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Howard Farran:
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We are in Singapore, in the dental office of Dr. Weng Cheu Yue?
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Weng Cheu Yue:
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Yes.
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Howard Farran:
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Weng Cheu Yue, and his wife, Louisa Yue, and these are huge movers and shakers, in not only Singapore and Southeast Asia, but I saw you lecturing in Medan, Indonesia. Did I say that right? Medan or Medeen?
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Weng Cheu Yue:
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Medan.
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Howard Farran:
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Medan. Medan, Indonesia. You are quite the high-tech legend. You're big into Invisalign. You're big into lasers. You're big into CEREC. You studied in Las Vegas with Dr. Chen, with neuromuscular dentistry, Dr. [Cling 00:00:51] Chen, in Las Vegas, with neuromuscular dentistry. There's so many things we could talk about. I don't even know where to begin with you. Tell us your story. Where did you go to dental school? Was it in Singapore?
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Weng Cheu Yue:
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Yep. I'm a home-bred dentist. 1999, 2000, I graduated from NUS, National University of Singapore. Then we have a four-year [bond 00:01:17] with the government. That's the time where we have to serve out four years.
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Howard Farran:
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Because they paid for your dental school?
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Weng Cheu Yue:
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Subsidized, in the sense that we don't pay our full school fees. 75% is supposed to be paid by the government. That is our way to return back to the country, in a sense. During that time, I had a chance to continue to learn, working with my basic dentistry. I wanted to know what more is in store for us. I had a good mentor, Dr. Lin, Dr. [Jerry Lin 00:01:58], Dr. [inaudible 00:01:58]. When they're doing surgeries, I would actually take a bus from my clinic, which is maybe about ten minutes away, to their practice. I get to see how they do some more advanced surgery. That was during my lunchtime. They arranged it quite nicely for me, thankfully, and I would go back to work after that.
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With the different posting in the government service, we also get to try out working in military service, dental school service, public health service. It really gave us a way to experience what dentistry on a ground level is all about. I went ahead and learned about ... First thing first is advanced posterior composite. That was the first time.
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Howard Farran:
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With Ron Jackson.
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Weng Cheu Yue:
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With Ron Jackson, yes. That started me thinking about more minimally invasive dentistry, for example, inlays, onlays, which is not so much of an emphasis in school, last time. I just think it's right, that we shouldn't cut down as much teeth as possible to make a crown. We should just conserve. Of course, now the key word is biomimetics, so we can't actually do that.
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Howard Farran:
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Explain biomimetics, in case someone is not familiar with it.
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Weng Cheu Yue:
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To me, biology ... We want to use whatever way we understand about the biology of dentistry, and we want to mimic the real situation in life. By understanding how the structure works, instead of over-engineering things, like putting things that's too hot, we should work with the difference in structure of the tooth, and allowing the flexibility, and at the same time the rigidity of the tooth to show through. In that way, we can bond a tooth. We can bond to a tooth, get it to work, and at the same time, we preserve our material, and at the same time preserve the natural material of the tooth. To me, that is biomimetics. Understanding bonding well, understanding the type of material well, will help us to achieve the results. One of the teachers that is really good at it is Pascal Magne.
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Howard Farran:
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Pascal Magne?
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Weng Cheu Yue:
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Yes.
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Howard Farran:
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From Brazil?
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Weng Cheu Yue:
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He's actually from Zürich.
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Howard Farran:
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He's from Zürich, Switzerland?
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Weng Cheu Yue:
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Yes, and he's now part of the faculty of USC. USC?
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Howard Farran:
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USC? The University of Southern Cal, in Los Angeles?
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Weng Cheu Yue:
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Yes, yes, and he is traveling the world to give lectures, and one of his lectures was in Sydney. He always has sold-out lectures in San Francisco, and then he came to Sydney, and I attended his four-day workshop. That set forth another change in my dental career, and my wife's dental career. Louisa, my wife. We started a new venture called Dental ED, which, again, provided dental education to the dentists.
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Howard Farran:
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You started that company? You and Louisa?
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Weng Cheu Yue:
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Louisa is now heading it. We took on the role of the Asian, or should I say, Southeast Asian director, and Louisa is the one heading the whole operation. For me, it's because I've been lecturing around the region. I do get into contact with very good dentists. It's been the movers and shakers of the different areas. With this Dental ED platform, we're able to provide dental study clubs, where we do a class every six weeks. Dentists gather together. In Singapore, we run it in such a format that we actually invite specialists or an expert of the field, about the topic.
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Howard Farran:
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What was the website? ED Dental?
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Weng Cheu Yue:
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Dental ED Global.
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Howard Farran:
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Dental.
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Weng Cheu Yue:
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ED.
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Howard Farran:
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ED.
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Weng Cheu Yue:
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Global.
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Howard Farran:
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Global.
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Weng Cheu Yue:
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Dot com. Dot com.
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Howard Farran:
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Dot com. And the mimetic dentistry was Doctor?
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Weng Cheu Yue:
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Pascal.
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Howard Farran:
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Dr. Pascal.
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Weng Cheu Yue:
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Magne.
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Howard Farran:
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How do you spell Magne?
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Weng Cheu Yue:
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M-A-G-N-E.
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Howard Farran:
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M-A-G-N-E, and he's from UCLA, or USC?
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Weng Cheu Yue:
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USC. He actually created an undergraduate program for them that is totally concentrating on CEREC dentistry, or [inaudible 00:07:08] dentistry, rather than having them to learn the traditional way of preparation and manufacturing, only to re-learn again after they graduate. I think he's very forward-looking in that.
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Howard Farran:
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So, Louisa, you're the one that started ED Dental. You're the one that's heading that up.
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Louisa Yue:
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It started thirteen years ago, by Emanuel Recupero in Melbourne, so it's been around for thirteen years in Australia, New Zealand, and the US.
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Howard Farran:
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Started thirteen years ago by who?
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Louisa Yue:
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Emanuel. The CEO of Dental ED Global.
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Howard Farran:
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Emanuel.
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Louisa Yue:
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Recupero.
