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Speaker 1:
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It is a huge, huge honor today. I'm in Johannesburg, South Africa. I was lecturing at the South African Dental Association and last night my son, me, Ryan, and Greg went to dinner with a father-son dentist and it's just a remarkable story. There's so many things I want to talk about. Probably 3 out of 4 dentists listening to 83% of the show are Americans and 17% are from about, what is it, 140 other countries. Is it 141?
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Speaker 2:
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[inaudible 00:00:39]
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Speaker 1:
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142, 142 other countries. I find the story of South Africa very fascinating. When you live in a country like America and there's 220 countries, you're only going to hear 1 little thing about maybe Greece or South Africa or something, maybe every month or 2. It's not like a newspaper can cover 220 countries all the time, so I found this story of South Africa very interesting. Some of the things that I find the most interesting about South Africa is the United States ...
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You have 3500 dentists in private practice, 800 dentists in public health clinics, so there's only 4300 dentists in a country of 53 million which mathematically that's only a dentist for every 12,325 people where America has a dentist for every 1850 people. That's like 1 to 2,000. You're like over 1 to 12,000 and planet earth has 2 million dentists for 7 billion people which is a dentist for every 3500 people.
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My first question I wanted to ask you is, how is South Africa doing and why is there only a dentist for every 12,325 people?
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Sybrand:
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Maybe Nic can answer that better because it has a historical background to it.
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Speaker 1:
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Tell us the history. What's going on in South Africa?
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Sybrand:
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Maybe we should as the guy who used to be in politics. Maybe he can tell you better. He had a very long life in politics. Maybe he can tell you.
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Nic:
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The limitation to my mind was politics. The limitation was that it was catered only for 1 group of people although the service delivery was all across the board, but they're only trained white dentists for a long period of time and dentists of color came to be trained only much later.
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When I was a student in 1977, I qualified. The first black dentist started qualifying from the black university. That's the essence, so there's a huge backlog. We acknowledge that factor. There's a lot of information that needs to go out there. There's a huge backlog [we're pushing 00:02:48].
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Sybrand:
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What the government is trying to do is not just trying to train new dentists, they also train dental therapists who are an intermediate between a dentists and an oral hygienist, but to get more of them to do primary healthcare and to get into the areas where we can't reach.
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You were asking yesterday ... There was so many people and we were walking around in [Monte 00:03:12] Casino. It looks like Vegas and you're literally seeing 5% of the population. The other 95% you don't see because they're just not in the bigger cities or the shopping centers.
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Speaker 1:
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Would you say South Africa is really a nation of 2 worlds, there's a rich world and a poor world?
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Sybrand:
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How do I say this? Unfortunately, there used to be 2 worlds and those 2 worlds came together now, but it's still ... The divide between the upper 10% and the lower 90% or ... We have a majority of people who can't afford dentistry or any kind of medicine, but the divide is just getting bigger and bigger because the cost of dentistry is going up while earnings aren't going up necessarily. Our currency is just going downwards, so the divide is getting bigger and bigger.
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Speaker 1:
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There's a lot of dental students that listen to this show, so a lot of the dental students are probably only 25-years-old or younger. Apartheid was '89 to '94, so a lot of the people listening to the show weren't even born yet or don't even remember. Go back to the history when you're talking about ... What was apartheid '80 and '94? In '94, that was a whole generation ago because this is now 2016, so '94 to 2000. It was how many years ago? It was '94 from 2016.
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Sybrand:
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22.
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Speaker 1:
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That's 22 years ago, so a lot of these kids don't even know what you're talking about.
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Sybrand:
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Also remember, in '94 or '81, I was also in primary school. To me it was just ... I remember my father. He was one of the people who were against apartheid, but I didn't feel the impact because I was isolated as someone of privilege or from privilege. He knows a lot more about the history and the politics because if you say '89 to '94, that is where the change came. Apartheid came from the 1950s. We inherited that as well.
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Nic:
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As a matter of fact, it goes back way back. Apartheid goes back to colonial years. We were a colony of Britain or England and they had this colonial system introduced into South Africa. In 1948, apartheid was formalized by law. A white kid could not go to a black school and vice versa. Give or take, the majority of the money was invested in white education. Give or take, money was invested in white healthcare. Give or take, money was invested in white whatever.
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That's how I got involved in politics because I really decided that that stage is not a workable situation. We had a change over of government in 1994 when Nelson Mandela became president, but that didn't raise the backlog. If you can compare it, it's like East Germany and West Germany becoming one Germany. They also had this problem uplifting East Germany, but West Germany was a very affluent community, a very rich community, so it was much more easier for them.
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At this moment in time, the tax burden to uplift, say the have nots, is just a massive task. It's a mammoth task to uplift the areas that we would like to see uplifted. Then dentistry falls in that category.
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Speaker 1:
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That's the same thing I heard when I was lecturing in Asia and China that ... One of the reasons the Chinese government and no one wants North Korea to really fall because when North Korea does fall, that's going to be a massive, massive clean-up.
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Nic:
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Almost the same. You can compare the comparatives between them. Yes.
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Sybrand:
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The other way to maybe put it into context is we had apartheid which is not really a nice word because it's taken directly from Afrikaans. The nice word, I suppose, is one that you had. It's segregation. That's exactly what it was. America also had that. It seemed as though America was us ... Maybe they were ahead of us by 10 or 20 years, but they also had the problem with segregation and they also had the challenges. Rosa Parks made a difference like Nelson Mandela made a difference, but they came later on.
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We are at that place where we have to start restoring the backlog and uplifting people. It's a big backlog and it's a really big [crosstalk 00:07:40].
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Nic:
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The ratio is the other way around. The white America was the majority. The white people, the privileged people in South Africa were the minority. It's the minority that now has to do [crosstalk 00:07:52].
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Speaker 1:
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At the peak of apartheid coming apart in '94, it was almost 10 million Dutch, English, White, European. Now that number has fallen to about half.
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Nic:
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It's fallen to more than half I would presume [crosstalk 00:08:07].
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Speaker 1:
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My question is half of the Dutch, English, European left, why did you stay?
