Howard: It is just a huge honor for me today to be podcast interviewing Dr. Wally Renne all the way from the Charleston South Carolina where he’s at the best damn Dental school ever, the Medical university of South Carolina, where he graduated in 2008. He is an active in undergraduate dental education and holds a full time faculty position in the Department of Oral Rehabilitation at the Medical University of South Carolina as an Associate Professor. He is the Director of the division of digital dentistry and directs CAD/CAM clinic and Aesthetic clinic. He is the course director for the preclinical CAD/CAM course. He has won several national and regional teaching awards for his efforts both preclinically and clinically. He is proficient clinically with the Planmeca Planscan, CEREC Omnicam, 3Shape Trios, CX 3600 and iTero. His special interest in patient treatment include advances in material sciences that improve patient quality outcomes. He is active in dental research and currently has several patents including a patent for a platform of long-term antimicrobial dental materials that have revolutionary bond durability components by inhibiting enzyme degradation of the hybrid layer while simultaneously preventing bacterial proliferation. That is so damn cool. Where did you figure out all this research stuff?
Wally: Man it's just pure serendipity and you know standing on the shoulders of giants that had helped me in my career. From the early stages to mentoring me and teaching me what I really needed.
Howard: Well you know the thing that dentist don't… No one wants to look in the mirror and find fault with themselves. It's so much easier to judge everyone else and you know for all of dentistry we've been building a wooden barn in the backyard and telling everybody to brush and floss and take care of it, and then it's always eaten by termites and then we blame the parents and sometimes you got to ask yourself, well maybe they made that a barn out of aluminum, it wouldn’t be eaten by termites.
Wally: Yeah.
Howard: So and also in my lifetime, it seems that dentistry has gone to what I call the aesthetic health compromise where back in the day had all this ugly gold and silver fillings that lasted thirty eight years to fifty…
Wally: Yeah.
Howard: …then they've been replaced with all this beautiful white plastic crap composite that gets eaten by recurrent decay in six and a half years.
Wally: Absolutely. Yeah there's a huge paradigm shift that are profession from longevity to aesthetics and I don't see why we can’t have both but we're not there yet, especially with direct restorations. With about a seven year longevity for the average posterior composite, I think we could better as a profession and you know, I know that in some people’s hands it lasts forever, I've heard, but I know what I could do with my hands and what I want to do is create a material that the average general dentist would put in and it will last at least as long as amalgam restoration.
Howard: But you know it’s all ego talk – what you show them the data. How long do you think the data says a posterior MOD composite last on a molar?
Wally: Six and a half to seven years.
Howard: And how long do you think does amalgam lasts?
Wally: Fourteen years plus.
Howard: Fourteen years, so twice as long.
Wally: Yeah at least yeah.
Howard: And every dentist is so ego driven, says ‘My composite lasts longer.’ Well what you're really saying… So your patients don't drink Mountain Dew, so your patients floss every day, so your patients you know they time their brushing for two minutes? I don't care if you're Mozart, your patients still drinks Mountain Dew and lives in a trailer.
Wally: Absolutely, I mean well you know the issue is that patients do the best that they can with the level of care that they can but the issue is with our diet in the modern day society, people are guzzling sugar we're not going to really change that, they're snacking – habitual snackers and we need a material that's going to adopt it and change for them that's going to be better.
Howard: So where, so you patented something?
Wally: Yeah, it was completely serendipity. I patented an additive to another particle additive to composite, adhesive and resins; that's a copper iodide metallic particle. Copper iodide is extremely antimicrobial and it does not lose its antimicrobial efficacy over time. So even at you know thirty years down the road it's still going to be antimicrobial.
Howard: So are you going to license... Let's go to sharp things. So mister wonderful, the Canadian guy’s going to say ‘look hey buddy don't build a brand name, don't build a brand name, don't build a big brand name of composites, screw all that shit. I got lots of buddies that dominates the space. You should license your technology to them.’ Is that what you’re going to do? Or are you going to build your own composite?
Wally: Well I got an NIDCR grant that's ending right now. It was a pretty good grant to research this better and now we're going to plan for phase two to get FDA approval and once I have FDA approval, I would hope that somebody would license this material. The issue is, on what I've been told by leaders in the industry that companies could care less about how long their materials last. Its $5 billion a year in the United States replace filling posterior composites. Companies make the putty that you put in the hole, it also make the adhesive. So the issue is do they really truly want something to last longer? And I would like to think and give them the benefit of the doubt that they do. But I've been told that they really are not quite interested in that kind of demographic.
Howard: Well you just said exactly, you can't generalize like I got – I’m Irish, 100% Irish. You can't say all Irish are drunks because only 38% of us are. You know you can't say that all Russians are alcoholics on vodka because only 40% are, you know, and so with these big companies, there's a lot of big companies; So one of them absolutely will.
Wally: Yeah. I think so.
Howard: And do you have contacts with those companies? Does the dental school?
Wally: Dental school not really. I do, there's some really good companies out there that truly do care about the quality of the materials and you know, I've been in talks with several of them and I'm excited to see what the future brings.
Howard: So tell us how it works.
Wally: So copper is intrinsically antimicrobial. They've been lining counter tops with it in hospitals to decrease nosocomial infections for years. It's resistant to mutations in the bacteria so they can't really resist copper. Copper acts at infinite electron Zinc, so as soon as the bacteria come near the electron Zinc that is in the copper, they die. They have a homeostatic cell charge imbalance and then we couple that with Iodide; Iodide is extremely antimicrobial in a short term, whereas Copper is the long term. Copper also inhibits matrix metalloproteinases through competitive inhibition of the Zinc binding motif, so we're going to inhibit all the enzymes as well. Copper also tends to inhibit salivary (07:02 unclear) so we're going to inhibit the degradation of the resin from the saliva. So we kind of nail all three aspects of composites failure and we're pretty excited about to have some very good results.
Howard: And what was the active ingredient in stannous fluoride?
Wally: Stannous fluoride, I do not know the method of that.
Howard: Stannous was tin.
Wally: Tin. Yeah. Okay.
Howard: So the silver filling was half mercury and the other half silver zinc copper and tin.
Wally: Exactly.
Howard: And you're going with the copper. I mean, an amalgam was antibacterial in so many ways- the composite shrank…
Wally: Yeah.
Howard: …where the amalgam expanded. So the seal was unbelievable and then everything… and then it’s half mercury, you'll never find mercury in a multivitamin.