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Howard Farran:
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How do you spell his last name?
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Louisa Yue:
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R-E-C-U-P-E-R-O.
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Howard Farran:
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R-E-C-U-P...
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Louisa Yue:
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P-E-R-O.
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Howard Farran:
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In Sydney, Australia?
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Louisa Yue:
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In Melbourne. He's based in Melbourne, so they've got over a hundred study clubs in Australia, New Zealand. They've got a presence in the States, too. I'm in charge of bringing it around to Southeast Asia. They've got a manager in China, too. We are growing quite rapidly. We always look for opportunities to collaborate, with Dentaltown, hopefully.
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Weng Cheu Yue:
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We run the study clubs on a regular basis. We also run the events. So far we have undertaken a few big projects, like having Galip Gurel. Galip Gurel is, in a way, the godfather of veneers. We conducted one hands-on for him so far, in Singapore. Mauro Fradeani, prosthodontist, again, a teacher of many teachers in prosthodontic work, especially his MIPP. Very minimally invasive in prosthodontics, trying to overlay full restorative, opening up the bite, not cutting down teeth as much as possible, getting good canine guidance in to preserve the restoration for long. We also have the Style Italiano group, if you know.
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Howard Farran:
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In Italy.
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Weng Cheu Yue:
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Yes. Angelo Putignano, a good friend now, and we are even plotting Italian invasions. We are thinking of getting his whole team down to Asia to have another big event. Now, he has almost 50,000 members in his Facebook group, and it's growing, and a large number of them are from Asia, so I think it's a good time that we can actually do something for the Asian community, with them coming.
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This year, we are now hosting one of his group members, Jordi and Salat. Both of them are very good dentists with composite, and they are published as well. After them, we'll be hosting Pascal Magne in August, in Singapore, for a two-day lecture, one on anterior, and then posterior composite. No hands-on this time around, because he just did two rounds in Australia, all sold out, back to back, because the first round was all sold out, and then they asked him and we managed to get another round going. We have quite big participation already for that.
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We actually got Mauro to run a course in Taiwan with one of the study clubs, dentist doctor [inaudible 00:11:12] that we have collaborated with, and also we have one coming up in April in Jakarta, for Galip Gurel as well. He's very well-received as a dentist in Indonesia, so I think that was the best place to host him.
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We also have plans in regional training centers, like in Cambodia, where [inaudible 00:11:38] is a big grove in economics and in dentistry as well. We have a good friend, Dr. [Tianyue 00:11:45], which is also a very interesting and amazing character as a dentist. He runs his hospital, he has two restaurants, a few farms, he has a construction company, he has his trading company that brings all the material to supply him with, just amazing things that he's doing there. Dr. [inaudible 00:12:14] in Taiwan, where he's now teaching DST. He's coming into Malaysia to run a course. We'll be seeing him in March and we'll be bringing him to Cambodia to start something there as well.
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We're really trying to start a regional alliance. The last [inaudible 00:12:34] was in Indonesia. Prior to that, in November, it was in [inaudible 00:12:41]. I gave a good lecture to a crowd of more than 300 dentists on occlusion, and then this time, in Maren, I was invited to give a one-day workshop on laser, and this time around in Jakarta, I was in there for two university programs, one for the University of Indonesia's chem program, and then for the University of [inaudible 00:13:13], another top university there, we did laser and hands-on for them, because they just acquired a new laser.
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Howard Farran:
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So you're big on lasers, you're big into Invisalign and neuromuscular dentistry. Does it all kind of tie into one?
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Weng Cheu Yue:
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Totally.
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Howard Farran:
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Explain how all four of those pieces of the puzzle fit together.
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Weng Cheu Yue:
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Allow me to start my lecture.
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Howard Farran:
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Absolutely. Are you going to show your lecture on this big screen?
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Weng Cheu Yue:
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I can go into details, but I will try to keep it succinct. For me, there's this big explosion in usage for lasers. Particularly two families, the erbiums and the diodes. When we talk about erbiums, we have two main groups, the erbium chromium YSGG, wavelength 2780, like this guy here. Erbium, yuck, right? That was 2940, the two guys that were there, one from [inaudible 00:14:25], one from [inaudible 00:14:27]. The erbium lasers are really useful because they work with water. The chromium fall, the specific thing that absorbs this wavelength of light, is water. If we quickly go around and look at this particular graph, this is the water absorption graph, or should I say, the relative absorption in water for this kind of wavelength. The erbium lasers are right on top.
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When this kind of light shines through water, water gets really excited, and then it can do its job for us. Water is present in soft tissue, in the hard tissue, so we can actually get both of it working. We do surgical, and everything, literally. So far, erbium lasers have the YSGG and the [inaudible 00:15:22] lasers. They differentiate by this coefficient on the graph, by actually 300% difference. Erbium YAG lasers, the other two guys, are better absorbed by water. This is slightly less, but slightly less is sometimes a good attribute, to a certain extent, because it allows a little bit more energy to be dissipated around it, instead of being absorbed by water, so we have a bit of a warming effect. The warming effect actually comes through as hemostasis, in surgical.
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So when we use the two to cut, we have more bleeding. When we use the water laser, less bleeding, because of that differential in absorption of water. We can see from the graph here, the YSGG, and the diode goes right through. Water does nothing. It doesn't absorb. So it is a good thing, as well, that's why we can use the diode to go into deep tissue. We all know diode to be good lasers for soft tissue, and most of us do use that, but we always face a problem of charring and carbonization of the soft tissue. If you use the erbium laser with water, you tend not to have those problems.
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Diode, for me, if I use it for soft tissue, it will be too slow and too inefficient, compared to erbiums. Recently, there's a very big development in the field of photobiomodulation, or biostimulation. Early on, it was known as low-level light therapy, or LLLT for short. Now we can use light to influence the healing capacity of the person. We can use light to biostimulate, to increase the level of ATP, nitrous oxide reactive oxygen species, all this helps the body to work better, in terms of healing and pain management. I'll show you a few cases to illustrate those facts.