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Nic:
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This is the most wonderful country in the world. I would not leave this country for any money in the world. I would like to stay here. I would like to make a difference here and I think we are making a difference. My involvement in politics at that stage when I got involved in politics was just that. I wanted to make a difference here where I grew up with the country that I love. They normally say the best dentists in the world practice in the country or the city they love.
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Speaker 1:
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Why do you think the other half left?
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Nic:
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That didn't [inaudible 00:08:48] my view or my vision. Maybe they saw a threat within the black community at that stage coming to age, the majority just looking so threatening at that stage. Living in South Africa in the changeover days was not an easy place to live and you felt threatened. I always felt very s- I speak one of their languages fluently, so I always feel s-
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Speaker 1:
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Which one?
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Nic:
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Zulu language.
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Speaker 1:
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Zulu.
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Nic:
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Which incidentally is [Zuma's 00:09:15] language and I'm not a supporter of Zuma at all. It helps when you get to know, if you have a way to something, and you address them in their language. You always feel this warmth from them as a person.
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Speaker 1:
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Now you had 4 children, right?
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Nic:
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Yes.
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Speaker 1:
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Did they all 4 stay? This is your son and he stayed, and he became a dentist. Did the other 3 stay?
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Nic:
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1 is in Australia. My oldest son is a lawyer in Australia.
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Speaker 1:
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Well, that's good the lawyer left. No country needs another lawyer, so that's a good thing. Tell me this. You had 4 children. Why did you follow your father?
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Sybrand:
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Well, I think that comes from the earlier question. Why did he stay? Same question to me is I was raised differently, I think. I was born into privilege not only because I'm white and one of the minority, but because he thinks the way he does. That spilled over to me and we share the same idea of what is possible in our country and in our city more specifically that we can make a difference.
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You can't be on the outside of the glass castle and throw rocks inside. You have to be on the inside and understand what it's about. From there you can make the change, so it's possible. Also we're invested. I was born here. Unfortunately, I'm not European. I'm African. I'm African as any other one and our family history goes back 400 years.
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Speaker 1:
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Well, you know what I think is funny about the word African is in America, black people are called African Americans. When you talk to any scientist, 100% of all humans lived in Africa 70,000 years ago. What am I supposed to have? I'm African American. We're all African.
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Sybrand:
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All African.
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Speaker 1:
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Isn't that what the evidence saying 70,000 years ago? All homosapiens were in Africa, so we're all African Americans.
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Nic:
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Not far from here.
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Speaker 1:
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Not far from here?
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Nic:
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Yeah.
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Speaker 1:
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Is that where they found Lucy?
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Nic:
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Yes.
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Sybrand:
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Not Lucy.
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Nic:
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Not Lucy.
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Sybrand:
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[crosstalk 00:11:11] lady.
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Nic:
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[Naladi 00:11:12], yeah. Homo naledi.
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Sybrand:
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Homo naledi is the latest one they found.
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Speaker 1:
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Is she older than Lucy?
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Sybrand:
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Older and I think ...
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Speaker 1:
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Where was she found?
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Nic:
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Very preserved. [crosstalk 00:11:22]
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Sybrand:
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I honestly don't know the exact spot, but it's close here.
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Speaker 1:
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Close to here?
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Sybrand:
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Close to ...
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Nic:
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Yeah.
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Sybrand:
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It's in [Gauteng 00:11:28]. It maybe an hours drive if you have to go out there, but it's close to here. I think she was older and she had traits of both homosapien and homo habilis, so it wasn't one. It's a completely new species.
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Speaker 1:
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Wow. I am proud to say that Lucy, which they named her Lucy because when they found her, I guess, Elton John was singing on the radio Lucy in the Sky with Diamonds. Was that the Beatles or Elton John?
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Nic:
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Beatles.
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Speaker 1:
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That was Beatles. She's now right by my house at Arizona State University. She's on loan.
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Sybrand:
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On display there.
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Speaker 1:
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On display there. They're studying it there, so Lucy used to be the oldest. You and I have a lot in common. We both have 4 kids and both of us have only 1 of the 4 that turned out good. I would just say it was Ryan because he's over there filming. I'm just kidding.
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You and I both had CEREC 1, CEREC 2, CEREC 3, Blue C- We've been CEREC. We've been on CEREC forever and I got to ask you all. Why have you been committed? 2 questions I got to ask you. Why have you been on the CEREC bandwagon for literally 3 decades? Number 2, in my country in the United States, about 95% take insurance. What I can gather about in South Africa, it's about the same at 85-95% of the people take insurance. You don't take insurance, so talk about those 2 things.
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I know it's 2 questions instead of one, but why do you guys not take insurance and why are you so committed to CERECs for 3 decades.
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Nic:
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The start could have changed, the reason could have changed. At that stage, I was taught [inaudible 00:13:07] and at that stage the conversion to composites for pasting the teeth was just the most horrible route to go. They just looked horrible. When I started reading the studies coming out at that stage at the university when we were just [inaudible 00:13:22] qualified. I read about this new possibility and when it came out, I just jumped in and was the first guy to buy in South Africa.
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Speaker 1:
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You were the first guy?
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Nic:
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Yeah. We were the first. We had 6 guys that went over the first time and I was 1 of them.
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Speaker 1:
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How many dentists in South Africa will tell me they were the 1st guy?
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Nic:
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6. We were in the same course. As a matter of fact, I trained one.
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Speaker 1:
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You were the first guy in South Africa?
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Nic:
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Yeah. We were 6, Casper [Bosman 00:13:48] from [inaudible 00:13:49], Jahn-
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Speaker 1:
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What year was that?
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Nic:
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1992. [crosstalk 00:13:54]
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Speaker 1:
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I got out in '87 and that's about when I bought CEREC 1. You've been committed to it the whole time?
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Nic:
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Yes. Upgrading was part of my business plan to go to the next level every time. That's one of the things in South Africa you should do. You should not just buy the 1 system and then stick to it. If it upgrades, you should move with it. That's a difficult one.
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Speaker 1:
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I think a lot of people would say ... Now did you buy that because ... I know you're out by Kruger Park, so you're not by the big ... Johannesburg is the big major city.
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Nic:
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Yes.
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Sybrand:
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Yeah.
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Speaker 1:
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Then you got Cape Town and Pretoria, but you're in a small area. Did you buy CEREC because you didn't really have access to a lab or was it for a different reason?