Wally: True but I mean you get mercury in fish and other consumables. I think amalgams was probably one of the best things for our profession. I believe in amalgam. If you look at the research done by Timothy DeRouen at the University of Washington, to others it's perfectly safe. I don't buy into the amalgams are killing us hype. I have about fifteen in my mouth and maybe that's what’s wrong with me. But I believe in it. We're trying to put…
Howard: Is that why your hair looks so good. That's mercury in your hair?
Wally: …and we're trying to put that metal back in the filling without telling anybody. So you know, lace a little bit of copper iodide in the composite resins nobody know, put some metal back in there.
Howard: So is it copper and iodine? Or copper iodide?
Wally: Copper iodide, and what there is salt. Interestingly it's a white power and they used to put in table salts for your daily consumption of iodide and so it's perfectly safe to eat. In fact, the FDA has it generally regarded as safe list for one milligram consumption and it's safe.
Howard: To prevent goiter.
Wally: Yes.
Howard: Yeah you know the biggest public health measures of all time were all prevention. I mean they put iodine in salt, wiped out goiter. They put beriberi and riboflavin in bread, knocked out those diseases. What was the other one? Scurvy was in vitamins. In fact you know what the first medicine on earth was? It was actually a lime. Remember it was the lime…The British Navy came back and they used it… whenever they came back, at least a quarter of all the soldiers had died of scurvy and brigade came back and this one intelligent physician noticed, ‘Oh my God no one had scurvy on this ship. So he ordered the ship quarantine, it was under wraps, they studied it, when they got done they said, ‘The only difference we can find is they had a barrel of limes.’ So there had to be something in that lime. So they called that the lime was C, vitamin C citrus and there was something in that lime that caused them not to get scurvy. And so they still call British sailors ‘limeys’ to this day.
Wally: I did not know where that came from that's awesome.
Howard: Yeah that is cool. So what do you want to talk about next? What is the state of dental… how long have you been a dental school instructor?
Wally: Almost ten years.
Howard: Wait, I wouldn't talk about your website before you leave that. Your website is www.cure-innovations. What would my homies find if they went to cure-innovations.com?
Wally: They could read a little more about the research, and the copper iodide and some of the grants that we've received if they're interested. It's kind of a platform for that company that I started.
Howard: And are you on Twitter?
Wally: I don't tweet, believe it or not.
Howard: My gosh. Didn’t you learn that if you have a 50 million followers you got the White House?
Wally: I need to do that.
Howard: I mean, Donald Trump, love him or hate him, he showed you one thing, if you got enough Twitter followers you can bypass every news agency known to man. I mean that guy can get up and go to bathroom at three in the morning and message 50 million people.
Wally: I love it.
Howard: Isn’t that amazing? But yeah, and the other reason you should go Twitter is very simple. Facebook, you're always going to be giving them the money. You know, you build up a… If you got three hundred followers and you post something, they won't push out to three hundred followers, they'll push sponsored ads, content all of this stuff and if you want to push it out to all your followers, you got to give them money and boost your post, but Twitter, I've never given a dime. So Twitter you know, Twitter these companies that you've never given a penny, that's the cheapest kind, I mean the easiest dollar earned is a dollar in expenses saved. So they'd build up a big Twitter following, it's free. You build up a… like I have three hundred thousand followers on Facebook, and if I pushed out this podcast between me and you and I wanted all three hundred thousand to see it,…
Wally: Yeah.
Howard: …I have to give them $300.
Wally: What?
Howard: But I got twenty one thousand followers on Twitter, so when I tweet out this podcast, all twenty one thousand will see it for free.
Wally: That's awesome, I need to start…
Howard: Yeah so I tell everyone, go to Twitter and save yourself a fortune. There’s the reason Facebook stock is skyrocketing. So how long have you been teaching? Ever since you graduated in 2008?
Wally: I have. You know there were those that gave me a chance early on and I'm forever grateful for them. When I was a senior dental school, they came to me and said how would you like to stay on and teach? And at the time with all the debt that I had I was worried that I wouldn't be able to make a living because the starting salaries as you know are about a fifth of what private practitioners make but I decided and take a leap, I always knew I wanted to teach. I tutored in college, I tutored in dental school and so I fell in love with it. I think dental education's the best kept secret of our profession.
Howard: That is very cool. So what is the career in dental education? I mean is it all clinical? Is it family practice? Do you get to do research and work on your companies like cure-innovations.com?
Wally: Yeah it's actually a blend of everything that's fun to view. So you get to mentor students and really shape and mold them and you teach them both in lecture and in clinics so you’re helping them with their very first post year composites, their very first CAD/CAM crowns and things like that. Then you also get to treat your own patients a day a week and that's actually the day that you actually need to make money, to make out for your core salary and then you get to do research. So they give you a day to do research and start companies and get patents and do innovations and things like that and… Collaborations are amazing, I mean there's a group especially at NUSC we have such a good family field here in our department that everybody kind works together and we do a lot of fun stuff.
Howard: But you’ll actually get richer in the long run everybody it's so counter intuitive... Remember the book, the millionaire next door?
Wally: Yup.
Howard: The millionaire next door is written by two PHD's and nobody wanted to read the results. I mean the bottom line is doctors and dentists and lawyers don't do that well. The number one millionaire profession was school teachers. Because when a school teacher said, just like even saying well I don't make a lot of money. So you’ll buy a smaller home and stay in it your whole life. You'll buy a smaller car and drive it for hundred thousand miles. But those ballers get out and be, ‘I’m going to be a cosmetic dentist, I'm going to be the fanciest dentist in South Carolina.’ They'll buy a five thousand square foot home, a Mercedes Benz; his wife will never work a day in her life. She'll drive a Range Rover; she'll destroy $10,000 a month and at sixty five, guess who will have more money? The people that live below their means? Or the people that made three times as much they didn't save. It's never about what you earn it's always about your standard of living. Some people take their lunch and some people have to go out and eat sushi every day for lunch. Some people can you know drink bottled water in the morning; other people have to stop by Starbucks and get a $7 latte and they don't have enough money for an IRA. It's amazing; we went to a dental party Saturday night right? I mean you would have thought Prince lived there. I mean, how unbelievable was that house? I mean me and Ryan, like this is the nicest house we've ever been to. And he said the dentist is from Glendale.
Wally: Wow.
Howard: Are you out of your mind? I mean anybody would drive by this house would think, okay either the quarterback or cardinals lives there. It's Michael, you know, Michael Jordan lives there, Rod Stewart lives there…Oh hell no. It's just some damn dentist from Glendale.