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This graph tells us where those options are, so we can see the erbiums are closer to this range, higher level water, so erbiums are good for that. Diodes, not there, but here, nearer to the red color, oxygen, hemoglobin, so we can actually use the diode to activate right here where the hemoglobins are, absorb the energy right into it, and then get the mitochondria in the red blood cells to do the wonderful thing of biostimulation for us.
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Looking at cases, right? One of the interesting cases that I usually put us through is this. There are many, many applications. One of the applications I use it for is implant dentistry. I did a certification course with Frankfort University for my implantology, so part of the graduating criteria is I have to present a lecture or a poster presentation, so I did this in 2009 regarding how we can use lasers in all stages of implantology.
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Part of it goes into this first role, where we use it for osteotomy, so we can do it for soft tissue incision. Top row, up there, where we cut off, we can see over here is that we can elevate a flap, and then use a laser to cut the bone. So we're literally doing osteotomy, osteoplasty, and doing osteo surgery to create the implant site, then we place an implant in there. We can also do it this way, where we can use it like a very fine instrument to dissect the tissue. Literally, I can dissect the periosteum off the mucosa now. All right, now I have a pouch. I can use my biomaterial and put it in my periosteum pouch, suture that. Now I score my mucosa, allowing for more stretching, and close the wound, less tension, good primary closure. You can do second-stitch surgery to open up the gum, to expose the implant and put a healing cap [inaudible 00:19:50], or you can contour tissues around your [inaudible 00:19:53], to receive those denture bond prostheses, or should I say, implant bond prostheses, more accurately.
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Sometimes it will occur where we get this dislodging of crowns. We can use that to clear away the overgrown tissue easily, and we can do the cementation rather well. I think I see a big potential in this field where we use that to treat peri implantitis, because I think many studies have shown that a laser can actually do a better job than most other methods. One of the ways to go about doing it is to present it in this case, where we do a multidisciplinary approach. I mentioned earlier, we have the endodontics, we have Invisalign, we have laser, implantology, and neuromuscular.
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Part of it is doing the surgery first. Before that, sorry, let me just go back one step again. You can see from here, a patient actually has a tooth that requires a root canal treatment over here. We have two pontics just to close up the gap that was created due to the shifting of teeth, because of the loss of the molar.
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We did a root canal. We did a temporary crown. They moved on to Invisalign, moving the tooth and closing those gaps, creating a space for us to place the implant, and we did CEREC to actually do a crown, and now we're going to ...
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Howard Farran:
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Can I have a question?
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Weng Cheu Yue:
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Yep.
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Howard Farran:
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I often see TMD. I've seen neuromuscular. What is GNM?
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Weng Cheu Yue:
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Yep. The traditional neuromuscular dentistry started almost 47 years ago. The [Jenkisons 00:21:37] started with that. Over the years, it's had some evolution. Of course, more subjects, as we find out more about things, we add on more information to the basic concept and philosophy, to have a better understanding. In recent years, Dr. Clayton Chan did more research, and he came up with this subset of neuromuscular, that we now would call the mainstream neuromuscular, in my opinion, gneuromuscular with a G. G stands for gnathology. It also stems from his background. He started as a technician.
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Howard Farran:
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A lab tech.
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Weng Cheu Yue:
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A lab tech.
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Howard Farran:
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In Vegas?
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Weng Cheu Yue:
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In Germany.
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Howard Farran:
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Clayton was born in Germany?
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Weng Cheu Yue:
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Clayton was posted to go with his father. His father was with the military, and he went to Germany with his father. He has brothers in [inaudible 00:22:41], and he also [inaudible 00:22:45] as well. In his own words, he's a little bit of a rebel in the beginning, but thankfully, he met the right person, his wife Jane, and that got him started thinking about family and the future, and that's when he started doing dentistry with [inaudible 00:23:05]. I think he will be the best person to tell his own story, but in short, he has information about technical, and he did training with CR groups, centric relation, and then neuromuscular, and then with more understanding of neuromuscular, he has incorporated all this understanding, especially with the gnathology, which is the fine tuning of the occlusion [inaudible 00:23:33], to support this whole philosophy that he has, and then to come up with gneuromuscular with a G.
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Howard Farran:
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When you're doing neuromuscular dentistry, Invisalign is a big part of that?
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Weng Cheu Yue:
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Yes. Again, there is a little twist that I put in there on my own as well. For example, to get to the [inaudible 00:23:58], let's go to that point.
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Howard Farran:
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You can finish your case. I don't want my question to ...
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Weng Cheu Yue:
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We'll just do that now. We'll go back to that laser part. This is my favorite part. From this case, the girl came complaining of pain in the left joint, awkward open and closure, the mom always sees her moving her face in a funny or odd way when she's chewing. She has close lock for two years. If you look at OPG, nothing too significant. Teeth are where they should be. The jaw seems to be a little more heated in the condyle-fossa, not so evident in the outline, but from this, of course, we can't tell for sure. A jaw x-ray, two or three x-rays all will be helpful.
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Basing on the neuromuscular dentistry that Clayton has taught me, we learn how to recognize every individual's isotonic muscle resting physiological position, where the jaw is nice and comfortable in the housing, and when they open and close, open and close, they are following a certain trajectory, some open and closure path. This does not cause too much discomfort. We need to reestablish. When a patient comes to us with pain, obviously they are into a pathological position already. Most of the time, I think we can accommodate, that's why we have no pain, no big issues, only when we fall off the cliff, that's when they start trying to see whether there's a solution for it.
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Using the method mainly to relax trans-electrical neural stimulation, so we work on the fifth nerve and seventh nerve first. Relaxing this fifth and seventh nerve, we are now able to tense the muscles, and then achieve that nice isotonic contraction. From there we are able to measure, using a computerized device, to see where the pattern lies. Where is the usual zone that the patient relaxes into, and what is the trajectory? Where is the open and closure path when they are allowed to be nice and relaxed?