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Nic:
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No. As a matter of fact we had, at that stage, I think 3 or 4 labs in my city. My city is the capital of my province, so it's not a small town. It's a city, but not the size of Johannesburg or Pretoria. That's the reason why ... We had laboratories around us.
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Sybrand:
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At that stage, the technology was new and new technology is expensive. He saw something that he thought would be the future and luckily he was right. Luckily he didn't invest in [crosstalk 00:15:13].
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Nic:
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Fortunately.
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Sybrand:
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Like I was saying, I was raised differently because in private practice we studied you do amalgams and you do PFM crowns, but I've never done an amalgam in private practice. It's because he wouldn't let me. I've never done a PFM crown or a metal crown because I only know CEREC. I can't even comment on amalgam or PFM crowns. I only know CEREC.
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Speaker 1:
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What are you doing now with CEREC? Are you doing omnicam, bluecam? What are you doing?
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Sybrand:
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Omnicam, yeah. We went through all of it, 3D and bluecam, and omnicam. Even the apollo. We have all of it.
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Speaker 1:
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Why do you not take insurance?
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Sybrand:
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There is also a historical question [inaudible 00:15:48] which, I suppose, he can answer better. There is a decline in the availability of funds for dentistry. In 1994, the percentage of insurance that went to the dentist was about 14%. Today, it's either just over 1% or just under 1%.
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Speaker 1:
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In 1994, 14% of the state money went to dentistry?
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Nic:
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Of insurance money.
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Sybrand:
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Of insurance money, not state money. It's private insurance, not government insurance. Private insurance still, not government.
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Speaker 1:
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For private insurance, 14% went to dentistry in '94.
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Sybrand:
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Yeah.
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Nic:
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Of the health budget, yeah.
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Speaker 1:
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Today it's 1%.
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Nic:
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Yes, maybe even less.
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Sybrand:
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It maybe less than one, but yeah. Let's say 1%.
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Speaker 1:
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Why did that disappear?
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Sybrand:
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Historically more attention was given to hospitals, and to specialists, and to hospital procedures, [inaudible 00:16:46], and dentistry was not seen as a crucial profession. They didn't need to have funding for that because you can live without teeth. You can't live without your kidney or liver, so maybe it just did not get the attention.
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Nic:
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I do think the dentists were also at fault here.
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Sybrand:
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Yeah.
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Nic:
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They over treated. As a matter of fact, they just did a lot of work on the medical insurance.
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Speaker 1:
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Say again.
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Nic:
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I think the dentists are also at fault here. Because the fees were so low, they're still very low at this point in time. That forces the dentists who works within the ambit of medical aids for insurance. It forces them to over treat or to treat something that's not necessary, or to ... We just see that all the time. That's one of the reasons I just said I'm not going to go that route, I want to go in an ethical dental route.
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Speaker 1:
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Prices are going up, but the benefits are going down. It's been doing that for 20 years. It's literally been declining every year since '94, but there just aren't any funds available for dentistry either in private or public sector.
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Nic:
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As a matter just to prove the point or to illustrate the point when you do a CEREC restoration, we would like to bond it to a tooth and there's a fee applicable. Some medical aides argue that they don't pay that fee, so then it forces the dentists to do something else or to charge the patient. If you work within the ambit of medical aides and you want direct payment from the medical aides or the medical insurance, you have to abide by their rules. That's the difficult one.
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It's not the clinical route that they think of. They think of money. That's the problem in South Africa.
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Speaker 1:
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I want to ask you another. This is a complicated question. It's too long of a question, but I find ... First of all, a lot of people listening might not realize. This is the highest HIV rate of any country on earth. Is that correct? You have about 25% HIV positive and 25% unemployment. By the way, the last time American had 25% unemployment was the great depression from 1932 to '36.
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This has 25% unemployment, 25% HIV rate, but I want you to explain the HIV rate because what I don't understand is when AIDS came out, all the healthcare community doctors used all the television advertising, radio, billboards, all this advertising, informed everybody what's going on and they nipped in the bud.
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Yet those same countries don't allow dentists to advertise. Why did countries allow physicians to allow all about HIV and nip it in the bud? Yet in this country, Coca-Cola can advertise and candy bars can advertise, but a dentist can't advertise. Explain why ... It was actually your president that was stalled, the HIV Act. Can you talk more about that, explain that?
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Nic:
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Maybe a little bit. I'm not involved in politics anymore, but at that stage you're quite right. President Mbeki at that stage had a lot of things to say with regards to AIDS is that it's very unscientific.
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Sybrand:
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And the Minister of Health.
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Nic:
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Say again?
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Sybrand:
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Minister of Health.
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Nic:
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And the Minister of Health as well. The AIDS cure was eating beetroot and garlic. That was the AIDS cure for the time.
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Sybrand:
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And [inaudible 00:20:12].
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Nic:
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As a matter of fact, it's been said that they could be charged for that because that's a crime against humanity. They calculate that give or take 300 to 500 people lost their lives because of that policy at that state.
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Speaker 1:
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300 to 500?
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Nic:
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Thousand.
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Speaker 1:
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300,000 to 500,000.
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Nic:
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Kids were born at that stage that could have been cured with ARVs. People who had AIDS could have been cured or treated at least.
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Speaker 1:
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The easiest to nip in the bud was the pregnant mother who just had to take an antiviral and then her baby was born HIV negative.
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Nic:
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Yeah. They had to eat beetroot and garlic at that stage. That was the cure in South Africa.
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Speaker 1:
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That's why the rate here is so much higher than all the neighboring countries.
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Nic:
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That's the one thing and we also have a president who said after he had sex with a lady with AIDS, extramarital sex to say that. His argument is he had a shower afterwards and that cured it. That's released him from the fear of having AIDS. It's just one blunder to the next from the one president to the next. That's what we have to deal with.
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Now we're thinking of first world dentistry and third world dentistry, and getting those 2 together. At this moment in time, we don't even have prime healthcare, that act together as of yet.
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Speaker 1:
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That was really a national tragedy. That's really why ... Those 2 presidents are really why the HIV rate is so high here.
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Nic:
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I would like to see one day that my president is also being charged because that's also a crime against humanity. To say something like you can shower and that will cure you of having had sex with an infected lady.