Wally: Wow. Well you know, academics does – there’s some hidden features in financial benefits. You get retirement, and you get medical benefits that are unparalleled and you know, on top of that they have programs to help loan payment for students. Which is you know the average loan indebtedness for 2016 was about $260,000 with over 30% having over $300,000 in debt and many at the $500,000 range. So you know that's the big.
Howard: So what's the difference between the 500,000 and the 260? How does one graduate with twice as much debt as the other?
Wally: Well depends on the school, obviously, and it depends on how much family support they have. A lot of students are getting some family support to help offset things that cost a living. Many schools you know those numbers that they report might just be tuition but there's also… Some people have to take out extra for rent and food and you could actually go crazy and take out a bunch for that. If you're living in like giant apartments and driving a BMW and stuff like that, you have to be careful. Lot of parents though will help some students with living. So they don't have to take out but anything for any loans except for tuition, which is smart.
Howard: So how do you, do you think that's changing dentistry? Do you think that the classmates graduate in this forte that's changing dentistry?
Wally: It's absolutely changed the profession. Whether we like it or not, it’s here. the average student graduating with that amount of debt… They've bought a private practice before they ever even started practicing. You have to try to put yourselves in that position. If you look at the debt to income ration; 1976 the dental profession was about 70% debt to annual medium income ratio. Now we're well over 100%.
Howard: Now say that again that one. That was too fancy.
Wally: So if you look at debt to income ratio, the median income in 1976 area it was about 70% per dentistry, which was for if you look at all professions that's amazing.
Howard: So it means if you made $1 income you had $0.70 from the debt?
Wally: Yeah.
Howard: In 1976?
Wally: 1976.
Howard: And what is it in 2016 or 2017?
Wally: It's a 107%.
Howard: 107%. Do you have a reference on that or anything or…
Wally: That was published by...
Howard: You could email me that howard@dentaltown, that'd be awesome.
Wally: I think it was Nickelson in the Journal of Dental Education in 2015.
Howard: Okay.
Wally: Yeah.
Howard: If you ever find that link or yet email it to me, howard@dentaltown. That is amazing. So how do you think it changes dentistry?
Wally: I mean so students are less likely to specialize because what happens when you specialize… And you know the average into straight right with student loans is higher than more digits, so it's about 78%. So the interest will accrue if you go on to a specialty. So literally if you go into a specialty and many residencies charge you, so let's say you're paying 70 grand a year to go a endo residency, your interest is accruing on your default of student loan, so you're really have another 30 grand a year tapped on that. So you're a hundred grand a year to go to a two year residency and then you have lost income. So by the time you graduated from that residency, you just blew a million dollars almost.
Howard: I know.
Wally: Now it's a little bit different. So we have about a 8% drop and people specializing. We have a lot of people going into corporate based dentistry, we have fewer graduates buying a practice, they are more likely to associate because you can't buy a practice if you already bought a practice with your student loan. Now, if there is a good side of this, if you could actually imagine it, dental education's getting better. We’re mentors to the students while not justifying a cost at all, at all! But remember there in dental school you smash your stuff, they step on your...
Howard: Yeah. I saw.
Wally: I mean, it was abused. Now we're there for the students twenty four seven for their career. I get phone calls all the time from graduates. I'm always going to be there for them. It's just the paradigm shift in the way we treat them and it has nothing to do with the financial component, it just has to do with the new generation of educators.
Howard: But it will help the financial component because the guy who led that revolution was out there in UOP. What is his name? The orthodontist, who was the orthodontist at UOP?
Wally: I don't know.
Howard: Who the named the dental school after UOP? UOP dental school. Yeah thirty years ago, nicest school, it was the Marine Corps mount of mentality. The harder I treat, the more I treat like shit. Yeah and then Art Dugoni, a UOP said, ‘These are our colleagues, why is everybody treating him like shit? Why is everybody mean to him?’ And he was on the floor doing everybody's name and that turned out to make bank form because schools like Art Dugoni get more money from their… Like in my dental school wrote me a letter asking for money, I can't tell you the vile thoughts that would go through my head. I mean I would just... The last thought I'd ever have, was actually giving them cash but create university, my undergrad adjustment school, totally different and they had a priest at Notre Dame, if he writes a really bad letter that short as bunch of typos they'll get ten million bucks because those Jesuits, you know there's one that lived on each floor. I mean when we were too young to buy alcohol, we just went to Jesuits room and he’d give us a beer. I mean they were on your team. You know what I mean?
Wally: That's the way things are going now, yeah we're on the students team for sure.
Howard: Yeah.
Wally: It's good, it's really a fun place to be and you know we really do care about the students.
Howard: So did you marry a woman dentist in your class?
Wally: You know I got married before dental school, in college and she wanted to be a dentist, I did not like dentistry. I thought it was as stupidest thing ever. I want to be a research scientist. So I graduated and started using research, and it was mapping genomes of CN enemies. I hated it. So I quit and my wife was still in college and I needed a job and so there was an ad for an assistant and my wife says, ‘You should totally do that.’, I’m like ‘This is going to be the worst thing ever. So I was an assistant for a year. And I was like, ‘I love this.’
Howard: A dental assistant?
Wally: A dental assistant, making ten fifty an hour for a year. And I worked hard, killing myself, but there's an old school dentist and he taught me a lot and I fell in love with the profession. I applied to dental school. They said we don't think you really want to be a dentist. So then I worked as a dental assistant for another year. And I applied again, and I got in and I got in with my wife. So we did go to dental school together. She then specialized in pediatric dentistry.
Howard: Wow that is so cool.
Wally: Yeah.
Howard: That's the only reason I don't want to go to hell. It's because I think they'll make me a pediatric dentist with Hitler and Stalin for the rest of my life.
Wally: I don't even know what kids’ teeth looked like.
Howard: My God, it'll be a four chair. They'll be Hitler, Idi Amin, Joseph Stalin, and me just doing pulpotomies on screaming kids. Yeah, God bless the pediatric dentist man. I don't know how they do it. I assume she's on Xanax or Valium or...
Wally: She’s got to have some equalizer.
Howard: So go back, digital dentistry?
Wally: Yeah.
Howard: So you're big in CAD/CAM, and you are proficient clinically in the Planmeca Planscan. That's the one that they've bought E4D out of the Dallas. The Planmeca they're out of Helsinki Thinlin.
Wally: Yeah.
Howard: Then you have CEREC Omnicam which was the huge merger of Dentsply and Sirona, then 3Shape Trios that's at Copenhagen, Denmark. What's the CS 3600?
Wally: Carestream.
Howard: That's the Carestream, okay I didn't catch that; And then iTero, and then Glidewell’s talking about one this days. Have you seen the Glidewell?
