Dentistry Uncensored with Howard Farran
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1326 Biofilm Prevention with Yoram Ashery, CEO of Nobio : Dentistry Uncensored with Howard Farran

1326 Biofilm Prevention with Yoram Ashery, CEO of Nobio : Dentistry Uncensored with Howard Farran

1/6/2020 6:00:00 AM   |   Comments: 0   |   Views: 237
Yoram Ashery is the CEO of Nobio and a long-time executive in the healthcare industry. He has served in executive management and held commercial responsibilities at several medical technology firms and was involved in bringing to market new technologies and leading startups from early stages to commercial success.

VIDEO - DUwHF #1326 - Yoram Ashery

AUDIO - DUwHF #1326 - Yoram Ashery

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Howard: it is just an honor and a privilege to be in Israel with Yoram Ashery who's the chief executive officer the CEO Nobio which means no biofilm and this is something I've but this has been a pet peeve of mine my entire career I feel like when I get out of dental school in 87 the fillings were all amalgams and every ingredient in amalgam is antibacterial but the patient the customer the consumer had tooth colored so we put doing these metal toxic fillings that lasted forever and we replaced them with these inert plastic composites and you know what a filling was 38 years old and you took it out and have a little recurrent decay a little cavities these composites at six and a half years when they fail it's mush underneath you're taking a number four round burn taking out oatmeal and I've always wanted I always wish the tooth colored filling had an active ingredient and it looks like yours truly I'm sitting in front of the man who might be the answer to all my dental composite prayers 

Yoram Ashery: well we're certainly trying to and first of all thank you very much for coming and it's pleasure to have you and so yeah let's jump right to it it's exactly that no I'm not having this back up from business and the last 20 years I've been engaged in taking new technologies from the idea stage to the market and practice and  white use so on the negative side I'm a newbie to the industry I'm fascinated and excited but I've always looked for things that would be close to like products and technologies that could help everybody and then the street great place so how does them find this technology 

Howard: talk to us your journey is really not all of this dentist listening to you right now yeah so 

Yoram Ashery: Israel is a small place and people know each other and it's easy to find I was involved in several sort of companies who did well I guess a little above average more than little and so I just know people and it was directed here and say here's the one that you may want to look at because it's it's kind of the things you like doing it's a simple thing from the user perspective but it could have a big impact in solving problems and it's right at this stage that it's you know proof of concept is there now make it to the product bringing to the market I three years ago the 

Howard: proof of concept is that you have something that can be put into a composite that would retard bacterial growth 

Yoram Ashery: yeah so two things one is it's a indefinite if I'm a Kroger or aluminum another critical because it doesn't release it doesn't leach it doesn't fade out over concrete space active indefinitely and it's also seamless because it could be incorporating normal spending material we're going to talk more about composites because that's what's on the market exactly approved and will be available on the FDA approval that is not an easy feat I would say overall about nine nine months or so nine months and how much money does something I get cuz it could  it's a lot of legal fees isn't well it's hard to count because it's spread over a lot of different activities a lot of testing to do a lot of consulting to 

Howard: do the FDA approval in the United States is the Stevie mark in Europe yeah we're uh that's our next target 

Yoram Ashery: we started that is the you know there's a big regulatory change going on in Europe now and so things are not clear right now and a lot of people work oh they are busy with things changing their reality sensorially it was quicker to get cmart than the FDA but nice probably years it's it's actually the reverse until the new regulation is understood and your business mine is the United States and Europe about the same size dental market because my interest is usually new technologies I look at the early days of technology and in the early days in the u.s. is much bigger because it's faster to about new technologies even though they need FDA is there's maybe a little longer cycle nevertheless once you get the FDA things start to move faster than Europe it's more remedies than Europe so when you implement the marketing plan needs it's easier to implement that across the country whereas in Europe you may need to go country by country work with different people different opinion leaders different dealers it's again I mean you're aluminium regular perspective could be a one's own but from a marketing perspective it's still country by country and that's the biggest you know challenge or effort when you roll out a new technology to the market yeah just a little advice that 