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Sybrand:
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[inaudible 00:22:00]
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Nic:
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Yeah. It just doesn't make sense. I must say, it must seem very odd to an American to hear things like this.
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Speaker 1:
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You know what I was also thinking is ... Would you say there's a shortage of dentists in South Africa?
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Nic:
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I would say there's a shortage of good dentists in South Africa, yes.
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Speaker 1:
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When I was in Singapore, like we met ... I saw this woman dentist and obviously a blonde dentist in Singapore at a dental convention. You know she's not from Singapore and she said she was the president of the New Mexico Dental Association, been practicing 30 years, and ... One day she just said, "What the hell? I just want to do some-" You know, a midlife crisis. She said, "I'm going to go practice in Singapore for a year." Next thing you know, she's been there 5 years.
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When you see these game preserves and you see this country, it's so gorgeous. I'm telling you, if you're in the United States and you're having a midlife crisis, or you're single, or you don't know what to do, this has got to be one of the coolest countries I've ever seen in my life. Are you guys hiring right now? One of my homies wants to move to South Africa. Would you give them a job?
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Nic:
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For sure.
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Sybrand:
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Yeah, sure. Come on out.
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Nic:
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For sure. We've got a job for him.
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Sybrand:
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Yeah.
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Nic:
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He can just come.
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Sybrand:
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Again, this is my home. I'm not from Europe. I probably won't adapt to Europe. I won't adapt to America. I am African.
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Nic:
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We don't need to go to heaven. We're living next to it.
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Sybrand:
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Yeah. We're living in our own African heaven.
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Speaker 1:
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It is. I agree. Tomorrow I get to go near where you guys live to do that Kruger National Park. Ryan, me, and Greg are doing that photo safari. While we're on that, the safari, I got to ask you one politically incorrect question. Probably the most famous dentist in America is a Dr. Palmer who came over here to your neighboring country Zimbabwe and shot Cecil the Lion. My question to you is, you guys live next to Kruger National Park. You guys are here. Some people in America say, "Well, you know big game hunting is necessary for some of these economies." What are your thoughts about big game hunting? Big game is ... What is it? Cape buffalo, elephant, lion, leopard, rhinoceros.
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Sybrand:
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Lion [crosstalk 00:24:14].
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Speaker 1:
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What do you think of big game hunting? What do you think of ... First of all specifically, what do you think of Dr. Palmer coming from America to Zimbabwe shooting Cecil the Lion? In general, what do you think of big game hunting?
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Nic:
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Let me start off. He is a hunter.
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Sybrand:
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I am a hunter and the biggest love in my life. Apart from my Mac is my Bowtech, my Bowtech bow, my compound bow. I love my bow. I have a different way of looking at it. I'm not really a fan of trophy hunting, so we only hunt what we can eat. There's also a reason for that. It's also traditional or historical as that not a lot people have access to meat. They can't get ... Whatever we shoot, we always give half of it away to people in need because we need food. You can't share a trophy, but you can give out meat and food.
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The Cecil, maybe it's blown out of proportion because there is some value in [inaudible 00:25:18], in keeping the numbers in tact. We did that in the Kruger Park especially when the population of the elephants get out of hand. They start destroying everything. They destroy the landscape, so there has to be a certain amount of elephants per square kilometer. More than that, they destroy everything and that's even worse than killing an elephant which I won't do, but for different reasons.
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I think in our country, the setting is a little bit different than America because we have people who are in desperate need of food, so hunting is a necessity. Trophy hunting is also a necessity for them because it's income which we want. We want the Americans to come and hunt in our beautiful country, but there are right ways of doing it and there are wrong ways of doing it. I think Dr. Palmer, there's a lot of ... It was one of our PAs that went on the hunt with him and there's a lot of rumors of-
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Speaker 1:
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You know one of the guys that went on the hunt?
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Sybrand:
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No, I don't. He's South African who took him on the hunt, the professional hunter. There's a lot of speculation that they lure Cecil out of the game reserve because then it's not necessarily illegal, but you're not allowed to lure him out. There's a lot of questions regarding that. As a profession, I don't see a problem with it because there's a law or there are laws governing it and that's important.
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At the moment, we are losing the population of rhinos in South Africa which can be solved if it's regulated. At the moment, there is a total ban on hunting rhinos. They are being poached, so we lost them all. I read in the paper today that there is a moratorium placed on the hunting of leopards for 2016 which means there is a limitation on hunting the big 5 for 2016. It comes partly from Cecil. They want to protect the numbers, but they also want to stop the hunting just for a year so the numbers can restore again. Then it will continue again, I suppose, for next year. They will see.
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Speaker 1:
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I want to talk about something else. What was the name of the [inaudible 00:27:31] I did? It started with a P.
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Nic:
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Pilanesberg.
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Sybrand:
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Pilanesberg.
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Speaker 1:
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Yeah. There was a fluoride mine by there, a fluoride mine.
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Nic:
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Yes.
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Sybrand:
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Yeah.
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Nic:
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Yes.
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Speaker 1:
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Dr. Palmer is probably the most controversial thing in dentistry after shooting Cecil. I would say when that blows over, it's always back to fluoride. In the United States, there's 19,000 towns and 70% adjust to fluoride, and 30% have voted it out or whatever. I noticed in South Africa just walking around here and going to those areas that ... Obviously there must be some areas where the fluoride is naturally about 2 parts per million because I see some people walking around with 2 part per million, 3 part per million, fluorosis, and then ...
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What is the status of naturally occurring fluorosis? A lot of people that ... This is on iTunes and YouTube. Sometimes non dentists listen to this, but a lot of people think that if you fluorite the water and there is [inaudible 00:28:35], that makes the teeth weak, and brittle, and break down, and that dentists are for that because whenever there's fluorisos, then they'll have to come in and have expensive crowns put on their teeth.
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I want to ask you specifically. Are there areas of naturally occurring fluorosis? When you see those patients, their teeth are brown, but do they have less cavities and root canals, and crowns? Is it just a cosmetic issue or is the teeth brittle and weaker, and more likely need expensive crown and bridge in dentistry?
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Nic:
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My dad grew up in the Karoo which is a natural fluoride area and he had ... He did not have one restoration in his mouth when he died at the age of 87. That's that natural area of fluoride.