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We determine the position, and we fabricate devices like this. It looks like a normal splint, but the thing that goes into it is a little bit more. Imagine that, if the bite is right, the patient would not have any issues. Obviously there's something wrong with it, and we need to alter it. Where is the position that we should open the patient to? Where is the AP, the anterior posterior position? How about the roll, the turn of the jaw? How about the pitch of the jaw? So there's the six axes, pitch, jaw, roll, up and down, left and right, front and back. So we can determine that roll. It's just like the car is having some alignment issues, suspension issue, you're not going to fix it while it's still on the ground, right? We usually have to put it on the jack, and then jack the whole car up. Let the whole wheels and the whole suspension and the axle, let it relax. Let it hang loose, then we can do our job. Same thing for the joint. We can't fix it while it's still in its usual bite. We relax it, and see where it hangs loose.
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From there, we determine the position, and record it down, send it to a lab, Las Vegas Esthetics or Doral Lab, in the US, help us with all this.
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Howard Farran:
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What's the lab in Vegas?
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Weng Cheu Yue:
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Las Vegas Esthetics. LVE.
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Howard Farran:
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Is that...
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Weng Cheu Yue:
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It's Ray Foster's lab. Ray.
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Howard Farran:
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Ray Foster.
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Weng Cheu Yue:
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Ray Foster.
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Howard Farran:
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In Las Vegas. What's his www?
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Weng Cheu Yue:
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I think it's www.lasvegasesthetics.
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Howard Farran:
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Las Vegas Esthetics? That's who makes your splints?
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Weng Cheu Yue:
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If you think about it, it's an orthopedic splint, because we are moving joints and muscles into positions. Doral Lab, in Miami, is also making them as well.
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Now we have the position, so now we make an overdenture, literally. Overdenture, or should I say a clear overdenture, with anatomical bite established, so that when the patient bites down, it's just as though you are biting onto teeth. Your [inaudible 00:28:52] go into the [inaudible 00:28:52], and you have a very stable relationship between the upper teeth and the lower prosthetic teeth.
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Anteriorally, we have the guide plate. In terms of the canine, anterior guidance, so that when the jaw goes [inaudible 00:29:06], it's proper disclusion of the joint and the bite at the back, so that you don't overexert forces.
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This device, the overdenture, is like our trial [inaudible 00:29:24], right? It's theranostic, therapeutic and diagnostic at the same time. Therapeutic, if we get it all adjusted to the right position of the patient, we now can level off the jaw, relate it over a new plane, allowing the upper arch to actually balance off to it, changing the cranial [inaudible 00:29:48] alignment, at the same time the whole posture will correct with it. We sometimes also need auxiliary [inaudible 00:30:03], like chiropractors, [inaudible 00:30:04], PTs, to help us actually manage some patients where they're more severe in certain positions.
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Howard Farran:
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In Poland, a Dr. Marcin Dolecki, he calls it chirodontics. Have you ever heard of that term?
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Weng Cheu Yue:
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Yes. The truth is, even chirodontics is...there's another chiropractic doctor in the US that's very good, that's Erik Dalton.
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Howard Farran:
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Where's he at?
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Weng Cheu Yue:
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I could check it out for you again. Basically, he has a whole series of blogs online that tells us how to relate the head to the toe, and everything else in between. Putting forthright the interconnectiveness of things, the inter-relatedness of things, not thinking one joint out, and then we thought that we're just treating the TMD. That's a trick question. Can you move your lower jaw? You can. Can you move your upper jaw? You just did.
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Howard Farran:
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That's a good one.
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Weng Cheu Yue:
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Basically, your lower jaw is hinged over here, at the TMJ. The upper jaw is hinged over the occipital axis joint. Literally, we can move those joints. It's just a matter of thinking about it. There's a relationship. [inaudible 00:31:29], Javier, they're all talking about it, giving causes on it too. We're talking about action-reaction force. Many people that I can show you later on are talking about postural positioning, changing the spinal relationship as well.
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In Japan, they did these very interesting studies. Nineteen teeth and below, compared to twenty teeth and above. If you have nineteen teeth and below, your chance of incidental falling and hurting yourself is 2.5 times more, because you have less teeth. If you have twenty teeth or above, you're better off. If you don't, no worries. You can make a denture and help them out. You reduce the chance of falling to 1.36 times. Literally, you need your head to be properly aligned, supported, in order for your whole functional component to work. Why not? When we work, when we eat, our fifth nerve is acting on our muscle of mastication. You cannot chew without moving your face. Your facial nerve is at work. You don't have to tell your tongue to go left or right. Your tongue knows where to go, where you're chewing, because it is also in connection with the five and seven, and when you're ready to swallow, the vagus nerve is ready to help you out and swallow. The five, seven, nine, and ten, all work together to feed to the trigeminal nucleus.
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At the trigeminal nucleus, you literally have this whole gang of four working together to feed. You can see fifth nerve, facial nerve, nine, and your ten, and even your eleven. They all go down together to the trigeminal modal nucleus, and all are doing the touch position, and pain temperature control.
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Going in at the spinal trigeminal nucleus, you now have a pain temperature sensation for perceptiveness. The principal trigeminal nucleus helps you with positioning because of touch and position. They have an analogous one that goes down the spinal cord that will help you map the whole body. What they're all doing is, they're trying to give you a very clear map of the body, or what is going on, and all of this works together. This is important because ... Can you hold this for me? Pass it back to me. You just received a very heavy weight. In that millisecond, you can just calculate and know your body position, just to hold enough energy to hold that position and not fall due to the weight, and then release it, same thing.
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Your body is doing thousands of calculations every millisecond, just to get you posturally in position. Same thing, your whole trigeminal nucleus is working with your trigeminal nerve, and working to get your head in the right position, while you're eating, chewing, and everything else, and they work together, so that your head will not be flopping down and then you're falling off. If you don't have enough teeth, you have a problem. You cannot exert that particular control into the finer detail, and then that affects your postural chain.
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That's why class two individuals have very [inaudible 00:35:07] posture. They have to try to balance, but they also have an issue with breathing. The airway also affects. Why? [inaudible 00:35:16] bite the tongue is in a very enclosed, small space. You can't breathe well. If you stay upright, the jaw gets brought back, and then the tongue blocks the airway. In order to get that, we stick the tongue out. In order to get more air, they need to open up their airway this way, so they have open air, and the forehead posture. You have forehead posture, the [inaudible 00:35:44] spine, C-5-C-67 area, we have compression, because of the stacking of the spine, and they have neck issues that develop over time.
