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322 Learn, Unlearn, and Relearn with Kamsiah Haider : Dentistry Uncensored with Howard Farran

322 Learn, Unlearn, and Relearn with Kamsiah Haider : Dentistry Uncensored with Howard Farran

2/25/2016 7:06:16 AM   |   Comments: 0   |   Views: 496

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AUDIO - DUwHF #322 - Kamsiah Haider



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VIDEO - DUwHF #322 - Kamsiah Haider




This episodes Discussion:

  • Learn. Unlearn. Relearn
  • Expensive Dentistry vs Expensive Dentist vs Expensive looking Dentists
  • Rockstars in Dentistry
  • After graduation, what to learn 
  • And much more!

 

Kamsiah Haider:

 

Dr. Kamsiah is a multidisciplinary dental specialist. Her current interest are in DigitalSmileDesign, which is a new field of her specialization. 

 

The DSD technique enables her to be more exact in her approach to cosmetic dentistry. She works closely with a few local labs and the DSD lab in Madrid, Spain.

 

She also practices bone-screw dentistry which combines dental implantology, prosthodontics and orthodontics. In 2003m she did a course in Orthodontics by the Academy of Dental Science in Malaysia . She worked part-time in an established Orthodontic Clinic from 2004-2011.

 

She earned her membership of the International Association for Orthodontist (iAOi) in 2014. She did her mini-residency with the well known expert and bone screw Dr. Chris Chang in Taiwan. 

 

Dr. Kamsiah obtained her dental degree from The University of Malaya in 1987, and became a tutor and Lecturer in the Department of Prosthetics, Faculty of Dentistry.  She went to do her Masters in Prosthetics and Gerodontology graduate degree at Scotland's University of Dundee and graduated in 1990. She has been a Diplomate of the American Board of Prosthodontics and Implantology (ICOI) since 1997. 

 

Dr. Kamsiah was a full time lecturer at the University of Malaya, an Associate Professor at the International Islamic University and lectures on prosthetics and gerodontics. 

 

Her dental implant journey started in 1990 when she attended a course in the University of Goteburg, the Branemark centre in Sweden, and trained under the supervision of the late Nobel Laureate, Professor Branemark and subsequently in 1995 did her sabbatical in Perth, Australia with Dr. Patrick Henry who is an associate and colleague of Professor. 

 

She practices guided surgery in her implant cases. 

 

She also lectures on Removable Prosthesis, Dental Implantology,  especially  on immediate loading in the All on 4-concept. In 2013, on the introduction of Dr. Patrick Henry she went to Lisbon, Portugal where she did a few mini-residency trainings with Dr Palo Maló of the world famous Malo Clinic.

 

Dr. Kamsiah has been in private practice in 1996.

 

 

www.drkamsiah.com 



Howard:

It is a huge, huge honor to be podcast interviewing Kamsiah Haider and it is 3 am. In Kuala Lumpur, Malaysia and bless your heart for getting up at 3 o'clock in the morning to interview me in the United States. How are you doing today?

 

Kamsiah:

I'm okay Howard, how are you?

 

Howard:

I'm doing just fantastic. I'm having all kinds of fun. Let me read your bio. Dr. Kamsiah is a multi-disciplinary dental specialist. Her current interest is in digital smile design which is a new field of her specialization. The DSD, Digital Smile Design technique, enables her to be more exact in her approach to cosmetic dentistry. She works closely with a few local labs and the DSD lab in Madrid, Spain. She also practices bone screw dentistry which combines dental implantology, prosthodontics and orthodontics.

 

 

In 2003 she did a course in orthodontics by the Academy of Dental Science in Malaysia. She works part-time in an established orthodontic clinic from 2004 to 2011. She earned her membership of the International Association for Orthodontics. The IAOI in 2014. She did her mini residency with a well-known expert in bone screw, Dr. Chris Cheng in Taiwan. Dr. Kamsiah obtained her dental degree from the University of Malaysia in 1987 and became a tutor and lecturer in the department of prosthetics faculty dentistry. She went to do her masters in prosthetics and gerodontology graduate degree at Scotland's university of Dundee, graduated in 1990.

 

 

She has been a diplomat of the American board of prosthodontics and imiplantology since '97. Dr. Kamsiah was a full time lecturer at the University of Malaya and an associate professor at the International Islamic University and lectures on prosthetics and geradontonics. Her dental implant journey started in 1990 when she attended a course in the University of Gothenburg and the [Brand Marks 00:02:13] center in Sweden and trained under the supervision of the late Nobel laureate Professor Brandmark and subsequently in 1994 did her sabbatical in Perth, Australia with Dr. Patrick Henry who is an associate and colleague Professor.

 

 

She practices guided surgery in her implant cases. She also lectures on removable prostheses, dental implantology especially on immediate loading and [inaudible 00:02:37] concept. In 2013 on the introduction of Dr. Patrick Henry, he was retiring and she went to [Lisa 00:02:44] Portugal. She did a mini residency training with Dr. [Pelo Malo 00:02:48] of the world famous Malo clinic. Dr. Kamsiah has been in private practice since 1996.