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Speaker 1:
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How [inaudible 00:29:25] do you think it was in the water? How many part per million do you think it was?
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Nic:
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I'm not even sure.
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Sybrand:
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There's no way of knowing that.
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Nic:
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I'm not even sure, but he can-
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Speaker 1:
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Were his teeth brown?
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Nic:
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He had spots on them, but not brown.
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Sybrand:
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Age appropriate maybe.
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Nic:
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Age appropriate, yeah.
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Sybrand:
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Age appropriate, I would say. We do have the areas in the country where there is an accessible amount of fluoride naturally occurring in the water. Those are the people you're talking about. They're also the people who come from under privileged communities, so they can't afford big treatment. We try and get those people away from fluoride by any means. You're going to get fluoride ingest anyway, just lower doses if possible.
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Speaker 1:
|
I found a gentleman here that wrote a ... I took a picture of this guy here wrote a book. He got a PhD in dentistry and he wrote a book on it. You recognize this guy?
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Sybrand:
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No. I can't even see it.
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Speaker 1:
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He was saying that these areas with a lot of forests was about 2-part per million. The ocean is a 1.4. When we put it in a city water supply, we put it in half the level ocean .7. There's still just 30% of Americans. They literally believe that ... Here it is, 2-part per million. You're saying the teeth don't need cap, don't get cavities. You're saying the teeth are better, they just look bad.
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Sybrand:
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Well, we know with extreme fluorosis you do start getting chipping of the enamel. We know that. The people with fluorosis we see seldomly have any fillings due to caries. They might require restorations because of that extreme hardness or brittleness you get from advanced fluorosis, but you can't bond to fluorose teeth.
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You end up doing cement crowns which might even be better to leave the patient as-is. That just depends on the aesthetics. If they want that to change, then you can do that. From the area they're from, usually it's accepted because that is [inaudible 00:31:24] the way of the world for them.
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Speaker 1:
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What would you say to people listening to this on YouTube that say that fluoridated water is a communist plot and the dentists bribed the government officials to put fluoride in the water so that all the teeth break down, so that we sell them expensive dentistry?
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Nic:
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To add onto that, the political scene in South Africa way back in the apartheid days, the black community saw it as mass medication. They saw it as a threat that we were giving them contraceptives or something of sorts. It was a major political move away from it. The people did not accept it politically to have water fluoridated. It was a political thing back in '77. There's a paper out in '77 on water fluoridation on this political issue.
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Sybrand:
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I think the new fluoride concept today is vaccination because there is a whole lot of opinions on should you or should you not vaccinate. It's the same thing with fluoride, I think. There's differing signs on a differing research, differing outcomes.
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Speaker 1:
|
I was involved in the fluoridation of Phoenix back in 1987. It was unfluoridated when I got there. Me and the dean of the local dental school, [Jack Nolanberg 00:32:35] started the Arizona Citizens for Dental Health. We got it fluoridated [inaudible 00:32:38]. It came down to 8 city councilmens would vote and then the mayor vote. The only person who voted against it was the only black mayor. He literally told me. He said, "You want this because when there's fluoride in the water, it causes sickle cell anemia."
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I got experts on sickle cell anemia to explain to him what sickle cell was and how it was genetic, and it was inherited, and nothing to do at all with fluoridation. It all comes back to what I believe. Now that I'm 53, I believe it. It all comes from a deep warranted mistrust in government. At the end of the day, it's all I trust.
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They don't trust the government agencies. They don't trust the government. I see half a century living on this rock. I just see a lot of people for a lot of good reasons that have just lost trust in public institutions, trust in government.
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I see a lot of people here. I can't tell you how many doctors have told me here that they think your president takes on bribes or kickbacks. We see that in America. I think that's the rise of Donald Trump. It's not so much that they think Trump is a good guy. It's just they're sick and tired of the 2-party city, the democrats or republicans.
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I think when you tell these people that the Centers for Disease Control says all these good things about vaccinations, well at the end of the day, they don't even trust the Centers for Disease Control. There's just a lack of trust. What do you think doctors and dentists, and physicians around the world need to do to gain trust back with the people?
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Sybrand:
|
I think, again, for South Africa this is a different environment because the comment that some people that our president takes bribes is actually incorrect. It is proven that he does. The public prosecutor found that he has a corrupt relationship with certain businessmen, so it's a fact. That is where-
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Nic:
|
[crosstalk 00:34:33]
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Sybrand:
|
There's no doubt about it. There's a starting point for mistrust, but also historically the majority of the country had to trust a new government. On all levels there's this mistrust. Also from the food side, if you have the water fluoridation, but you also in America especially you have the sugar controversy, should you or should you not. The only thing that might cure that is time.
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One day we'll see maybe we should have or we shouldn't have, but there is no way to predict one way or the other. You're right. If it comes down to the trust, the public trust, or the trust of the government, it's difficult at the moment. It's very volatile politically, so we don't even get to the water fluoridation topic at the moment.
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Speaker 1:
|
I want to ask you a very politically incorrect question. Do you mind giving away your age? How old are you?
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Sybrand:
|
I'm turning 38 on Thursday.
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Speaker 1:
|
Okay, so 38, 38. We'll buy him a drink for his birthday. We're always good for that. We'll buy you a beer. By the way, we had so much fun at dinner with you guys last night. I want to ask you a very politically incorrect question because you're sitting next to your father.
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The big fans of these podcasts, it's a lot of dental students. When I go around the world, about a quarter to a third of the dentists, it's a family deal. You're going to dental school, how many of you have a mom, dad, uncle, cousin, grandma, grandpa is a dentist? One-fourth to one-third of the hands go up. It doesn't matter if you're in America, India, Brazil, it's a very family occupation.
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A lot of these kids are in school thinking, "I don't know if it's going to work because my old man, he believes this. He does root canals with Sargenti root canal paste paraformaldehyde. I don't believe in that, but I can't really ... " How do you tell your old man, "Dad, that ain't right?" How do you work with your dad and what do you do because family is first, frien- All you want is ... They say the only 3 things you want in life is family, friends, and good food.
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How do you work with your family? What is your conflict negotiation? How does that work? Do you want me to have your dad leave the room for this part of the answer?