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If the bite is not even, they have high and low positioning. If they bite in, and if the jaw is deviated to the side, you can see the jaw will go this way, the head will go this way a little, and the whole spine will turn together with it. You see deviated to the left, you can see the person's right side will be more forward. His hand is one forward, the other. You can see that. Whole body, now we have that whole dimensional change, and scoliosis is created. Idiopathic scoliosis, created, and if you really investigate, there's many studies. In a way, if you look at things, our head is now aligned, everything's all connected. It's going to pull all these muscles differently. A 40-pound bowling ball going off the axis is going to pull on this kind of muscle first, lateral muscle and straight muscle of the neck, and this is going to cause your first vertebrae atlas to change. Thus, we have spinal stenosis.
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We're going to come back on one small nerve. Think about crimping the biggest wire in your body. We don't know what is not going now, and we don't know what is not being fed back. The posture change will now be affected, because instead of decompression, we have compression developing. Pain will start to feature heavily in some individuals.
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Connected chain means that every single one of us can exert a certain action and movement, because one joint stabilizes the others as we move, and we pass on that whole cascade from one to the other, in order to move smoothly. If one is out of sync, we have to exert more power, or pressure, or energy, and sometimes it creates pain because of that. The whole joint has to function in a proper neuromuscular way, in order for everything to function well.
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Your jaw joint has totally everything to do with your cervical joint. Everything has to do with your toe joint, all the way down, because everything is compensating if one is not working well. Once we have cervical misalignment, don't expect your whole spine to be straight anymore.
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With all this pain that comes about, we go to see a chiropractor, pain management orthopedic, and all this, when we could have controlled it at this level, because of the postural change. It's where the head is. You look at orthopedic, and they don't even draw it in. They only start with the first atlas, all the way to the coccyx bone. No hands, no head. No legs. There is a lot of influence, but they don't want to take responsibility for it.
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As dentists, same thing. When we come to airway, even, for example, talking about class two situations, class two always have blocked noses, because they are mouth breathers. When you're mouth breathing, you're not using your nose. You don't clear your mucus in your nose. You clear it on a regular basis, breathing through your nose. Congestion. The mucus in our nose helps us to filter the air, filter the air, lubricate, warm, humidify. Before you get in there, the sinus lining produces nitrous oxide, to get that vessel dilation that happens in the lungs to have proper oxygen exchange. It only happens in the sinus if you breathe through it.
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If you use the mouth, it's dry, unfiltered, irritates the throat, sore throat, and then they have all this congestion going on, and they keep seeing the ENT for decongestants, antihistamines, steroids, nasal wash, but there's never an end to it, because they never clear the mucus. If they change from a mouth breather to a nose breather, we can now slowly clear it out, and then as they establish nose breathing, it gets better, no more of that infection, or else surgery, no middle ear infection, no rhinitis, sinusitis, all of this is common.
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As dentists, we can train them, using myofunctional activity. Close the lip. Up the tongue. Breathe correctly. We alter the way they breathe. You can alter the shape of the jaw. We alter the face. We alter everything else. The ENT do not do hot tissue surgery in the mouth. The blockage is right down here, at the [inaudible 00:40:45]. The thing is, there's a proper way to manage it, a conventional way, but as a dentist, we can also recognize this whole space like a car cabin. If there's no space at the backseat, they keep stripping the cushion. Unfortunately, this soft tissue will regrow. Many patients do face relapses, and they'll tell you, "Yup, back to square one. I need to use a CPAP now, or else I can't breathe and I have sleep apnea."
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As dentists, if we know where is the forward position of the jaw, within the southern zone, we can move the jaw there, hold it up, and now we have the front car seat going forward, and we have more space for the back. We can occasionally influence a person's ability to breathe at night, because when they fall asleep, their whole jaw doesn't fall back as much. There's vertical stop, and then we create an environment where he can breathe again at night, where he's not depriving his brain from oxygen. We can do that as a dentist. Easily, the truth is, if we know enough.
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That's why the Academy of Craniofacial Pain also has a special paper out that recommends dentists going to sleep medicine, to be trained in TMD, because there's a lot of in-between things, and the patient is put into extreme positions sometimes, to open their airway, so if you know best, both will be good.
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For example, back to that question of the girl. Identifying her position, we're now able to find the opening and closure path that she's in now. See, she's opening and closing without deviation and without pain. She opens, she deviates, then once we've established the position where she opens and closes now, the starting point and end point is now established.
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Howard Farran:
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You're really a holistic doctor. You're doing sleep medicine, neuromuscular dentistry, orthodontics, laser, implants, cosmetics, aesthetics. You're ...
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Weng Cheu Yue:
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Integrative.
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Louisa Yue:
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Integrative dentistry. Like I said, the function for Weng Cheu has always been before aesthetics. Aesthetics is a by-the-way outcome, but it always ends up really nice, an enhancing of the features, but the whole approach has always been function first. The way we see the future of dentistry is that healthcare professionals should work more closely, and treat the whole person in a more integrative fashion. We always say that we are starting a healthcare revolution here. We want all the specialists and all the experts to come together. The human being is a systemic whole. We don't walk around in parts.
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Our current medical world has really apportioned different parts to different specialists to take care of, and the problem with that approach is that we've got patients, they have pain in the ear, and they end up seeing the ENT, which couldn't resolve the pain, when actually the root cause of the pain might not be in the ear. In this case, it might be because of impingement on the joint, which could have been due to the bite. People don't realize that a well-trained dentist in the neuromuscular field could have treated that problem. In the end, a lot of times, we see patients who have seen the neurologist, the ENT, the chiropractors, they've seen a whole long list, they come with a whole long list of ... They've seen 31 practitioners, and either by word of mouth they end up in our office, or sometimes it's that they just came in for a regular cleaning, and we pick up on the problem.