 

 

You are a legend. You are a legend, I mean congratulations on just an amazing career. I don't even know where I would even start with you. We can talk about anything you want to but I always try to guess what people are going to be wondering and they're probably wondering what is the bone screw technique?

 

Kamsiah:

Bone screw technique? The one that I learned is the temporary anchorage device. Instead of using the external head gear, we use mini screw for more cases where you needed to use head gear before. You can retain the position of the teeth better instead of using the external headgear, we use mini screws as a temporary device.

 

Howard:

Very, very interesting. Tell us about digital smile design.

 

Kamsiah:

I think this is one of the best thing that's ever happened because I was always looking for the missing link in dentistry. All the while, there's something that actually is not enough. Something that really doesn't gel. Some, they're guessing and sometimes you have to re-do or you have to repeat your cases. The first time I met Christian Coachman was in New York, 2015 but he didn't really get to me. Next I was reading about digital dentistry and I went to one of his classes and I find that this is the missing link that I was looking for. This is actually the missing link and the link is that, how to integrate into different format. I can see patient from a 12 o'clock view, from the frontal view, a stretch view and now we can decide, when you look at a patient, you can decide is it a veneer case or is it an orthodontic case.

 

 

I use digital smile design in most of my cases now, even in completely dentureless cases. In full dentures, in implant cases, in [impario 00:05:32] cases. When I design, I have that in mind. The concept is that, I use that as a base line. From there on, I've been practicing digital smile design and I've found that really, really useful.

 

Howard:

How could Dental town be honored enough to get you to create an online course for us?

 

Kamsiah:

You have a Christian course one there.

 

Howard:

We do but you are Kamsiah from Malaysia and I think that would just be so amazing to have a course from you. You're a legend and to have a course from you all the way from Kuala Limpur Malaysia, I think that would just be beyond romantic. That would just be so cool.

 

Kamsiah:

Really?

 

Howard:

Yes, I do. I really do. I think that would be interesting and I think that's what's so fun about the Internet. It shrinks the world down into your lap top, to your cell phone and it's so exciting to be able to be listening to dentists all around the world as if you were next door to me.

 

Kamsiah:

Exactly. That's why I actually met so many of my new friends, my new dental friends from Dental Town. I've met Cory Glen, I've met Aman ... a few other guys from Dental Town and I learn a lot from them. I keep on communicating with them, keeping in touch, asking them questions and even I send my pieces to America as well.

 

Howard:

A big shout out to Cory Glen, I hope he's ... he probably doesn't have time to listen to us now. We wish him well. He is one of my idols and he got sick and he's going to beat this little sickness. I think about him everyday. I think about him all day every day.

 

 

One of the things different when I got out of school, we both got out of school in 1987. I know you look young enough to be my daughter but we actually graduated at the same time. Back in '87 all of the cosmetic dentists, all they could do is file down teeth and do crowns and veneers and I love seeing the true cosmetic dentists like yourself who incorporate orthodontics because I really believe that you can't even call yourself a cosmetic dentist if you're not mixing orthodontics into it because when you just level and align the teeth, you save so much tooth structure from being filed down doing veneers and crowns. Do you agree with that?

 

Kamsiah:

Exactly, completely. When my son was about 12 year sold, he refused to have treatment by anyone else. He did want me to treat him so that's how I came to orthodontics. Later on, I discovered that you know, it's minimal invasive and I can move the teeth a bit and plant my crown or veneers or implants [inaudible 00:08:56]. With also in mind you can plan your cases better. Always think ortho, how the position of the teeth, the sizes, you have to move it. Sometimes you only need to move one segment. You don't have to move the whole addition, just a segment, Or to intrude or in through the teeth.

 

 

I learned by leading bones screw and later on you can do your gum contouring. It really helps if you think ortho as well. That's why I incorporate my orthodontics and DSD together. But my mind, when I think, now you've got a case, I will think ortho first.

 

Howard:

I agree. You talk a lot about learned, unlearned, re-learn. What do you mean by learned, unlearned, re-learn?

 

Kamsiah:

In the 21st century, most of us can read. In fact, in Malaysia, the rate of literacy is almost 100% but it's unfortunate if we can't learn, unlearn and re-learn. We can re-invent ourselves to be a better person by acquiring a new [inaudible 00:10:22] to incorporate into our daily practice. In whatever field we do, we must always learn or unlearn to be dogmatic about certain things and that's the reason why I believe that we should learn and unlearn.

 

Howard:

What do you mean by expensive dentistry, expensive dentists, expensive looking dentists?

 

Kamsiah:

The expensive looking dentists are like [inaudible 00:10:56] and Christian Coach.

 

Howard:

Are you saying that in order to do the height in dentistry that you need to have a certain expensive look?

 

Kamsiah:

No, no. You just need to have good teeth.