Howard: Canada they always want to pretend they're another country but they're just that another California state line across the top there there the ever loft you're looking at Canada Brassica 

Yoram Ashery: but in many other ways you know culture wise and so on in some of the European countries although from the healthcare system they're quite different than maybe more on the European side right America so you found so somebody referred you in Israel this new technology and when they showed it to you were they already thinking dentistry or yeah this was actually boarded industry it has a lot of runway in other areas of a right the industry is the focus and what's really fascinating is that they can solve really big problems but it's pretty seamless for the users you don't find many situations like that so if you take for example this this composite syringe it contains a technology and no great for the technology but for the user it's going to feel and look and behave exactly the same as composites that is like your film composite resin based composite these today because we the technology the antibacterial technology is incorporated into particles which are based on silica similar material to the standard filling material or the filler in the glass filler in the composite the nominal and I know hydrated so on and the antimicrobial functional atom molecules are bound covalently to that fillers so they exert their activity and anywhere that a bacteria comes in contact are close to the composite but from the user perspective they don't feel I mean we tested this we've given about thirty petitioners to test these materials in a blind fashion compared to some of the most popular brands and they couldn't tell the difference so it's great that you can solve these problems but without asking your user to change the routine or anything in their workflow and just use it as sameness and

Howard:  we we've known about things like this in the past like we knew that bacteria had a harder time growing under high noble gold than composite because the the high static energy of the gold what was the what was the gold crown most popular gold crown before gold in a thousand dollars 

Yoram Ashery: well metals generally speaking have in Depok to the properties because in the president community to release ions of those ions kill bacteria so some more like silver mercury released more than some of the heavier metals but just generally speaking bacteria doesn't grow well on bells and that's that's kind of the generally truth on the flip side composites that actually promote growth of bacteria and that's kind of a sir but it is in fact the truth this group published in 2007 this studies showing that butter egg was faster on compositive and I'm just another plastic and that's right where you actually want to prevent it you're actually doing the opposite so by positives are not such a great material my opening statement was that 

Howard: you would take out a 38 year old amalgam and you know decay you take out a six and a half year old composite it was mush so they're all the older dentists terms are all aware of this 

Yoram Ashery: good composites they'll shrink as the cure there's a little bit of shrinkage and that creates a small gaps could be 5 10 20 microns between the filling and the tooth and that's just enough for bacteria to leak you given if it's not all around oh and only one side versus the other there still that's shrinking force causes so some gap and some lip Kuryakin going and some features and then they have a party there and you there's nothing you can do now on or anything can  stop it it's just a matter of time until it grows and grows and you have recurring decay but with this technology it kills the bacteria right there and it would not allow those lesions to come back so you can potentially have respirations that could last another show I know this your composite was named because another important feature of the technology which may be better in some cases than others but here I think is the right thing the other problem with the traditional antimicrobials which are soluble in leech is that they also disrupt the normal flora it changes the balance of the microbiome and you don't want that because they're known to have downstream effect engine changes that just and so on and the bigger issue no more people talk about it as resistance and on the quotable resistance so if you have a long-term release of an antimicrobial doesbacteriamutating and become resistant and that's that's a huge problem today generally speaking in the world of microbiology and of the crew goes into biotics and so on the beauty of this is because it doesn't leach out there is an opportunity for resistance and it doesn't disrupt the microbiome because it only kills the bacteria that is in contact with the respiration and only in that filling it doesn't affect whatever else you have in the mouth only where you want that protection this is where it happens

Howard:  so what happens on taking that little truck to caucus regions rubs up next to this composite and what happens the bacteria 