Wally: I have.
Howard: What's the name of theirs?
Wally: The IOS Fastscan.
Howard: IOS what?
Wally: Fastscan
Howard: Fastscan. Is that going to be a player?
Wally: I don't know. I haven't actually touched it. I think you know, the exciting times in dentistry where you have so many players in the field now and you know all systems are pretty darn good. You know everybody has their favorite but the reality of it is, it's not much about the system, it's more about the dentistry.
Howard: And what do you mean by that? That you think do you do better dentistry?
Wally: Yeah I mean, for example if you pick up a Planmeca Planscan and you fabricate a crown with it and on the same crack you fabricate Omnicam restoration it depends on the dentistry on how well those things are going to work for the patient and the fit and the bonding and you know it's all about dentistry it's just the way to do things. And so garbage in, garbage out. If you still do a crappy dentistry, you could scan it with the $56,000 Lamborghini scanner and you’re still going to crapped at. Unfortunately, you can't fix bad dentistry. So that's why, I love teaching this new generation of students because they could pick up any scanners and scan with it, they could design crowns, they merge with CBCT data. They do all guided implants with doctor (00:25:04 unclear) here, and they’re just geniuses and it's the dentistry that is always the pickup. For them the CAD in technology is easy. It’s really cool.
Howard: So what percent of the dentist in the United States you think have digital radiography, as supposed to film?
Wally: Jeez man. I'd hope a 100% but you know, probably 80.
Howard: 80% adoption rate.
Wally: I don't know.
Howard: So what percent do you think have upgraded from a PANO to CBCT?
Wally: Maybe twenty, ten, ten to twenty.
Howard: Yeah. I’d go with ten. What percent have upgraded to from lab to chair side milling?
Wally: Maybe 15%.
Howard: So the question begs. What is it going to take to CBCT's go from 10% penetration to 80 like digital radiography replacing film or chair side milling replacing a lab to go from 15% to 80%? Do you think it's the price of the unit? Do you think it's the learning curve, the long learning curve? I would say CAD/CAM was like buying a music lounge room, I mean. Just because you bought a Fender guitar doesn't mean that you're now the Beatles. You have to spend the time to learn how to play it. But what do you think is holding back the adoption rate?
Wally: You know I think that up until recently it was just really geared towards the dental enthusiast that’s like tinkering on the computer and stuff but it's darn so much easier and the technology’s gotten so much faster and more accurate. We’re the point right now where we’re going to surpass the early adopters.Were heading into the mainstream adoption if you like within the next five years or even saying it's forever though but few things need to happen. Dental schools need to adopt their stair to care such like MUSC has and teach it as stair to care not something special, not something that you need to turn to piece and type in a code like a new code to use or students could use it whenever and then secondly, the price need to come down. These systems need to be sub $50,000 range for a complete scanner and mill.
Howard: I agree. You also teach aesthetic dentistry?
Wally: Yeah.
Howard: Take your wife for example. Say you had to do number eight.
Wally: Yeah.
Howard: Would you really do chair side milling or would you throw that one to the lab?
Wally: No, absolutely. No, I would do it in a heartbeat.
Howard: Really you would do it in a heartbeat?
Wally: You know I feel like as the clinician to sit there and characterize that restoration, right there for the patient and put my signature on it. You know unless I had a lab technician that was in my office, I would prefer that. But for me to mill a restoration and to be able to put my signature on it and get that to blend there's nothing more satisfying and I feel a slam dunk more than a lab. Even with sending photos and sending giant descriptions of what I want because I'm there for the patient. Now, like I said I think the pinnacle would be having a master ceramist in my office to do it right there but if you're talking about distance lab, I think chair side is better.
Howard: And what would you mill for her number eight incisor?
Wally: I would probably mill, right now I know she's a B one shade, she's a probably E-max and medium translucency, it's a gorgeous material and it's freaking indestructible.
Howard: And what would you mill if that was her first molar?
Wally: Same thing.
Howard: Same thing?
Wally: I think lithium disilicate properly prepped and bonded is the gold restoration of today. You're going to hit me inside.
Howard: And not needing to do all the zirconium?
Wally: I'm not a zirconium fan?
Howard: Why is that?
Wally: I don't want my restoration to be the indestructible, immovable rock in the mouth. We have to rethink of what we consider failure. I don't want the tooth to fail. I don't want my stuff to fail, you know. And hopefully ten, fifteen, twenty years down the road.
Howard: That’s a great subtle point that I think twice of the heads of lots of people that if there's no given that restoration the root canals going to crack and the root canal fails and it’s going to be extracted. I mean if I drop Tupperware, it bounces. If I drop a porcelain plate, it shatters but if I have an elephant stand on a porcelain plate, you say what’s stronger than Tupperware is when the elephant stands on the Tupperware, it deforms it.
Wally: Yeah.
Howard: But it depends on are you dropping that Tupperware or are you having an elephant stand on it?
Wally: I'm a strong believer in (00:29:38 unclear) approach. I want my materials to wear and adapt and move. That's why gold was so amazing and it still is. That it develops with facets. It adapts with the patient over time. Zirconium doesn't move.
Howard: Now let's say the most dentistry uncensored racist thing I've ever said in my life, and I shouldn't say it, I know I shouldn't say it. But let's just say it because it's so true. All seven of my restorations right now are on gold. When I travel and lecture in Africa, Asia and Latin America, they all love gold. And you come to America, white women will put gold, ears, nose, belly button, ankles, watches, their whole body, but not their teeth. But my Hispanic Latinos will, I mean, Latinas will, my Native American Indians will, my African Americans. I got African Americans come to my office just want a gold little tin foil on their front teeth just cause they thought it looked clutch. So what is it with just white women in America where they won’t put the most perfect restoration in the mouth which is just gold?
Wally: It's all media driven and you know, it's sad. Gold is the best, as you know, the best thing. Now, here’s the problem I have though, with gold. We used to, back in the sixties and seventies, teach more conservative gold restoration preparation styles. Partial coverage, overlays, onlays, inlays. Everything to everybody now is a crown. And it's unfortunate because when we hit the PFM era of dentistry, everything had to be a crown. Now we’re transitioning back to the all-ceramic era where we could bond but yet still everything is a crown. And I think as a professional we need to be more conservative and start to adopt those types of treatment modalities like what we did back when we were doing a lot of gold work.
Howard: Well have you talked to a cosmetic dentist, who's not on insurance like David (inaudible 31:29) and say, how do you do that kinda thing? I just take out what's wrong and then replace what's wrong.