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Weng Cheu Yue:
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And the truth is, dealing with this kind of problem is not easy. It's not easy because you have to be well-versed in many areas, and able to spot a problem that you think you can actually manage, so it took us years as well to figure out exactly, can we spot that point? It comes to a certain point now, where we realize, "We have the confidence to treat them." Again, once we know more, we also know another rabbit hole. We know that we don't know enough. That's why we recognize that it cannot be done just by our own effort. It has to be a collaborative effort.
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That's why I feel that speaking around the region, the reason is because I want to spread the ideas. As much as I learned from Dr. Clayton Chan, I think what a lot of dentists would like to know about this, especially the younger ones, before they get too deep into traditional stuff, I would say, "Just look forward to a new world of possibilities." When they can find that vision, and they're on board with us, they are going to be the new type of researchers and clinicians to help us to develop the idea further. Then we're going to be even better and better at managing these kinds of case collaboratively.
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As dentists, we can do it, but also we need the help of the ENTs, the chiropractors, the orthopedics, the neurologists, the sleep scientists. Everyone should come together. The fact is that we don't have them under one roof now, and we don't have them thinking about the same thing also. That's the hardest part. I think one day we will achieve it, that patients will not have to go to different parts, or different levels of the hospital.
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Howard Farran:
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You went to Las Vegas to learn neuromuscular dentistry. You went to Frankfurt, Germany, to learn implantology. Where did you learn ortho?
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Weng Cheu Yue:
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In Singapore, under [Kenneth Liu 00:47:15], I went to Hong Kong.
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Howard Farran:
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What program was that?
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Weng Cheu Yue:
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Invisalign master class.
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Howard Farran:
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Invisalign master class.
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Weng Cheu Yue:
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Under Dr. [Yau Ikong 00:47:28], also a fantastic dentist, doing Invisalign.
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Howard Farran:
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Will you write his name down?
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Weng Cheu Yue:
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Of course. Of course Clayton also has three modules on ortho as well, supporting that.
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Howard Farran:
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So now you're actually an Invisalign instructor, too, correct?
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Weng Cheu Yue:
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No, I'm not.
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Howard Farran:
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Or an Invisalign ...
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Weng Cheu Yue:
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Provider.
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Howard Farran:
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You went to the Invisalign ... When someone takes impressions for Invisalign, the impressions go to Mexico, and they're poured up at the model works in Mexico, then it goes to Costa Rica, and you were invited to go to Costa Rica. Why were you invited to go?
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Weng Cheu Yue:
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One of the earliest providers of Invisalign in Singapore ...
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Howard Farran:
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Tell that story! Tell that story.
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Weng Cheu Yue:
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Of course. It has something to do with Dentaltown. Basically ...
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Howard Farran:
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You've got to get the Dentaltown story in.
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Weng Cheu Yue:
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Yes, I will. I read this advertisement at the back of a magazine. It was talking about accreditation costs for Invisalign. It happened to be provided in Hong Kong, at the time. I give a call to make a booking, and the Asian-Pacific director, Mark, was there in Hong Kong, and he said that if I could manage to get a group of dentists organized for Singapore, he would start a first accreditation class for us in Singapore. So I gather Dr. [Jerry 00:48:58], Dr. [Ronny 00:49:00]. They also say that we've got a big group together, and that's when we had that first training done.
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Howard Farran:
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That was 2006?
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Weng Cheu Yue:
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5 or 6, around that time.
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Howard Farran:
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2006.
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Weng Cheu Yue:
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2006, I think. Since then, we've been doing Invisalign. Of course, at the time, we were still not that well-known, and not that well-publicized in this part of the world. Over time, we would continue to work hard on it, and we have become platinum elite providers, over the last few years. That gave us the opportunity to visit the main center, where all the action is.
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Howard Farran:
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That was in Costa Rica?
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Weng Cheu Yue:
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In Costa Rica.
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Howard Farran:
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What was that like?
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Weng Cheu Yue:
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It's a beautiful country, a lot of coffee. We went to HQ, this very nice commercial area for industries, and technological companies, tax-free. It's a very, very big center, with many rows of copiers, and the technicians are assigned to a certain region, in order to help us to create our [inaudible 00:50:18]. I do see some changes that they are doing now is that instead of having cubicles, they're having more small little areas where many more technicians and clinicians are working together, more collaboratively, looking at many of the cases together. They all look at the cases faster, and also more accurately, probably.
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We talked to the design team, and also the computer team, the development team. Dr. [Ramos 00:50:52] also was there to hear us, why we incorporate. I've taken her bite, for example. You can see from the joint x-ray now that the left side is very curved. It's bent, because of her overcompression of the left side every time that she closes it. We decided to use Invisalign after we established the bite position, after almost nine months of myofunctional conditioning. This is the starting of Invisalign, and then we use Invisalign. There's still a lot of transverse movement. We have a lot more verticalization movement. We're getting the bite exactly to where we want it to be. With this kind of treatment, you can see, over time, given enough space and the function is right, the jaw has straightened up over the last sixteen months of treatment. Even the right side. You can see it has improved too.
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In this way, incorporating neuromuscular, determining where the bite is, and using Invisalign to gear the bite towards it, we are able to actually affect a very interesting outcome for the patient. We know the destination for orthodontics now. Orthodontics is incorporative of joint and bite. This is also thinking about the person as a whole, in terms of posture. It's important. Let me just share another point. In this case, same thing, she has a deviative bite, the midline is off, neuromuscular allows us to actually establish the midline. We send this to Invisalign. Invisalign will receive a model with overbite. This way, my technician, and [Jason Ramos 00:52:52] was briefed by me personally, exactly what we are doing with this kind of submission. Most cases will be submitted like this, with the bite already, and we adjust accordingly.
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With this, the whole point is, now we know where the end is. Now we're just clearing all the interferences of the bite, and finally the teeth are able, or should I say, the upper and lower arch can now finally close up into position.
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Howard Farran:
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On your website, it's DP Dental. What does DP mean? Dental Practice? What does it mean?