Yoram Ashery:  that come in contact would die in the sipping rate it disrupts the memory structure basically breaks into pieces and they just you know washes that naturally there's no life bucket area when it comes in contact with this particle it changes the membrane and then causes it to die or lysis yeah the particles contain a very high concentration of functional groups we use the different versions for different applications specifically these composites we use a particle which has it is silicon dioxide core similar to the spent filler  in the composite and functional groups which are ordinary ammonium and they're permanently bound and the chemistry is such that allows a high concentration for surface area on the particle and when you concentrate all the activity in one point which is the particle it's very lethal to the to the bacteria from the microorganism so as it come close you don't even have actual contact but it could be you know a few tens of microns which is about the size of the gap it's already very effective against the these bacteria the quality millions are have strong positive charges it affects a litter static force on the membrane that the structures structure the integrity and then it's called my sister here just fast because it's the membrane dysfunction

Howard:  so this is so I mean the ring playing for me is it's too good to be true I'm a it word since have to intrude if this works it's empty approved this is gonna be what the biggest game-changer most disruptive technology and posterior composites for sure humans breed you know 18 they're 20 times a minute and I've always noticed where there's a maximum airflow on those skinny front teeth there's less decay there then in back where these big square teeth and cheeks laying on one side that times on another it's a base of the recurrences aren't posterior teeth yeah so this would if this works he'll this would completely disrupt the entire posterior composite market you know

Yoram Ashery:  I think it has a big impact on you know treatments and the sorts of treatments the nice thing about this technology it can be corporate in any material so from commercial standpoint we will probably at some point open enough to include another material so we just own images for the infinity you would license the technology dowser commercialize UNIX brand and that would be the lead product to go with but I think at some point we will allow others also to use the technology in their formulations it's it's compatible with moving Anamika the the better direction because

Howard:  if there's already companies that make package and distribute and sell composites to the world's two million dentist wouldn't be easier just to get the IP technology the patents license it and just put it in other brands instead of Wistar the urine but well if I guess 

Yoram Ashewe thought about that that may be definitely has an advantage and so we would like to combine the two approaches so have our own brands let's also open it up to others we're strongly associated with this brand we use this for the education for establishing new technology in the market and so on so I think that would leave in the early days but further out it's gonna be everywhere are really our mission is to have this available for every patient and so whether it's the wrong formulation from someone else's you know that both are fine with us so what's the next book 

Howard: will the dentists in America be hearing of in the next 

Yoram Ashery: I think very soon I think they have already heard there's a C course going to be out of the PA program soon we have it at this course live at the median September and there's additional educational events in the planning and in terms of shipping and supply and so on that's the plan for the first half of next year we're now getting set up with a manufacturing and everything and so I think by mid next year or every dentist will be able to use this there's a dedicated website in reservists are the kids it's ruled after the market we will ship to people that fruit started keeping they can have a first experience I started to get started yes why Suzy go to know because calm intercom at home they can register for a free starter kit right and your wait until 2020 so that people will see more clearly with 2020 well there's simple adjustment on their operations because yes so you see back see more clearly 20/20 vision you can see clearer this will be a huge game-changer I think it's gonna be very beneficial I think it's gonna solve maybe one of the bigger outstanding problems with composites today so you know it has a lot of advantages and the market prefers that but still has that limitation which is not insignificant about longevity and the ability to recurrence 

Howard: so if we can solve that I think that could be really if you listen to their language carefully these haven't mechanical and civil engineers they're building bridges you know they're building crowns houses I'm there to meet but it's really there a farmer and they built this barn and then they tell the patient to take care of it and brush it and keep the barn clean but the barn always fails from termites and so I believe leads in dentistry as the dentist are mechanical and civil engineers and then they get beat up by biology we don't we don't I mean any of the fillings that fail this time because they break it's not because they fracture it's because bugs yeah eukaryotes and prokaryotes on and the research on fungi or working with the bacteria the fungi are laying down a layer of on the biofilm protecting the bacteria from antibodies and T cells and neutrophils and so we tall so we  do all this dentistry then we lose to other families of life-forms you know so we lose in biology 

Yoram Ashery: composites or have this exact problems because they are not doing anything to prevent that buildup of biofilm and you know when people brush their teeth you know the to remove it's more than mechanical brushing rather than the pace than everything you add those components maybe help to restore some of the lost mineral and and fix some of the damage that was caused by bacteria a little marine pH and and softly the tooth and cause that minerals due to flow out so we're trying to bring mineral back and restore the teeth but he can't keep going this over over and over north so we're trying to block the problem upstream to prevent that you know by a film and and pH drop which cause I forgot that but if you go back and study brushing