Wally: That's rare though. No a lot of people…
Howard: But 95% of dentists in America take Delta, which is a PPO. It's something like, I think it's a 82%, take two or more PPOs, and by the time you get to the 48 percentile, they’re on four to twelve PPO plans. And if I send in an onlay or an inlay, it's automatic reject. If I send in a crown, they pay half.
Wally: Well you know we have to decide, as a professional, if we want to fight for it. There's an article recently saying we have enough, as much power as the NRA, as a political organization in dentistry. What do we fight for though? We need to fight for, you know, insurances. There's nowhere else in the world that you get reimbursed more for more aggressive stuff. Like in surgery, they’re not going to charge a certain more if they do a greater incision for your open heart surgery. But in dentistry, they charge more for being more aggressive.
Howard: And it's a lot of it’s insurance-driven. And dentistry, so dental insurance was started by the biggest union in America, The Longshoremen's Club. Any shipping container that came in and out of this country with unpacked by a Longshoreman and so in fifty eight they started a dental insurance and they covered x-rays at a 100%. Well the x-ray machine had been around forever and the adoption rate was nada. And as soon as they started covering a 100% for x-rays, every damn dentist had a x-ray machine. In just, something crazy like four years. I mean, just like dominoes, everyone’s like, what? I'll cover a 100% for x-rays? So I mean, historically, going back from forty eight, I said fifty eight, 1948. So from 1948 to 2017, I mean the whole history has been very insurance-driven. And when I lecture in other countries, I cannot tell you, I mean, I love my friends in Tokyo, in Paris, in London. But like when you go to those three great civilizations, Tokyo, Japan, London, England, and Paris, France, the governments pay you $100 for a molar endo.
Wally: Oh my goodness.
Howard: So guess what they do? They put a post in every one. They got to do the whole damn thing in under twenty minutes. Or they don't set the fee for an implant which they can get $1500. So do you think you're more likely to get a molar root canal or be told that it needs to be extracted and place an implant?
Wally: Yeah absolutely. Extraction and implant.
Howard: So money, I mean, money’s the answer. What's the question more times than we'd like to think?
Wally: Yeah. Unfortunately yeah. I have to completely agree. I don't like it though. That's one reasons why I went into academics. I don't want somebody to tell me what I have to do for dentistry.
Howard: Yeah. I agree. But I do think looking around the world helps you understand your own tribe better. Because so much of your own tribal stuff, you have all this rationales for what you think's going on, but then when you look at, okay, here's dentists in fifty other… That's why whenever I'm on the road I listen to lessons from Singapore, lessons from Japan, or lessons from Tokyo. Because it's those subtle differences that make you understand your macroeconomics better. Like next week, I lecture in Sydney in Melbourne. And I'll probably tape a dozen podcasts on..because just a little bitty, I mean, here's Australia, the same size as the United States, they're both 3.6 land square miles, you would think their dental schools are all exactly the same, but they're just not. You know, they're just not. So what would you say, so what else do you want to talk about. You could talk about anything under the sun. What else would you want to talk about?
Wally: Yeah I don't know. You guys want to know you know dental school, what we're still teaching these days?
Howard: Yeah. Do you actually or did you wanna go through the difference between the Planmeca Planscan, CEREC Omnicam, 3Shape Trios? Did you wanna go through those or not really?
Wally: Really yeah.
Howard: Go through Planmeca, what if someone just said to you, “I see you're proficient with those five machines.” Tell me the lowdown on those five machines plus the Glidewell IOS FastScan.
Wally: Yeah. So you know, I think that each system has some pros and cons. The Planmeca Emerald which you know is supposed to launch anytime now is the new Planmeca scanner and it's incredible. It's super fast and very accurate, it has real color and it's completely open. Meaning that I can export STLs freely and do anything that I want with them. I could also import STLs, I could take core files from Atlantis and import that into the system and mill crowns before I ever get (inaudible 36:27) back in the lab. I could merge with CBCT, any CBCT any DICOM data. I could export my wax ups, I could make surgical guides unclear) and you know Here’s one right here that I made this morning that’s a 3D printed surgical guide with the form labs using the Planmeca software, and I gotta order the sleeves and glue them in. but it’s a fully guided system. It's amazing and I think it's a great system with good customer support. The Omnicam has, you know…
Howard: I wanna to stop you just for Planmeca. So Planmeca at Helsinki, Finland, bought E4D out of Dallas, Texas. Is everything you’re saying really the old E4D or is Helsinki, Finland, technology, was it a merger, was is an acquisition?
Wally: Shine, Ivoclar, and Planmeca, are three owners in E4D. They're all kind of, they're four partners. And..
Howard: The four being Shine, Ivoclar, Planmeca and E4D.
Wally: E4D is still of great presence. They're still in Texas, the guys down there, Gary (inaudible 37:37), they're still all there doing RND. They have training facilities, they’re pumping out this new scanner that's coming out. So they’re actively working. But the nice thing is they get support from Ivoclar, they get support from Planmeca in Finland with things like CBCT guides, merging their scanning data with DICOM data. They have a platform, I could make my own braces with invisalign-type braces with clear aligners, 3D printing my own trays using Planmeca software. So it all integrates now.
Howard: So Planmeca software will do clear aligners?
Wally: Yes.
Howard: Just their own technology? I mean you don't have to use invisalign or…?
Wally: No. They partnered with, it's an attachment that you add on to the, I mean of course, companies are going to charge you for all their cool bells and whistles right? So you buy this add on to their Romexis software that lets you print your own clear aligners. And you can merge a intra oral scan with the DICOM data, highlight the roots, move the teeth and then print a series of clear aligners. You could print surgical...
Howard: In your own office?
Wally: Yeah.
Howard: So an orthodontist could get rid of his invisalign lab though, which is steep, I mean, it’s a thousand bucks a case.
Wally: I know orthodontists that have rooms full of pretty printers that are printing all their own things using this technology.
Howard: Oh my god, you got to score me with that podcast. Can you fix me with that? And an online CE course. I mean, when you talk to an orthodontist they all say, I say, “What percent of your practice is invisalign?” Let's say about 20%. I say, “What's the pro, what's the con?” The pro is, you know, the obvious. The con is, oh my god, it’s a thousand-dollar lab bill, per case. What do you think these guys are printing on own aligners at?
Wally: The cost is gonna be about $3 an aligner.
Howard: That, oh my god. Can you fix me, can you email and introduce me?
Wally: Yeah. It would blow your mind. The software is incredible, it’s absolutely incredible. You have all the information, you see the roots move in the bond because of the DICOM data merging. It's incredible.