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Weng Cheu Yue:
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Again, our regional practice started ... I want to put credit to Dr. Eugene Chan as well, my senior, who also helped me a lot in the early phases of understanding this system. 2004, this is where we started the first practice. Again, this is very interesting. Everything, we start with a vision. We start with a dream, and with that, then things will happen. My dream was that in dental school, in our final year of practice, we have to do a business plan. That business plan, you tell the whole class what you're going to do in the future. Together, with a few [colleagues 00:54:13], I wrote a plan that I'm going to open a practice in [inaudible 00:54:16], this place, in this mall, four chairs, and doing everyone's dentistry.
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I wrote that in my plans, to have that business plan. I still have that, that I presented to the class. That was in 1998. When I was working with [Jerry 00:54:36], in 2003, they already have three branches. They want to open the fourth branch. All I did to [Jerry 00:54:48] was sharing that this is a good place to think about opening a practice, and he did. He opened there, one first branch, bought this place here. That was the fourth branch of his group called D. Pacific.
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Howard Farran:
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"De" Pacific?
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Weng Cheu Yue:
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D. Pacific.
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Howard Farran:
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Oh, D. Pacific. For Dental Pacific?
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Weng Cheu Yue:
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That's what he called his practice. That was the beginning. I worked here. In 2006, we took over the practice. We converted the name to DP Dental, taking the initial of D. Pacific. DP.
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Louisa Yue:
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If I may add, at that point in time, because [Jerry and Ronny 00:55:42] wanted to set up a town practice, so they wanted to consolidate, but it's also ... In a bid to let one of their associates actualize their dream, that's when they sold their practice to us. At that point in time, also, we got to pick our Mandarin name for our practice, and that sculpture that you saw outside in the practice, Chung Qíng [inaudible 00:56:08], I think that really, truly epitomizes the type of dentistry that we want to practice. Chung, in Mandarin, means honesty, ethical. Qíng means passion, heart. [inaudible 00:56:26] means the core. Our Mandarin name for the practice really epitomizes the spirit of the dentistry that we want to practice, honest dentistry with our heart, with the passion, with everything being very patient-centered.
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Howard Farran:
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You two were born in Singapore?
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Louisa Yue:
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Yes.
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Howard Farran:
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Do you also speak Mandarin?
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Louisa Yue:
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Yes, we do. In Singapore, in school, we start off bilingual. Mandarin was also our first language, as well as English.
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Howard Farran:
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I only have a couple of minutes left with you. You were talking about starting with your vision, and the seven habits of highly effective people. We talked about starting with the end in mind. I studied economics. I have my MBA in economics, and if you ask anybody with a PhD in economics what was the fastest-growing economy of all time, it's Singapore. Nothing went from, not to be disrespectful, but even the founder's book was From Third World To First World.
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Louisa Yue:
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Mr. Lee Kuan Yew, yes.
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Howard Farran:
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A lot of the listeners around the world don't know the Singapore story. Would you mind sharing your thoughts of the Singapore story? If you like business like I do, this is a miracle. Singapore. There's nothing like that, ever. Talk about the Singapore story. Either of you. Both of you.
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Weng Cheu Yue:
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We have been blessed early on, in the way that we grew from a fishing village. We were eyed by the British as a good common post, in the center of the strait of Malacca. At the time, the Dutch had taken over a lot of Indonesia and Malaysia and were establishing themselves here. The British decided they needed another post, and Singapore was chosen. That was how we got colonized.
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Louisa Yue:
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We have a deep port, so that's to our advantage.
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Howard Farran:
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Singapore was a British colony, or all of Malaysia?
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Weng Cheu Yue:
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Malaysia also got colonized, as well.
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Howard Farran:
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There were British colonies everywhere.
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Weng Cheu Yue:
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That's right.
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Howard Farran:
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Singapore and Malaysia used to be one country, correct?
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Weng Cheu Yue:
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The way they signed the treaty, the Malay ruler literally signed this place away to the British as a port, so it was given up. At the time, we had so many islands all around here that it's nothing, big deal, that you give away another island. It's just an island. Nothing there. The British developed it well. They developed it into a free port, allowing a lot of trade to go through Singapore, and that is when we really go from strength to strength, as a must-come area, when they come to this part of the world, to transport goods from east to west, because there's a sheltered pathway. Indonesia is blocking everything. They just go to the Strait of Malacca, and they go into the Indian Ocean, and then the South China Sea.
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Singapore then became better and better through this, and then the war came. The Japanese came and occupied this whole place for three years and eight months. The British were expecting the Japanese to attack from the other side, so they have guns facing out to sea, ready to do battle with them, but the Japanese were clever. They took over Malaysia and came down by bicycle. We lost because they came by the other side.
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After three years, things were returned to British rule, but a new group of well-educated individuals, Lee Kuan Yew and his wife were educated in England, so they are very, very good lawyers, and they top their class all the time. The wife topped the class more than Lee Kuan Yew, so she's the better student. They decided, "Look, we have to do something about it. We cannot just let the British rule us forever. We have to do something. We fight for independence."
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Howard Farran:
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That was Malaysia for independence or Singapore?
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Weng Cheu Yue:
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Singapore.
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Howard Farran:
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That was 1965?
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Weng Cheu Yue:
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63, around the 60s, and then we joined Malaysia first. There was an understanding that if we're going to go out on our own, we're just a small island with no resources. We have nothing. We have no gems, no oil, nothing, just human resources. We should be incorporated with our hinterland, Malaysia. We should grow together. Unfortunately, for political reasons, we were being separated out.
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Howard Farran:
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You kicked out the British. You wanted to join Malaysia.
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Weng Cheu Yue:
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We made all these arrangements. We went in there for a while, and then we got...
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Howard Farran:
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Kicked out.
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Weng Cheu Yue:
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Kicked out, and then we asked to become independent. In August, Lee Kuan Yew made the declaration to tell the whole of Singapore through the radio that we are, now, independent. From there, he has taken on many, many visionary ideas into how we can continue to grow as a free port that is helpful for us.