Howard:  dry brushing is what the bristle is what's the soft straight bristles removing supply there's leaching I almost think of a certain glass ionomer where you know you have gossamer fillings and they like them because they would reach a fluoride in calcium but all has an expiration date you know 

Yoram Ashery: if you're releasing something you're you got to three problems one is it's not in pro you know it's gonna deplete number two you're losing max maybe you're losing strength number three it goes out on specifically over you know release of fluoride or if it's antimicrobial even worse that could have you know you know collateral effect you just want to protect that little place of the restoration and the interface with the tooth that's really when you want to protect you don't want that whole environment affected just  that little place and that's where that's what's nice about a non leaching technology that's really only acting inward and what Ares do you think that technology serves to me I when I see a glass summarizing in Japan Australia New Zealand so I think countdown they've always been aware of the of the biological or the biological side so I think they will adopt this I imagine people listeners right now

Howard:  I mentioned the pediatric dentist are most curious because they have the most challenging patients to get them to brush and floss and not eat backers me both of those that it's harder to do a case he might we've got a kid moving in the chair and you really need to work fast and so it's

Yoram Ashery:  it's another challenge of doing good restoration these kids sometimes so high-risk patients people with lower saliva flow because of medication they take elderly anybody who has a challenge with you know keeping their oral hygiene all these are high-risk patients about a fifteen twenty percent of the population or a considered high-risk support for carries 15 entire site 

Howard: and then there's they're forgotten in four percent four percent of Americans will finish out their life in the nursing home and when they go the nursing on the average patient gets on one new root surface cavity a month so once you put grandma or lamp on the nursing home one year later she's got 12 roots or establish staff doesn't really like to handle or allows even for these well they're you know I even I wouldn't spend an evening and a half a dozen different nursing homes and between Wichita and Phoenix Arizona work and it's this is overworked I mean not you would meet this nurse and are is always an LPN I wasn't a registered nurse it was an LPN licensed practical nurse or ER there's a CNA certified nurse assistant and they had this entire wing of people and each one they got the feed bathe shower give their meds brush her teeth foster teeth and what I thought was incredibly crazy anything any wouldn't fell down the routine protocol was to call the fire department because there is no way this little fight that you girl was gonna get this 250 pound six foot tall grandpa up out of the West showered by undivided stuff this is just crazy but luckily you and I don't have to worry about that because I noticed that only women live that long there's almost no men in a nursing home it's a tough job let us know 

Yoram Ashery: so  service decay is a huge problem so we're starting in restorations and composites but there's also an adhesive with the same technology by commencing the key going into any other material we're not starting to look at other applications and for development so this would be not in 2020 but maybe the u.s. they're like orthodontics immense and nice prepend bikes probably uses the same problem essentially got bacteria that's coming in the interface with the tooth and once you remove those braces off you have the lesion which is that'd be a mother listening this time embracing them and be replaced by clear aligners 

Howard: I'm a podcast interview probably the 50 greatest orthodontists around the world and clear aligners is only 20% of the practice there's still 80% hardwired and years some teenage children do you think a fourteen-year-old boy would you would you give them clear aligners and put the ball in his court all the time all your other glue those brackets to his teeth people 

Yoram Ashery: children definitely traditional braces is the better choice in control yeah you can sure make sure that you know there's compliance with the treatment and there's proper monitoring and apartment planning I mean you're moving bones and it's important to get it right so what are they thinking about another area very interested in mentions you mention extractions or root canals and we know what's the main reason for failure it's really not - reinfection ryan said he got a sealer which is in the bacterial I could give you good peace of mind we've we haven't we've tested the feasibility of that that's one of them makes mixed products so to eat is a

Howard:  course she did last share PD meeting and you found that and you're gonna put it online who is your product champion who who's your dentist that's gonna go out there some of them so at the academic level 

