctors and dental clinic's management.
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Howard:
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So, you guys both like management.
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Joya:
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Yes, he ... Dr. Minami asks me what he wants me to do, and I will check what I can do. If I can do what he wants me to do, I will help. So, he manages, and he tell me what he wants me to do, then I will do that job.
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Howard:
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You have one office now. Do you think you'll ever go to two offices? Do you think you'll ever set up a second or a third office?
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Shinya:
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Yes.
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Howard:
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Yes? That sounds very exciting. Do you like managing offices?
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Shinya:
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Yes. Education, I like education.
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Joya:
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He has more passion for educating doctors and educating dental staffs in his clinic.
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Howard:
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What else are you passionate about, what else do you ... ? Is there anything else you wanted to talk about?
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Joya:
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He wants to educate more doctors and help them to become good dentists. His dream is to educate more, more, more dentists, to help them to become good doctors, good dentists, I mean.
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Howard:
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That's fantastic.
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Joya:
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And that, if more dentists become good dentist, more professional, the patients will benefit, because patients can go to the good dentists to consult or to go to the dental clinic with good doctors. Professional doctors.
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Howard:
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When you're looking at the 100,000 dentists in Japan, where do they need more work to become professional? Is it root canals, is it fillings, is it orthodontics? Which area would you like to them improve more on? Which area needs improvement the most?
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Joya:
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Everything, he said.
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Howard:
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Everything. Dentistry's very hard, isn't it? It's hard to learn at all.
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Joya:
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For him, it's not that difficult, he thinks it's more easy.
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Howard:
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It's more easy? How's the state of dental implants? Do you guys place dental implants in this office.
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Shinya:
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Yes.
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Howard:
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Yes? Does the insurance company set the fee for an implant? Or can you charge more fee, like orthodontics? Can you charge whatever you want, or does the government tell you what you have to charge for an implant?
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Joya:
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They can charge more. The government doesn't say anything about implant.
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Howard:
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Wouldn't that make implants more popular? Does the government set the fee for a three unit bridge? So, the government sets the fee for a bridge, but not an implant?
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Joya:
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That's right.
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Howard:
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So, wouldn't that make a lot of Japanese dentists place an implant for a better fee and a better profit margin, than a government mandated low fee for a three unit bridge?
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Joya:
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He thinks the implant is only a part of the procedure, and he doesn't think implant as a lucrative procedure. He doesn't think it makes more money. He thinks what is needed for the patient. So, he doesn't really think to make more implant, to do more implants in his clinic.
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Howard:
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If someone was missing a molar, 100 times, if 100 people were missing a molar, what percent of the time would he place an implant and what percent of the time would they do a three unit bridge.
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Joya:
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He will explain all the choices.
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Howard:
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Wow, that's nice.
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Joya:
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It's for the bridge. Temporary.
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Howard:
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What percent, okay, that's a removable bridge, and then that's an implant, then ... Okay, so, he showed a removable bridge, and then he showed an implant. Does he also do a fixed bridge where he puts a crown on this tooth, a crown on this tooth and the three unit tooth? So, between those 3 treatments, what percent would be the removable bridge, versus the implant crown, versus a three unit fixed bridge?
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Joya:
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In his clinic?
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Howard:
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Yeah.
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Joya:
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Maybe 20% will choose implant, and 40% with the three bridge, and that one. Removal crown, 40%
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Howard:
|
That's an interesting thing. In America that's called a spider.
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Joya:
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A spider?
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Howard:
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Because it's got 4 legs and it's not very popular, and I always thought it should be popular because it's more low cost.
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Joya:
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Why it's not so popular in U.S.?
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Howard:
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Because America has one million lawyers, attorneys, and they're very ...
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Joya:
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Rich?
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Howard:
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... sue happy. If a patient swallowed that, the dentist feared it would be a law suit. Have you ever had a patient swallow this?
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Joya:
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Never. Is it common in U.S.?
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Howard:
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To swallow it?
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Joya:
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Yeah.
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Howard:
|
No, but it's very common in the U.S. to fear more about the lawyer than it is what the patient needs. Like you might not think you need an x-ray, but you would take an x-ray because in case you got sued, you'd want to be able to show the x-ray.
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Joya:
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It's very interesting.
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Howard:
|
You would want to do this for someone who wanted to save money, but you would be afraid that if he swallowed it, you'd be sued. So, Americans do a lot of ... Are there a lot of lawyers in Japan?
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Joya:
|
Recently the number of lawyers increasing, he thinks. They are searching their job, then they come into the dental industry. So, he thinks the number of lawyers is increasing in dental industry.
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Howard:
|
I'm sorry to hear that. On this spider, would you take an impression and send that to a lab, or would you make that back here in your won lab?
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Joya:
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He's outsourcing.
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Howard:
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He'd outsource it to a lab? What about a root canal, what is your root canal technique? How does the average Japanese dentist do a root canal? Is it lateral condensation, vertical condensation, got to perch on a single cone?
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Joya:
|
They use both vertical and lateral.
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Howard:
|
Is there anything else you wanted to talk about? Is there anything else you're passionate about or wanted to share with me today?
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Joya:
|
He want to increase the number of dentists who can educate another dentist.
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Howard:
|
Do you lecture to dentists? Does he set up seminars to lecture to dentists to educate them?
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Joya:
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He only takes place lecture in his clinic or in his friend's clinic.
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Howard:
|
So, your wife is an orthodontist. Does she do mostly fixed braces or does she do removable clear liners like Invisalign?
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Joya:
|
She do fixed here.
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Howard:
|
Does she do Invisalign at all, or is it all fixed?
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Shinya:
|
Very few.
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Howard:
|
Very few? Does she do mostly lingual braces or buckle braces? Are the braces on the labial or the braces on the lingual?
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Shinya:
|
Labial.
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Howard:
|
Labial? What percent of the time, if she does 100 cases, what percent of the time does she pull teeth to do the braces, extractions?
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Shinya:
|
Seventy.
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Howard:
|
Seventy percent would get extractions? Does she like orthodontics? Does your wife like doing orthodontics?
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Shinya:
|
Yes.
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Joya:
|
She loves it.
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Howard:
|
She loves it? That's great. It's nice to have a happy wife. You don't want an unhappy wife.
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Joya:
|
You know this?
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Howard:
|
Yeah, cleft palate?
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Joya:
|
She wants to do more braces with this one.
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Howard:
|
She wants to treat more cleft palates.
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Joya:
|
Yes.
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Howard:
|
She's interested in cleft palates.
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Joya:
|
She is interested.
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Howard:
|
Wow. Are cleft palates very common in Japan?
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|
Shinya:
|
It's not that common.
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Howard:
|
It's not that common? She just wants to learn? Very few. But she's interested in learning more about cleft palates?
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|
Joya:
|
That's right.
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Howard:
|
That's fantastic. That is amazing. Anything else you want to talk about? I'm so thankful that you let me into your office, arranged a translator. I'm just very honored that you came on. Is there anything else you wanted to say to anyone?
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Joya:
|
He's also thankful to you.
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Howard:
|
I just want to say that I love Japan. It is so clean. It is so organized. It is so safe. It is so high quality. The people are so friendly and helpful. It really is arguable one of the nicest places in the entire world. I mean, I don't think I've ever seen a city just this clean and organized and happy and productive. It's just like a perfect society. It really is. It is really a perfect society.
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|
|
So, thank you very much for inviting me into your home, into your dental office.
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Joya:
|
You're welcome.
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Howard:
|
You guys are amazing. Brian, thank you so much.
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