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Sybrand:
|
No. It's a good question. We do refer to him as the Silver Back because he's graying. Like I was saying, I was raised differently and he forces me to put myself in an uncomfortable position because that's the only way you can grow and move forward. There is no conflict. The conflict is usually just how to handle conflict, but at least we think the same way.
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From my side with the CEREC training and at the university, I have a great, great love for students because they are new to the profession and you can't really teach an old dog new tricks. You can teach the younger guys that the profession is amazing, but they have to look at the science and they have to get involved with technology. It's like teaching an old guy to use a cell phone.
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It's difficult for my mom and it's difficult for him to a point. That is the frustration to me is the gap in technological savvy that you'll get with ... The younger people will have it as a standard. They'll have it. Where the elder people, it'll die out because you might know it or might not know it, but he grew up without electricity. That's how far back he goes.
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Me, I was raised differently. I was raised in technology. The first iteration I ever did was a CEREC before I even did amalgam, so I was raised in that environment.
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Speaker 1:
|
This is [inaudible 00:38:20]. I want to go and to work with my dad, it'd be a great opportunity, but you know what? I'm his baby and I don't care if I work for him for 20 years, I'm always going to be the baby. He's always going to be dad. They're sitting on the fence. Should I go to work with dad and be the baby even though when I'm 38-years-old I'll still be the baby? What advice would you give them if they're sitting on the fence like should I go in with dad, should I not? What are the pros and cons?
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Sybrand:
|
I should answer this because we have ... As the younger dentists, we have this problem that we don't compare ourselves to other young dentists. We compare ourselves to the successful dentists. Immediately we ... We want to achieve that.
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|
I don't think there's a gap though. I just think it's something you can aspire to because this is the best learning school in the world. If you have a family member who is in the profession, that is a better learning school than a university and that's what I got. I got all that knowledge, so the next generation should be better off. That's what happened here because I was able to achieve in less than 10 years what took him 30 years to achieve.
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|
That's not because I'm special. He gave me the opportunities.
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Speaker 1:
|
How many years have you worked for your dad?
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Sybrand:
|
10, 11, 11th year.
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Speaker 1:
|
11 years. How many times have you had to go to mom to be the tie breaker?
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Sybrand:
|
Oh, no. No, no. We don't get mom into the practice. No, no, no. That's a no.
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Nic:
|
Maybe I should also fill in a little bit here. I'm very proud of this stance maybe. That is that I told him that there could be no difference in our practice with regards to the quality of work. I thought my quality was there and he needed to get his there. He got his quality there and he's got his quality there at this moment in time. What he did in the interim, he qualified himself further with regards to endodontic treatment.
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|
I refer my endo to him now because he's got a post-graduate registration with regards to endodontics. At this moment in time, I don't like to do surgery and he does guided surgery with the CEREC, and refer that to him. In a certain instance, he's my superior. He's my superior with regards to endodontics now and to guided surgery.
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Speaker 1:
|
Don't you just love hearing that?
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Nic:
|
I'm proud of him taking that on. He can't do a crown like I do and I pride myself on my preps. I still want to see his preps as beautiful as mine.
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|
Speaker 1:
|
I want to take a note to say that this podcast would not be made available if my son Ryan over there wasn't helping his old man. I don't know a damn thing. I don't know how this is done. People always say to me, "How do you do a podcast every day?" It's like, "Well, I think it's fun because you just get to meet really cool homies and talk dentistry for an hour. I think it's a blast." He's the man who does it all.
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|
|
Talk about CEREC. Some people ... Talk about how you went from CEREC to guided surgeries and implants.
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|
Sybrand:
|
I think every dentist nowadays wants to have a label. You're an aesthetic dentist, or you're an endodontist, or an implantologist. We don't have that. If I must label myself as something, it is to do with technology and CAD/CAM. It might have started out as CEREC being CAD/CAM and it was ... It's always the go-to part of the profession if you talk about CAD/CAM or computerized [inaudible 00:41:40] CEREC, but it has so many branches. It's got imaging and radiology, and it has laser.
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|
Now guided surgery is in the second generation. CEREC guide 1 was a little bit cumbersome. CEREC guide 2 is just amazing. The science out there says that it's more accurate with guided surgery if you place an implant which I would advise for the younger guys. The one thing that I'm actually sad of is what took him ... The one thing you can't buy is experience. What took him 30 years to achieve and to learn with that muscle memory, we probably won't get to get that sort of, I want to say quality, but we won't get that experience because technology is making it easier.
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|
|
I can place an implant probably easier than anyone has ever done it before. That is the combination. My colleague said that guided implantology is literally the combination or the combination of 200 years worth of research and technology in dentistry because it brings digital imagining, scanning, radiology, CBCT, implants, it brings it all together, and this is like the precipice of what we've reached at the moment.
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|
|
Yeah, I would suppose stem cells will be the next thing, but it's just an amazing ... I love the technology. I love where CEREC takes you because they're just a whole lot of integrated products. It's not just the one thing. It's the fact that there are so many of their products that integrate or work together that make this technology awesome.
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|
Speaker 1:
|
When you do implants, talk about the average cases. Are you usually doing a single root form for a single tooth replacement?
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|
Sybrand:
|
Yeah.
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|
Speaker 1:
|
Are you talking about doing implants for over dentures, are you talking about [inaudible 00:43:29]? What is your average implant case?
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|
Sybrand:
|
Well, it's at the moment single cases because I don't enter the profession of implantology because of implantology. I entered it because of CAD/CAM. I am not going to invest my life into implantology, so the single simple cases are good for me. We have quality controls and we have 4 colleagues at the moment. If you want to place an implant, at least 2 people have to sign-off on it. We have ...
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|
Speaker 1:
|
In your practice?
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|
Sybrand:
|
In our practice. We have to check ourselves. I will do a planning or he would refer a patient over to the planning, present the case, and we have a bunch of like 8 or 10 dentists who come together on a monthly basis. Then we discuss here is my case and here is the planning, here is the extra, the CBCT, and then we discuss the case. The people as a lot of questions and yeah, maybe you can move the implant, maybe you can do this as a clinical step. Then we all agree and everyone can bring a case, and then we move on.
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|
I think with CAD/CAM the only thing you did is the procedure is easier, but you still have to go back to your planning. If you fail to plan, you plan to fail. We give a lot of attention to that, the planning stage of anything whether it's endo or a crown, or an implant. Everything goes through a whole lot of discussion and that I think is key.