Yoram Ashery: we work with Professor John Featherstone from UCSF and you know the founder of cambro the carries risk assessment Viking garrison yes so he's on the scientific side and the disease side Emily so what she's saying I think he believes this is the potential game changer you know he's very strongly passionate about this what's the work with dr. Peter recommend he's also at UCSF head of the restorative signs a group and he's actually running a clinical trial now and looking at how these technology these materials can prevent dim realization of the calcification that the study I believe will report results also beginning of 2020 we'll see clear 20/20 sure on the Kol front where we were proud working with sovereign group and Lucian job in terms of helping us with the go-to-market and the strategy and the media and partnerships and so on so it's a great partner and helping us a lot and you know they have their opinion leaders like John flew people first beam crystal are no marking job Brian Wray from Washington so it was a good  group of people that you know been exposed to this technology earlier on gave us great feedback we started working with them for I'll send more than a year nobody almost three years now so when as we started to put that technology into a product and a formula we started working with these wonderful people in terms of you know getting more feedback find unique things positioning it correctly choosing the right applications which material to do so we have four products the right now FDA approved it's three different composites Universal composite a flowable and in bulk coat the deep secure so basically covering your the type you know needs for restorations and an adhesive Universal bond it's a prime minimum to the bottom we're actually working now one on one single bottle system that's probably going to be out later next year so back to these people so they also helped us with the educational programs and the content some of them spoke with these events and we'll be working with them and probably more people as we start to roll this out and this external school of 

Howard: why UCSF 

Yoram Ashery: well most of those dr. Featherstone we knew him so so this technologies we go back most a decade to the early days they started that the about Medical Center in Jerusalem in the Hebrew University and professor of advice led that group as one of the inventors he's a dentist and microbiologist and just finished tender as the Dean of the School of Dental Medicine tiller big University and so he saw more relation yes you know best woman yeah yes cancer didn't yesterday was alright at the university he's not Susan dentist and microbiologist and one of the founders of no Bo the chairman and the chief technology officer here 

Howard: composite I mean I understand the aesthetic health compromise anything that's here that's silly especially on posterior she's like I'm a dentist I've been talking to email for half an hour I can't see your back teeth and you know you see front teeth and and and girls more I get that but I'm the I mean my gosh centers will be a upper second molar that's a location no let's just do it gold on let's see Matt this worth you know but would insist do this wants it right I'm the only person that's ever going to see this unless you go to an ENT and they say you know I want to colored and so you want to colored Rose or mr. peacock effect I mean the number one goal of the species is to attract a mate and reproofs I'm on spring and then it all comes down to beauty 

Yoram Ashery: we did some market surveys over the last year and one has shown that half of deadness in America all right there were because there's no demand for it yeah so you just focus on composites and that's what you do and that's you know so mixing things another survey we did was about what's important in selecting a material for a restoration would for a posterior versus anterior and when you look that mysterious they properly great aesthetics as the least or less important where mechanical performance and handling properties are the top priorities and then aesthetics are further them when you look at interiors it's exciting so aesthetics is very high so there's some people the is in certain post here and

Howard:  the anterior felonies they're never eating about its sensitive it hurts you know whatever but in the back under the compression horses that's a problem that's why the self etching primer like clear velocity you go back way back in the day of the eighties a lot of their bonding companies you know you these are selling to protocol media sensitivity and so they have this whole team a lecturer doctor telling you what you did wrong you never offered and you over enjoyed it you under dry day you you know it was always a dentist's fault but the Japanese listening to this and thought it's probably the chemistry and they came out with clear philosophy and just took over half the market overnight while the other morning ages were still trying to tell you it was all your fault and as much as you would tell them my rubberband but had never dried in overdrive but it was it was still an issue with some patients and it didn't matter if it was only fight percent if you did 20 fillings and some comes back and says insensitive so we're sort of the back I think we're bonding agents it's mostly driven by sensory and then handling the ball feels a new thing that's um because they're  not giving us more money for fillings but every time the earth goes around the Sun the staff will want to raise based on astrology and you have inflation so you have to keep up with their plate the insurance isn't going to keep giving you more money to keep out of their pollution so they're the insurance is gonna hold the fee constant you act everything has to pass by fingers is this product faster is it easier I've been saved by working from great Greek Creek