Howard: And their loyalty to invisalign, if you're an orthodontist, I mean they bypass your orthodontist now. What is it, Smiles Direct?
Wally: Yeah. And there's Clear Correct as well.
Howard: Yeah, so I mean once you're, I mean, I would imagine it's very hard to have a strong loyalty with the company. It's like Uber. I mean Uber from the get go, people are saying, well you’re rude to your cab drivers, like they don't even want cab drivers. They want all driverless cars.
Wally: Yeah absolutely. I don't see orthodontists having any trouble switching to in-house made aligners. Particularly, they’re going to be the ones, the orthodontists, planning these things on the computer. That's going to be the big hold up though.
Howard: So we're talking about adoption rate. We’re 80% at digital x-ray, 10% at CBCT, 15% labs.
Wally: Yeah.
Howard: I would assume the adoption rate of invisalign for orthodontists is got to be 99%.
Wally: Absolutely.
Howard: What percent of them do you think are now milling out their own clear aligners?
Wally: Less than 5%.
Howard: Less than 5%. So that would be the hottest online CE course in Dentaltown history.
Wally: I don't think people even know about it.
Howard: Can you make that course or do you know an orthodontist dude?
Wally: The case right now that I'm printing out, that I'm going to be making some aligners for.
Howard: Would you ever consider making an online CE course for Dentaltown?
Wally: I have not, but I would love to.
Howard: Well I would love to. The thing is this, I mean when I got out of school thirty years going 1987, Delta paid me a thousand dollars for a crown and a thousand for a molar root canal. Now thirty years later, they give me six hundred for a crown, and yet my staff, every time the earth flies around the sun, they all want another dollar. Their whole raise is based on the zodiac. And they always come to me with these charts of the solar system telling me when the earth will be in orbit for their next pay raise. And so you have to start using technology. I got the four figure deal. It's got to be faster, it's got to be easier, it's got to be higher quality but it has to be lower cost. And so many times in dentistry, they go, “I got the greatest idea and it will only add 20% cost to your dentistry.” And I'm like, “Dude, the insurance companies have already whacked me 40% and your best idea is to make everything 20% that more expensive?”
Wally: Yeah, they’re killing us. And you know, like they take this surgical guide, it cost me $3 to make. And you know, I would pay $400 for this. It's a two-implant guide from another company. And I think, you know, finally, every
general dentist could afford to make their own surgical guides with open platform software. This whole concept of everything being closed is just ridiculous to me.
Howard: Okay explain to my homies the difference between open platform and closed platform.
Wally: So open means essentially that you're able to get files in and out of the software without getting charged, and files that can be used in any other software. So think of a PDF, you could open a PDF on your phone, on your computer, anywhere, on your tablet and you could read it. The STL file is the PDF of the 3D world. You could open STL on any 3D program on your phone, computer, and any 3D printer to print an STL file. And so Romexis software lets you pump out STLs of surgical guides and lets you bring in all sorts of things. Where some companies don't like to play nice with that kind of architecture. They have their own proprietary files you can't do anything with.
Howard: And which companies are those?
Wally: Well so it’s starting to change but for example, CEREC is closed in a way, but with 4.5 software they're going to open up, which is super exciting.
Howard: Open up a little bit, a crack of light in the door, or blow it open?
Wally: Let you export STL's and import, I believe. Which is going to be pretty awesome. And then 3Shape is going to be fully open soon. With their newest update. They now charge me a dongle fee every time I want to export or open file, I get dinged. But they're going to open that up so that's going to be amazing. And you know, I think Carestream is completely open right now. So like the plans, the Emerald, so they'll let you export and import. So everybody's getting wise to this.
Howard: Because some of the stuff, like say an intra-oral scanner impression over a traditional. Like it's, you know, obviously, the low hanging fruit of being a better dentist is magnification. Upgrading your monkey standard sapien eyes to 2.5, 3.8, you're a better dentist. When I take that oral scanning impression and I see my prep big screen, I've never been more humbled in my life.
Wally: Absolutely.
Howard: But then you have the price of the machine, but then they say, “Oh, you have to have a $200 a month contract.”
Wally: Yes.
Howard: So I was like “Dude I wasn't even using $200 a month in Impergum…”
Wally: Right.
Howard: “And now I got to pay you $200 a month for a service contract.”
Wally: I hate…
Howard: Not to mention buying the damn machine for seventeen to twenty five thousand.
Wally: Yeah, well be careful, cause a lot of companies will charge a little bit for the machine and they'll bang you for $500 a month. And so there's hidden fees to these things. I know Planmeca does not do that. There is no monthly fee to operate the system. Neither is there, I don’t think for CEREC but 3Shape and iTero and Trios, and all these companies like to have this monthly service fees that you have to pay.
Howard: Yeah. If you had to buy one, which one would it be?
Wally: Oh boy, you're killing me with that, I don't even know.
Howard: Let’s not touch that one.
Wally: Yeah.
Howard: You said now, yeah. Well you know, what's funny is yeah, cause what you're talking about is the initial cost versus the total cost. Like today, I was out there with my son Ryan, we went for a three mile walk and you know, every time, we were talking to the electric guy cause he’s trying to dig through the street to find a power line that went out. And I said, when they built these streets, they would’ve put a crawl space, you know, one time you never have to cut up a street the rest of your life. But every time there's a problem they go to lowest bidder. And it was 48 years ago today on July 28, 2017 and July 28, 1969, Neil Armstrong stepped on the moon. And it's funny when you listen to John Glenn and Neil Armstrong when you ask these guys, “Did you feel safe up there?” They all said the same thing. I knew I was up there and something built by the lowest bidder. I knew I wasn't in a Mercedes Benz, I knew I wasn't in a Cadillac, I knew I was in a Dodge Dart. I mean they put this whole damn thing up for a bid and it's pretty scary when you're in the lowest bidder. You know, same thing on roads in construction. Everyone always asks you know like, “God I can't believe how long they’ve had that street turn on.” Dude somebody bid it that could have done the whole street in thirty days. I thought the funniest thing that I've ever witnessed in Phoenix is the government decided they were going to expand the 101 North, and it was only going to be five miles long. And then free enterprise society, they were gonna build bring in the Arizona diamondbacks and they were going to have a close stadium with retractable worth that they could air condition the stadium.
Wally: Wow.
Howard: Guess who finish in half the time?
Wally: The stadium?
Howard: They had a retractable roof and the government had to build a flat road
five miles long.
Wally: I believe it.
Howard: A flat road five miles long takes twice as long as the damn baseball stadium with a retractable roof.
Wally: I believe it.