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|
Speaker 1:
|
What I noticed about the CAD/CAM with the CEREC Sirona or now [Dentsply 00:45:00] Sirona is that when you have a 1 system, when you have the CAD/CAM, and you have the [Galileos 00:45:05], when you have 1 closed system, it's kind of like Apple. It just seems like it's a lot easier. They just get it done. When you start mixing a CAD/CAM system from, say, Planmeca and a CBCT from, say, Carestream and you're sort of mixing, it just seems that you really have to be a lot more tech savvy. At the end of the day, a lot of less people just get her done. It seems like having the one system ... Would you agree by having the Galileos and the CAD/CAM, and the [inaudible 00:45:37] milling-
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|
Nic:
|
You feel comfortable.
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|
Speaker 1:
|
At the end of the day, it's just easier to get it all done.
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|
Sybrand:
|
Yeah. It's exactly the point. Maybe for the younger guys, it's easier to learn a new technology. If you're in a company like Sirona, everything is built on 1 principle. Maybe just the look and feel of 1 CAD/CAM system is carried over to the next, so you always keep the feel of the software so you don't have the old people having to learn anything new, anything completely new. They just build on the existing knowledge, but it might be easier for younger guys to be able to learn anything. They Facetime and they podcast, and they do everything all at once. They multitask-
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|
Speaker 1:
|
Yeah. Ryan could do it. No problem. He's 22.
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|
Sybrand:
|
[crosstalk 00:46:18] I'm pushing 40. Maybe not even me.
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|
Speaker 1:
|
I'm 53. It's extremely confused me.
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|
Sybrand:
|
It might be easier for them to do it.
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|
Speaker 1:
|
I've been in so many dental offices where someone will say, "Well, can you print out that CBCT for me?" Here's 3 dental assistants and no one knows. Then they go to the dentist and no one ... It's always some little ... There's always this 1 little thing where when you show me like, "Oh, that was easy," but they just didn't know. It seemed like when you go into these closed systems [inaudible 00:46:45] Mac, iPhone, Dentsply Sirona, there's CAD/CAM, Galileos, it just seems like it's easier to do. If you're a Ryan, it wouldn't matter. For me who's technology challenged, it would be [embarrassing 00:46:58].
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Nic:
|
I just think the other thing that maybe adds the value too is that if you have the 1 company system, the research is being done in-house. They've got all the research and they've published their research. I do think it's just uncomfortable using the 1, the closed system as we do.
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|
Speaker 1:
|
Are you agnostic to the titanium or do you like a specific implant company? Will that change now that Sirona merged with Dentsply because Dentsply has a couple of implants? What implant system are you using?
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|
Sybrand:
|
I'm using Champion implants. It happened by chance. It was totally by chance. Like with any company, I think you become close with a company, you become friends, but the MD from that company had these really nice things to say that all of the implant systems work. They've got research. The 1 variable is the dentist and his skill, and his knowledge. That's where more work needs to be done. The same thing with ... 1 of the big bosses from Sirona, Fulcon, he wants competition and he likes competition. He doesn't want the competition to be bad. He just wants to be better. He wants their products to be better.
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|
All the CAD/CAM systems work. They can all do ... Every system can do a crown. Every system can do an inlay. Most implant companies have guided surgery now. The good thing would be to keep it in-house, to have one system to do everything. That's Champion implants, yeah.
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|
Speaker 1:
|
I never even heard of it. That is so amazing. I had to come all the way to South Africa to hear of an implant system.
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|
Sybrand:
|
To be fair, I'm lazy. I like the minimally invasive procedure that they have. I don't want to do the big cases.
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|
Speaker 1:
|
You know the owner of this?
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|
Sybrand:
|
I don't know the owner. I know of him, but the director in South Africa is Dr. Andre Pech and he lives in Cape Town on [inaudible 00:48:51]. He lives in the western Cape. It's a German company. They are actually close to Sirona in Bensheim, close to Frankfurt.
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Speaker 1:
|
Right. I have only got a few more minutes with you and it's over. Just tell me now what's got you excited in dentistry. What are you passionate about now? When I ask the young kids and I say ... When I got to dental schools and say, "What are you most excited about in dentistry, why do you think dentistry is better, and other careers," it seems like the major answer they always tell me at least half the times they'll say, "You know, my sister works at a desk job and she sits in a cubicle, and she does the same task over and over." Being in dentistry is that it's never boring. Every patient is different. Every tooth is different. You might be able to do implants, or ortho, or fillings, or PDF. It's so diverse. It's not monotonous.
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|
|
You're 38. You'll be doing this for many, many more years. What's got you passionate now? What gets you excited about still wanting to be a dentist after all these years?
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|
Sybrand:
|
I think I'm [inaudible 00:50:00]. The 1 thing is the technology because I could only imagine where it's taking us next. Every time a dentist has a question or a problem, the nice thing is to tell them that it's already been looked at. What I'm really passionate about, I think, is the younger generation. I'm looking forward to them coming out. Maybe it's at the expense of the older guys, but I want the new generation of dentists to come out because we are going to start learning from them technologically I suppose.
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|
I'm looking forward to the younger guys coming through and I'm really passionate about trying to get them to move along. I'm also on the National Council and that's also 1 of the things I want to do is to get the young dentists to become involved, and to be able to get the technology because the older guys can afford it, the younger guys want it, but they can't afford it necessarily. I would just like the younger guys to be able to get into the technological part of the profession which it changed my life and it shaped my life. I would want it to do the same for them.
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|
Speaker 1:
|
When people come to me and they say like ... I get this question [inaudible 00:51:05], "Do you think I should buy a laser?" I was telling the same thing, you know, there's oral health needs and there's mental health. I know this with my 4 boys. If I put them in the bathtub when they were little with no toys, they'd be out in 2 minutes. If I do a bunch of boats, and trucks, and Tonka toys in the bathtub, or the sandbox, or the beach, they'd be there all day.
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|
|
I always think that most important thing about lasers, CAD/CAM, CBCTs is if it gets you excited and passionate about dentistry, you have to have it because the flip side of that is burn out, disease, depression, I hate my job, I only do it for money. Then they start eating Vicodin, and drinking beer, and going home and getting drunk. The next thing you know in America, almost 18% of all dentists during their 40-year career will go to in-treatment for alcohol, well, substance abuse.