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Louisa Yue:
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I think if I may draw a comparison between the progress of Singapore to the growth of our practice. Our leaders have always been very forward-looking, always looking far into the future. That's why, right at the beginning, education, we are all to be bilingual. If you're Chinese, then you learn English and Mandarin. If you're Malay, English and Malay, but there's that bilingual policy. In terms of all the different sectors that we are going into, to help boost the economy, we're always very forward-looking. The latest would probably be into biotechnology, and setting up the infrastructure to attract the top Nobel Prize winners to Singapore, to develop into that area. Likewise for us, at DP Dental, we always have been looking ahead. Weng Cheu has always been looking ahead, and that's why we adopted the laser eight years ago, way before it became common. The CEREC was also around seven years ago.
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In any business, we always have to look very far ahead, and also not rest on our laurels. You always have to keep on keeping yourself abreast with what is the latest, and that is why we travel all over the world, to learn from other practices around the world, and to constantly keep apace and to know that we're there at the forefront of technology, but we're also applying it in the most conservative way, in a way that's aiding preventative dentistry, and if we really cannot prevent, then we do early intervention. Now we're looking into integrative dentistry.
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Weng Cheu Yue:
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I think the keyword is "integrative." For example, you can see when we incorporate all our thinking and our equipment, they all work together to create the end product for the patient. Just like Singapore, we cannot just depend on one thing. The world moves ahead very quickly. We just have to stay ahead of the competition, to a certain extent, but to me, we're not really competing. We need collaborative ... That's why Singapore has very a good relationship with the US, and yet at the same time, we have a very good relationship with China.
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Howard Farran:
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I want to pin you down to more specifics. What did Singapore do, specifically?
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Weng Cheu Yue:
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The government initiative of trying to provide that stability for everybody. Stability, in a sense, means stability in your home, in your work, your investments. People had to come to say, "We are governed by a rule of law." If you make a contract, the contract stands. If it doesn't, you go and clarify it with a lawyer, with a court, you can even go to international court, and we can settle things. Everything is by that. Everything is clear, in a rule of law. Next is that we really value relationships. We are too small to make a biased stand.
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My friend is in the diplomatic arena for Singapore. Whenever we are in the UN making a vote, we vote by principle, by what's right. We follow that principle, and we write it all down, not because we are taking sides. We can't. When we take sides, this time we win, the next time, we are going to be ostracized again by other countries if they see that we're just playing politics. We don't. We go by principle, and that continues to hold us up in good stature, so that when we demonstrate, we say we're going to help, and we're going to benefit the other country that is helping us, we really deliver. For example, the relationship with the US. We're one of the few countries that can go and do all our games in Nevada. We can fly the plane, we can bomb the plane, we have the top military aircraft from your country.
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At the same time, we are able to help China develop their townships. We are able to give and transfer technology, know-how, and planning, to up their level of living standards and management, to be able to run new cities more effectively. We offer our know-how and airport controls to many cities in Asia and beyond, helping them out to develop their country properly.
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We want to do collaborative work. We know, but we don't want to hold it to ourselves. We share. At the same time, when we share, we are taking care of them, and we know that we're being taken care of as well.
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Howard Farran:
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We were taught that one of the things that Singapore did was stamp out all corruption. Would you say that was a big part of the game plan of Singapore's success, was that they just tolerated no corruption?
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Weng Cheu Yue:
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With less corruption, there's more efficiency. When you say that you go and you want to set up a company, you want to get it to a certain point. You just need to do this, this, this, and this. You pay certain administrative fees, and you get there, and by that time, you really get a company with a name, and you're ready to go. You don't have to pay anybody else, anybody in administrative some extra money to extradite anything. They are paid well for doing their own job. Even our ministers, you can see this YouTube video that our minister, prime minister, is the highest-paid one. You have some other ministers that are lowly paid, but they are from very big countries. For example, it's out in the open now that in Malaysia, you can see that prime minister, he has the ability to take money and explain himself in such a way that even the whole country has nothing they can do to stop him from doing what is wrong.
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I do believe that it is the very low corruption rate in Singapore that allows for public service efficiency, and also that instills a very good mindset in everyone that's doing business with us, to know that we are trustworthy, because there's a real law to govern everything that we do properly, so that we have the confidence and the trust to do business here. Being able to connect to so many parts of the world, we are able to make the difference. For example, if you drop your container here, you know there's another container going to your destination in a few minutes' time. You can transfer your cargo accordingly, and you're off to another street, and you're on your way. We are able to do that because we aimed to achieve it, many, many years ago, with openness, to embrace changes. I think we didn't look at this lack of resources as a weakness, but we look at it as a bonus. What else can you do when you have nothing? Just do your best.
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Howard Farran:
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You're a legend and a role model all around. I think you're an amazing man, and behind every amazing man is an amazing woman. I think you guys are Batman and Robin. Congratulations on all your success. I hope you do more with Dentaltown. I hope we do more with you.
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Louisa Yue:
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I'm actually in the process of writing a book, to share my management experience, for the past ten years, and if I might have the honor, in your word now, on camera, that you'd write me the forward of that book?
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Howard Farran:
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Absolutely. Consider it done, and then when you're done, we'll blast it out all over Dentaltown.
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Louisa Yue:
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Thank you.
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Howard Farran:
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I hope someday you build us a course on Dentaltown. I think that'd be a huge honor.
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Weng Cheu Yue:
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We'll work on it right now.
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Howard Farran:
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All righty. Thank you for your hospitality. It was great seeing you lecture in Medan. It was great seeing your office here. It was great going to dinner. My boys have thoroughly enjoyed your company. You're just great people.
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Louisa Yue:
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We'll continue to connect you with all the top dentists that we know from all around the world. I think they should be on Dentaltown.
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Howard Farran:
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If you're ever looking for a vacation, and you ever want to see Southeast Asia, my three favorite cities in Southeast Asia are Singapore, Hong Kong, and Sydney, and those are just a must-three, that you have to see in your lifetime. You have to see those three. Those are three of the greatest civilizations on Earth. Thank you, buddy.
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Louisa Yue:
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Thank you, Howard.
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