Howard: So yeah, the reason I'm ranting on this is you can't look at the price of the scanner. You got to look at the price of how much they're going to ding you for every impression. What is your contract fee? Can you get out of this contracts? Who’s your maintenance man? It can't be the government. Be it a convention and get the government convention special that's you know, 20% off. You got to sit down and do your homework. What is the total cost?
Wally: You really do. Don't rush in to buy any of the…
Howard: That‘d be the most controversial article you should write for Dentaltown magazine. Let a hundred and twenty five thousand read it. Go through each of the technologies.
Wally: I have.
Howard: I want it. What is the initial cost? What is the ongoing cost? What is the total cost?
Wally: There's…
Howard: Let's put htis out to the world together.
Wally: But so…
Howard: Do you see why I named this show Dentistry Uncensored?
Wally: I see. You're trying to squeeze me for the. This information is, you know, secret, but I will tell you. Be very careful you have to look and see what is going to be the five-year cost of ownership. Because the reality of it is, five years, that machine’s worth nothing. It's obsolete, okay. I promise you it's obsolete in five years. So you want to know what is the total five year cost of ownership? And so is the company that going to warrant you that for the full five years right off the bat? Or at three years are they going to hit you with a very expensive warranty fee? You just need to do your homework.
Howard: So do you have that article written?
Wally: No.
Howard: You're not going to publish it out or are you afraid the dean's going to call you in his office?
Wally: I don't want to piss off other companies. You know, I'm a huge Planmeca fanboy, as you know. But I love the Trios, I use it all the time. And the Omnicam is a workhorse at the school. So you know there's a lot of systems that I use and love. I don't want to piss off the companies but…
Howard: But it's funny because your forefathers, they just call it transparency. That's all they called it. And they liked transparency. And everybody wants everyone else to be transparent until you expose their transparency. And then they come at you like you assaulted them. It's like, why is this not just straight up information. I mean, we're just talking transparency.
Wally: I mean, yeah. And plus, it changes all the time. Companies, they have deals all the time.
Howard: But when I think the low cost though, I always think of Glidewell. I mean Jim Glidewell is the IKEA of the furniture market. He's the South West Airlines of, and the low cost leader always usually gets the biggest chunk. Like South West Airlines flies 27% of sea miles flown, IKEA's the number one franchise deal. So Jim Glidewell that is, well it's hard to say he’s the largest out in the world. I think it’s Jim Glidewell at the largest side. There's a group in China, Shenzhen modern dental says they are. But he is definitely the largest in the Western Hemisphere. So what do you think of his IOS Fastscan?
Wally: I think, you know, I haven't seen a finished product yet. I would love for them to send me one to use and test. I test accuracy for a lot of different companies when it comes to digital scanners. I don't have any good connections at Glidewell. I do appreciate what they've done though. If you look at the disruptive innovation that they created by coming in under the market price on a lot of their things in producing the same quality at lower price. It's pretty remarkable.
Howard: You email me your resume, what you've done, what you want to do and I'll put it in a scan.
Wally: Thank you. That would be awesome.
Howard: The reason I like Jim Glidewell, the reason I really do is I grew up in Kansas. My mom, they were from Parsons, Kansas. I mean, I don't have an uncle or an aunt that had any teeth when they left high school. Do you know what I mean? And so my first intro to continuing education was The Pankey Institute. There's an elaborate presentation, the A patient, the B patient, the C patient, the D patient, the F patient. I'm sitting in the front row realizing, “Wow! He thinks my entire Farran, family reunion is an F.” And we’re not even making the D criteria. Maybe the fanciest lady in the pedigree, maybe she would have been a C, but they don’t even wanna treat Cs. And what I liked about, it was like my favorite football coach, was Alabama. Remember the bear, he said, “Man if you make As you go to Harvard, go to Stanford. If you make Bs, go to the Ivy League Schools but if you flunk out of school and you make Ds and Fs, you send them to the Bear in Alabama,” and I just thought, “That's the real world buddy.”
Wally: That’s awesome.
Howard: Remember it was that way before your time. Have you ever heard of Bear Bryant?
Wally: Yeah.
Howard: Yeah. So what I liked about Jim Glidewell is his given more Americans the freedom to afford to save their tooth. And dental conventions always want to have, you know, and I love these guys. Like the Matt Roberts of the world, you know that built the Mercedes Benz and I drive a Lexus, I get it. I love Matt Roberts, I love that but how many people in America can drive a Mercedes Benz for everyone that takes the bus? Or buys a used car?
Wally: You know that's one reason I like digital dentistry so much. My cost on restoration is about $35 a tooth. I could have that poor person come in and fix their whole smile, my whole overhead’s just a couple of hundred bucks if I do it fastly and efficiently. And you know, will the aesthetic be at that level? Maybe not. But I kind of think it's exceptional. And I have a sliding scale of how much I charge my patients based on their economic need and the complexity of the case. I can afford to do that with chair side cam.
Howard: And the aesthetics I also think is very overblown because when, I mean, I'm a dentist for thirty years. When I'm talking to people, I, only on girls do you see like maybe the front upper ten teeth and the tips of the lowers. But god damn when you're talking to a forty year old man, fifty year old man or if he's got a liver spot you're not going to see a maxillary tooth, you’re never going to see a molar. I mean who cares, and the other thing with these amalgams, they talk about their high overhead and a lot of these bonding agents cost over… You know, like right now, oils trading… In my lifetime, oils traded between ten and a $100 a barrel. And right now it's somewhere around forty, fifty bucks a barrel. Bonding agents all trade over one million dollars a barrel. And if I ask any of my six year old boys, they come in with a burger hanging out of their nose, their hair is matted up, they wear the same, you know, raiders t-shirt three days in a row without changing it. I say, if I gave you a silver one, it will last you till you’re as old as me. But if I give you a tooth colored one, I got to give you a shot every six years the rest of your life. You know how many ten year old boys say, “I don't want a shot.”
Wally: Yeah I agree, absolutely. The issue that I have is with those individuals on the CE circle. And I respect them as clinicians, but they give this false perception of what's possible on the average general dentists hands with composite resin. You know I think it's a great material that could be used in many instances. I'm not anti-composite, I'm trying to create better composite. But the reality of it is, is that amalgam is just so much better of a restoration, far as longevity and durability. I just think that as a profession, we need to rethink of what we do. Even glass ionomers probably better than many composite.