Yoram Ashery:  so here's some price and how we'll Infinix composite these three products are foldable your bonding agent your bulk fill house but we it's gonna be about the same as the you know leading materials on the market so we'll try to as much as possible absorb the cost of the technology and not ask the practitioners to pay extra or maybe is slightly extra not not significant so every time but maybe ten to twenty percent range of existing materials but it you know there's a lot of prices up there's a lot of channels there's a lot of Universal about leave go direct will will Moni old dentists on Instagram be able to buy this on Amazon or directly from your website this many places above the record from users so you suck non-exclusively again 

Howard: yeah because I diminishing like yummy but he can see some companies like an den Schweitzer Rhonda they have some divisions like caulk that only go through distributors Tulsa general product will those solder act in a hurry you know same thing don't bioW care through the distributors but they are implants direct where you can buy it online some distributors if you sell directly than carrier product but they'll get on Amazon and sell their own products but can you see now we show you but if you're trying to sell your stuff through Henry Schein they said well you can't solve a yeah so that's why your feet the fire will I be able in 2020 to buy Infinix on Amazon

Yoram Ashery:  that's a great question we have finalized that yet we're discussing our our rollout with certain old parties in the market some you know some of the big distributors so many factors and wants to get involved on limited over co-exclusive or some other form of you know advantage called it and we're looking at those different options 2020 to have this technology available through some major viewers distributors if you will and perhaps with some of the major manufacturers so we gonna have several options and also directly from 

Howrad: so then that being knowed Amazon maybe later difficulty understanding exactly how many dentist actually purchase stuff on Amazon for the practice well there's no clear numbers out there will another major people are selling on Amazon but you can find almost every product there right a few someone house yes and then you have to wonder who  body and there is it legit product you know they call that grain market green was waiting for a new to its might be good for the market modifies things 

Howard: so you're just looking for the best domina losers if you're looking for a new technology you prefer to buy through the source just to make sure that's so you are either so you think you will be able to negotiate selling this to Patterson shine Banco Burkhardt and selling it directly from your website

Yoram Ashery:  oh okay that thought it will see that I'm not I don't know yet right now and you know if this is the the issue we can maybe you know it's an interesting it's an interesting industry because this is what we call channel conflict 

Howard: Dentist yes so your business and you you get a product and it's going to come to you somehow and that channel is very complicated it's very historical and this is the way business has been done for a long time and I always noticed that Greater New York its kind of because for years neuro Amazon has a booth and it's always like the I would say they had that men and black people there was a couple of guys back there buying suits and they're they're privately talking to a bunch of the people but III I don't know what's happening but obviously Amazon is looking at this industry but they haven't really busted a move I mean four years ago in New York nothing's happened so do you think that the industry is so rooted in tradition that's just the way it's going to be 

Yoram Ashery: yeah I think the distributors are providing value to their customers that is important to keep their practice of running so it's not just about fulfilling an order it's more about you know serving your equipment and you know expediting thing when you really need it today you know if your unit is down or you're forgotten or something you want somebody you know heavy a big part of it is I think the biggest part isn't one 

Howard: when I launch downtown 28 the air at was said that five seas it was to sell commerce like Amazon content like news commercials connectivity but community and I saw mine breath coming in once a week is my only link to the outside world I didn't care if al Hughes recommended this file a or b but if I asked him hey what is what does the inner dollars for a gentleman who is what file is he using he would know and then we get cost and by the time the average over a subscriber by the time to dentist paste twenty five cents of every dollar to staff ten percent of the lab six percent supplies that's not the issue and people goodbye implants directly from say Russia or China or whatever for $99 but if you have the $25,000 implant case Friday and you're missing a screw you're missing this and the most value my implant grip would have is hey Thursday at the bar grill up the street that carry on us you know who does 1500 airplanes here he's going to be there and these three guys so it was that community it was like you so I think supplies being at least four to six percent costs it's kind of like after you make payroll and pay your light bill do you really care what your electric bill is I mean every dentist in Arizona could install solar on his roof and get rid of his electric bill but the electric bill is the last bill on their mind because that's fine your problem 