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|
|
Of that, it's about 85% alcohol. 15% will be narcotics, other stuff, whatever. It seems to me that the best thing about CAD/CAM, I wouldn't really so much argue that maybe it's for your patient that your CAD/CAM is doing something that a great crown and bridge guy couldn't do. What I think it's about is it just got you excited and passionate about dentistry.
|
|
Sybrand:
|
I love doing it and I love going to work. I did a case the other day. When I finished the patient said, "He's not going to pay me." I thought, "How can you say that?" He said, "Because you're enjoying it so much. It can't be seen as work." It was wonderful. It was a wonderful compliment, but it's exactly how I feel. You can go to work. Every day is a new day if you're doing something different every day. Of the whole process, even if it's CAD/CAM, I enjoy every single step of it, even the CAD/CAM part or the computer part, and the patient part, and the prep. I enjoy the whole thing.
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|
|
It's amazing experience for me to go to work and be able to do what I love doing even if it's just after 10 years of being in the profession.
|
|
Speaker 1:
|
The same question to you. What's got you passionate and excited about dentistry?
|
|
Nic:
|
I must say the privilege I have is that I'm living my dream and that is dentistry. I've enjoyed it ever since and I'm enjoying it even more. It becomes more enjoyable every day. I do think maybe it's the way we practice it as well. We don't want volume. We don't want to see 40 patients a day. If I could see 1 or 2 patients a day, that's efficient to me. As a matter of fact, I enjoy seeing 4 a day, 2 in the morning and 2 in the afternoon.
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|
I feel like I'm living my dream and I'm passionate next to the patient with regards to what I'm doing with him. Same as maybe to reiterate what he is saying and that's the thing. If you see the patient acceptance of the treatment and if you take the patient step-by-step on what you're doing, I just don't understand how can other people say that dentistry is maybe a dull profession. It is the most wonderful profession on earth if I can convince anybody. I've convinced quite a number of kids to do dentistry. They come and say thank you, every one of them after they've done it. As a matter of fact, some of them are working for us at this moment.
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|
Speaker 1:
|
Well, I'm proud of 2 of my dental assistants. Big shout out to Alana Goode, to Kelly Bradley. Those are 2 dental assistants of mine that are now dentists. I'm very proud of those 2 even though they made all [inaudible 00:54:17]. I want to say that you said something very profound that you're not on a insurance mill seeing 40 people a day, that you don't take insurance. I think a lot of dentists are burned out because they take this insurance, the fees, half the fees they lose money on the procedure and barely make money.
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|
What would you say to someone who's 30-years-old, burned out, hates dentistry primarily because they take this insurance and the fees are so low they have to do really quick appointment fillings, extractions, almalgams, and they just hate dentistry and they're burned out, but they're afraid, they're scared to give up their insurance check?
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|
Sybrand:
|
Well, I said 1 thing in the lecture we had yesterday is, "You can't be good or the best at everything, so pick 1 thing." I like America because America, the guys are quite specialized. I know very little about general dentists in America, but you see the more specialized versions of it coming out and that's it. You have to find what you love and you have to do that.
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I know there's a story of a professor in America. When he was asked what should I do with my life, the professor said, "Don't do anything for money, do what you love, do it well, and people will pay you to do it." It's the same with dentistry. You can't be good at everything. I'm very happy that I'm not good with orthodontics because I don't want to do it, but I love CAD/CAM. Maybe that's it. It's not about accepting a benefit from a third-party funder. It's doing what you love whether you get paid a lot for it or not. If you become good at it, people will pay you more.
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We did it and he started long before I even joined him to move away from the third-party funders. It's not an overnight thing. It took him 10 years and it's a battle every day because you have to educate the patients that the payment is their responsibility and not the responsibility of a third-party funder. It's not something that happens overnight. It's a decades long hard work and I'm reaping the benefits. He had to struggle through those years.
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Again, I'm not special. I'm very privileged to the position I am in. Maybe it's that, that I just say I want to take control of my own life. If you are dependent on a third-party funder to do that, you have no independence. In fact, you are working for someone else. You are working for someone who is willing to pay you a certain amount of money to do a certain procedure according to their rules.
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Our surgeon says that you have to take control. You dictate the treatment because you are the doctor, but it's difficult and it takes time to educate the patients. I'm lucky that he started long before I got here.
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Speaker 1:
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You guys were lecturing yesterday?
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Sybrand:
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Yeah.
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Speaker 1:
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What was your lecture on?
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Nic:
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On CAD/CAM. We are lecturing tomorrow again. It's CAD/CAM and some procedures and so on, but CAD/CAM in general, [inaudible 00:57:20], talking about materials tomorrow. [inaudible 00:57:24] we lectured on CAD/CAM.
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Speaker 1:
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Well, will you do me a huge honor? Dental Town has over 350 courses, they've been viewed from all over. It's embarrassing that most of our CD courses were put up by Americans. I see Dental Town as international and I do not have a course from a dentist from South Africa. It would just be a huge honor to have a CAD/CAM course from you put up on Dental Town.
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I also want to tell you that there's hundreds of dental schools around the world in Brazil, India, and Asia where these online CD courses on their smartphone are a huge portion of their curriculum. You'd be educating dentists all around the world, but it would really add a lot of international prestige to our little Dental Town community to have a course by you guys. Do you think we could ever get that?
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Sybrand:
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Yeah, definitely.
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Nic:
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We will be honored to participate.
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Sybrand:
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Yeah. We'd be honored to do it, definitely. Anything you guys want.
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Nic:
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Thanks for the invitation.
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Speaker 1:
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Man, I can't wait. Seriously guys, thank you for all that you do for dentistry, thank you for all your passion. I think you gave a lot of great information and a lot of good positive karma, and motivation to a bunch of dentists, especially a bunch of dental students. Thank you so much and I can't wait to have a beer with you again tonight.
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Sybrand:
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Thanks so much.
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Nic:
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See you tonight.
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Speaker 1:
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Okay. Bye-bye.
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Sybrand:
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Thank you.
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Speaker 1:
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Thanks, Ryan.
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