Howard: Well where it really crosses the line is with, you know, Alzheimer's is crazy in America. By age sixty five, 1% has Alzheimer's. But by eighty five, 40%. So you go into these nursing homes and the nursing home data is very universal that they get one root surface cavity per month in there. So if they've been in there one year, they got twelve. This lady doesn't know her name, she doesn't recognize her kids, she doesn't know anything in the world and they do these shiny resins on the front teeth and their mushed in six months. But if they were amalgam or glass ionomer, they might last three to five years. So you got your fellowship in the AACD and you're a cosmetic dentist, on a seventy eight year old lady who doesn't know her husband’s name?
Wally: Yeah, I mean…
Howard: I mean at some point you got to be able to have balls to say ‘Look dude you're not even a doctor. You're a fanatic, you're a nut job.’ I mean I think a doctor should have many tool in their toolbox and if you just sit there and say I'm going to throw away all the gold and all the amalgam, all the glass ionomer, because I'm a proud member of the AACD, well okay, now dude you're not even a doctor, you're a quack. You're an extremist nut, you're not a doctor.
Wally: Well I think we need to consider the evidence that's published in literature as well. I mean it's pretty well known amongst any researcher or material scientists in the United States that composites just don't really last that long. It's just the fact in the posterior dentition. Then if you start talking about root caries, nothing probably lasts shorter than a composite restoration. In fact, you’re probably doing more harm than good.
Howard: Wow, you’re doing more harm than good. And so if you were, if you had an eighty year old, cause in the nursing home, you go to the nursing home, they're all women, and there's only one man and they’re named Lucky. And so that's why you want to be healthy. You want to be that one guy in the nursing home or you have a hundred women all to yourself. If they wheeled in that eighty year old lady and she's got Alzheimer's, so you know her brushing and flossing is gonna be horrible. How do you brush? And then I've gone into a dozen nursing homes in Arizona and I watched the oral health. So they got the CPA, they're not registered nurses, they're not licensed practical nurses, a two year, they're a certified practical nurse, and she takes a toothbrush, puts a pea of toothpaste on the front. She goes back and forth five times and then says spits in the cup and that's the dental regimen and that gets done once a day. So you know there's no oral health care. She's got Alzheimer's, she's got rheumatoid arthritis, and a certified nurse assistant’s got to do that to all twenty four ladies in her wing during her shift.
Wally: You know I think that's the biggest health care crisis in dentistry right now. It’s the aging American's and the way that they're treated and as a professional, we need to get together and try to scientifically create new and better materials to help these patients. You know, we need to create bioactive glasses that are gonna also be antimicrobial and anti-enzymatic for these patients. They’re never going to brush their teeth. They're never going to brush their teeth. And so we have to do better as a profession. And I know people are working hard all across the country trying to figure this out.
Howard: So what do you care for? You're a man, you'll never make it to the nursing home.
Wally: Well, you know, I have patients…
Howard: You'll choke to death on a cheeseburger long before you ever make it to the nursing home right?
Wally: I hope so. But…
Howard: But I like these coverings, Zimmer, they had a press release about a new… So when they do a hip transplant, if it gets a staph infection, that's just brutal. I mean, that's the number one cause of death in a hip transplant, is a staph infection of that implant. They're claiming they think they a new coding on a hip titanium that will not allow streptococcus mutans or strep to grow in. Have you heard that?
Wally: I have not. I know that I have been working on coding titanium abutments and screws and implant platforms with antimicrobial vapor deposition of copper iodide to advance biofilm around there which will prevent that (inaudible 59:51) that you see with a lot of implants. But yeah, companies, the issues are with the FDA approval, it’s very expensive. If you have a proprietary coding on a hip per se, it’s multimillion dollar research that's going to review acquire to get that out. And by the time it comes out you don't even know if something better hasn't been released and it's very, and it's a gamble for a company. So I'm surprised then we're actually through with something.
Howard: Yeah. And they'll pass things like NAFDA, but they won't pass things for like FDA zones, like I feel really bad, the house I live in, you know why I live in this house? You know why the lady sold to me?
Wally: Why?
Howard: She was born and raised in America, an American her whole life. And she had brain cancer. And the only drug out that was treating this was in Scandinavia, and the FDA hadn't approved it. I understand that FDA hasn't approved it. She's an American, you haven't approved it. But I'm dying and I just do it anyway. And the answer is no. And it's like okay we're not asking Medicaid, Medicare. I have my own money in America, buy a drug made in America, and that poor woman had to sell this house and move to Scandinavia.
Wally: Wow.
Howard: And it's like, I understand. It's kind of like I understand if you're the government and say, “Hey Howie, you know you're trying you know purple soup and there's no research on it.” Well that's okay if I was doing it because of something silly.
Wally: Right.
Howard: But if they said, “Dude you're dying of brain cancer and you'll be dead in four months and this was made by a bunch of guys in a university who think this will work.” Yeah why not, I mean, it gets to a point where it becomes life and death. Do you think the FDA could at least just say, you're on your own. Or why can't they can't just take one of these Indian reservations where they allow casinos, you know, they allow gambling. And these casinos all over United States that are next to big towns, you know where the casinos are. Will tell you, what (inaudible 1:02:01) reservation, you know these drugs aren't FDA approved, go to any Indian reservation hospital and they'll try. If it comes down to life or death.
Wally: Well because they're not technically American territories right?
Howard: Right. They're nations within a nation.
Wally: Right. So they technically should be able to bypass those types of regulations. That's an idea I never thought of, you know. I know of several personal people that I know that are dying, unfortunately, and you know, to try to get some treatments within United States, these revolutionary treatments that are not proven unless you get enrolled in a study, you can't get these treatments that are not approved. And to get into the study there's a lot of politics involved.
Howard: Yeah I really like that one that's coming out of Cuba for lung cancer.
You see that one?
Wally: I have not.
Howard: Oh yeah, the Cubans have the highest lung cancer treatment there is. And it's just sad that you have to go to Cuba to get it. Because in America, your doctor can tell you about it, but I don't know. You’re never supposed to talk about religion, sex, politics or violence. So we'll stay away from all those. Hey man, I'm your biggest fan. And I love all you've done. I would give anything if you make an online CE course for Dentaltown and or article, that’d be amazing. Kudos for everything you do.
Wally: Thank you.
Howard: And even though with your perfect hair, I have to hate you. I still love you to death. That is some perfect hair you got there buddy. Is that a wig?
Wally: That, I mean no. A lot, alot of product.
Howard: A lot of product. Okay. Well there is no product on my hair. This is all natural.
Wally: You’re all free though. I like that.
Howard: Alright buddy. Well hey, seriously, thank you so much for coming to the show. I had so much fun talking to you.
Wally: Thank you appreciate it.
Howard: Thank you Ryan.