Yoram Ashery: yes I've either dealers play an important role and so that's why I would say direct is not the first approach the supplement and some time you know maybe not immediately I think still distributor but most almost all the major companies like 3m that's my carrot cetera sell their materials through distributors  play an important role and that's their supporting and although they're not you know they've kind of been different to the brand that I'm promote the brand will need to do the promotion and generate the demand for education activities and so on i think the petitioners prefers to buy through the distributor because of that additional service which is by the way you see a lot of so you have the big national ones like you must find Edison banker but you have the regional ones are getting bigger and bigger and I think well that's a.m. because that personal attitude 

Howard: well it's the it's the business cycle you know just assume you're got a Nobel Prize in Economics for the business cycle and that the it's never going to go away because they didn't add a human's are making all the decisions and humans you know after you've made ten years of bad decisions you know usually it's kind of correct but it's the consolidation deconsolidation pierson-el so there is a supply house and every major sitting one or two and then the consolidators p47 Patterson again when public and rolled up a bunch there Patterson Stan Bergman of Henry Schein Benko Chuck and Rick they roll up a lot of bills so it all nicely consolidated and then as soon as those four carriers were basically selling 75% of all the supplies then he's starting to see it bounce back the other way to deconsolidation and I've seen a Dental Supply open up I mean I think podcasted ten different people who started their own supply us and they're opening up all the time and the same thing happened with beer when I got out of school there were 15,000 breweries and then the Budweiser does the make loads came along they consolidate everything and pretty much everybody was on drinking buddy Nick and then as soon as everybody was about ten years ago it started Dee consolidating so since I've been a dentist we've gone from 15,000 breweries to mostly just 80% was by Nick and but in no lie and now it's Dee consolidating and there's a brewery on every part so I think that it's the human cycle once the total industry is completely deconsolidation yeah remember that first video game what is that pong the end of these bars and he bounced the ball back and forth at pong it's the pong between consolidate be consolidating and consolidating so that's just a cycle but on that note right now private practitioners like me in the solar office we shrink about seven percent in the last ten years and we've been replaced by DSOs which are expanding the number it means on what we call these so when you dso’s so most people think of like Harlan that just passed that thousand locations are about Fontana was 700 or Aspen sedimentary I notice in business strategies a lot of people I'm your time that your strategy to go after the independent practitioners with your what you say earlier but some people just sit there and say well gosh I just go get Heartland it realize the value of this there's a thousand locations what do you do you see that as you have a DSO strategy partly places a bunch of followings that fell with recurrent decay they're gonna have to replace a lotteries for free

Yoram Ashery:  yeah I think these those are interesting from you know as far as technology because they may have maybe more resources to evaluate and it's a it's a it's a you know a business decision practitioners part of the reason these those are growing is because they have those horizontal resources you know if you're solo practice you need to make all your decisions yourself Plus which technologies are using the practice management around isn't so long then and take care of patients at the same time these cells is a little more that scalability and so if you want to introduce a new technology another price aggressive and so on but again the scale is  obviously important especially over budget the larger ones and yeah they'll you know realize the economic benefits of the technology like this do no less recalls for example so not just a patient satisfaction and the professional satisfaction include better job but also as a financial benefit to that so I think these shows would be another important component of Norden rolling this out for nutrition was here two weeks ago in Tel Aviv

Howard:  did you talk to Gordon Christian CRA advisor with John W fer foreign Michigan have you talked to John and dental advisor ordered and 

Yoram Ashery: actually we met a couple of times in Provo Utah so that's what you know he came here he was had a lot of people to see so unfortunate doesn't come here as often as as people want but Gordon is the is a good friend and very word this technology in other ways mrs.  Christensen the wife of HD in microbiome is a microbiologist she's  a great microbiologist and she does a lot of work in this area and published a lot in this area as well some of her really innovative work about characterizing bacteria in in decay in cavities is really James I know this is very basic scientific data you know who knows how that may change treatments down the road and 

Howard: she's been some very innovative work there I mean she's she's identified a new species or bacteria in the mouth several times this one was like Marie Curie I mean she's amazing anything specifically about your product or 10 over cluttery or finding a study together so that's something else event start have you sure this to him not yet you know were Lulu early and

Yoram Ashery: the you know folks with the American Academy cardiology it's a relatively new society I think of this daughter's four years ago but it's growing quite rapidly and their focus specifically in this in this area when they only 

Howrad: maybe they just eat cheese and crackers and so the American society very ology yeah 

Yoram Ashery: yeah there's a lot of important people that we still have to speak to and get more involved in this project well you need to tell this woman here that before you leave Israel I want to talk to the the dentist and microbiologist and recently retired beam slow-mo replaced the inventor of this technology and my gosh that's the Reverend voice yeah 

Yoram Ashery: we try to get him in here this morning actually but even though he's retired is so you know schedule is impossible but well things try to get some of them each said we're leaving tomorrow morning so any 

Howard: because when you study philosophy they said Socrates said humans had to great in between fear and greed those are the two great emotions but actually yeah that's the framework of a human being taking like that because were you live in the biosphere and everyone is either praying on something to kill and eat you know a cow a chicken a plant and something's preying on us wheeler between predator or were either predator or prey and when we place those fillings minute we place those fillings from our human homo sapien framework other life-forms who want to live just as much as you want to live are looking for a source of food and the more we move this game of Dentistry to biology I mean I and occlusion you know it's cario Theriot and inclusion and there's some exciting stuff from them with occlusal disease I think we're on the corner from finally getting an objective of measurement from all these scans and Invisalign you have you have when you take x-rays you can see cavities with gum disease you can Pro you can see measurements but for occlusal disease you don't really have an objective measurement and but my gosh cared the theme of the day caries is the big game especially for the kids and anything we can do to hear Homo Sapien an advantage over bacteria and microorganisms and microbiology is just gonna be a game changer and I want this to be the biggest game changer because well you know the bacteria on the one hand he's part of us there's about three times more bacteria in you and me than human self all right so I think that's we're more about teria than the human if you would like to think about it but it's a suit vo the relation and it's important we don't want to disrupt that because that's 

Yoram Ashery: really part of us only when you have the problems they need a very vocal intervention just to make sure that it doesn't have the bad consequence in this case you're talking about caries or recurring carries if you think about it the bacteria are really driving the Cascade of tooth loss you know just over the initial decay and then you have a recurring decayed once twice and then you have a root canal but then that gets infected and an extraction get an implant but that doesn't still bacteria it doesn't you know leave you then you have periodontitis and if you have a adventure and you can have dentures for - same thing which then it gets contaminated that's usually Candida eyes it's a worse actor than mutant and that can also have systemic consequences you know a lot of airway pulmonary complications especially in the elderly people so oral health and bacteria are together and we need to control and I think what's exciting about no Bo and then finish technology is that really it can play a role in each of these treatments in the from the prevention through the right now we're focusing on the restoration and that's going to wear these things it's going to roll out initially but we really aim for the entire continuum starting from the prevention to the respiration there wood canal the implants I think that's overall gonna have a big impact when someone discovered it was being made by a fungus to fight bacteria

Howard: I mean you know that penicillin fungi is where we got penicillin and humans are what fifty thousand years old and they figured out a way to generate penicillin and kill fungi probably a hundred million years ago so it's a game that will always be evolving it'll always be changing and I can even if this was perfect success I'm positive within a million years the bacteria or seriously you're a busy man and thank you so much for making time for me to come in and invade your space so your desk and thank you for sharing an hour with my homies it was an honor to podcast you well thank you very much so appreciate you coming here and really honor to speak to you always.

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