 

Howard:

You need to have good teeth? You have beautiful teeth.

 

Kamsiah:

Well, without...

 

Howard:

What's that?

 

Kamsiah:

Without ortho.

 

Howard:

With ortho? You had ortho? You're going to ...

 

Kamsiah:

Without. Without.

 

Howard:

Were you born in Kuala Lampur?

 

Kamsiah:

No, I was born in a little town in [Saudino 00:11:33] Malaysia actually. I call it Kuala Lampur because I came to study here.

 

Howard:

You came to study there?

 

Kamsiah:

Yeah.

 

Howard:

I'm going to be up the street from you next month lecturing in Singapore.

 

Kamsiah:

Oh really?

 

Howard:

How far way is that from you?

 

Kamsiah:

A one-hour flight.

 

Howard:

A one-hour fight? Yeah, do you go to Singapore very often?

 

Kamsiah:

Not really because their currency is too strong.

 

Howard:

Their currency is too strong? I would save money if I visited you instead?

 

Kamsiah:

Exactly.

 

Howard:

I've noticed a lot of people refer to you as a diva in dentistry. Have you heard yourself being called a dental diva?

 

Kamsiah:

No.

 

Howard:

Lots of people they'll list diva's in dentistry and your name will come up and I think that's because when I was in school, dentists were mostly male in the United states and now, half the graduating class is female. I was wondering, when you got out of school in '87, what percent of the class was boys versus girls?

 

Kamsiah:

Oh, in my group there was only one boy.

 

Howard:

There was only one boy? Are most dentists in Malaysia women?

 

Kamsiah:

Most dentist in the government services are women. But in private practice they're mostly men. Men will go into private practice than the government service.

 

Howard:

Why is that different for women?

 

Kamsiah:

I think women would prefer to have a monthly paycheck, have more time with their family than to come enter into practice. Probably like in America, you have some women prefer to go into a corporate dentistry but in Malaysia, the government of Malaysia actually provides free dental care and most of my friends, most women would prefer to go in the ministry of Health than to open their own private practice.

 

Howard:

What did you do? Do you work for the Ministry of Health or do you have a private practice?

 

Kamsiah:

Me, now my own private practice. I never worked with the Ministry of Health. Upon graduation I went back to dental school to be a tutor and I continued, I want do Dundee to pursue my post graduate after that and I came back and teach again until 1995 I think, then I quit.

 

Howard:

What do you prefer more? Private practice or teaching?

 

Kamsiah:

Teaching.

 

Howard:

Teaching?

 

Kamsiah:

Teaching and research.

 

Howard:

Will you make some courses for us on Dental Town? Some of your teaching? I've seen so many of your cases. You're an amazing dentist.

 

Kamsiah:

Thank you.

 

Howard:

Do you think you might ...

 

Kamsiah:

I will try.

 

Howard:

You will try to do that? That would just be so fun. You work closely with a few dental labs, DSD lab in Madrid Spain. How did you find a lab all the way in Madrid Spain all the way from Kuala Lampur, Malaysia.

 

Kamsiah:

Well, after meeting the [Coachman 00:15:12] brothers, I keep in touch with them and I kept posting [inaudible 00:15:17] and when they saw that I had a little bit of a problem about my DSD. Not in terms of design but in terms of implementing it. They were looking at the labs. The nearest lab for me to send is in Spain, not in Brazil.

 

Howard:

Christian Coachman is from Sao Palo Brazil, yes?

 

Kamsiah:

Yes.

 

Howard:

Do you refer to him as the inventor of DSD? Would you say he's the founder of DSD? The technique?

 

Kamsiah:

He and a few other guys I think, architect.

 

Howard:

Yeah, I think there's about a dozen dentists in his family, isn't that right?

 

Kamsiah:

Yeah. 6 generations of dentists.

 

Howard:

Are you a general dentist or do you specialize?

 

Kamsiah:

Well, if I were to say I specialize, I can ... a specialist usually limits themselves to one practice like orthodontists yeah? I think mine basically is more on Prostho. I'm a prosthodontist. But later on, you know, [in plan 00:16:37] and cosmetic dentistry, I'm not considered as a specialization. I call myself more of a prosthodontist.

 

Howard:

More of a prosthodontist? What tips would you recommend to general dentists that are trying to be better in prosthodontics? What common mistakes do you see? What do you think they could do to become a better dentist like you?

 

Kamsiah:

Occlusion. Understand occlusion.

 

Howard:

Tell us your thoughts on occlusion. I know there's a big controversy in the United States. There's so many different occlusion camps and maybe two of the larger ones are neuro-muscular dentistry versus Panky Dawson occlusion. What camp would you consider you fall under?

 

Kamsiah:

Mine is more on the muscle. Even from my prosthetic training in Dundee, we don't actually go into [centric 00:17:46] relation. We don't [inaudible 00:17:50] very high, crossbow teeth. We use more of a very low cost teeth so that patient could actually find their own way then to actually push patient into a position where they're not happy to be with. So let the patient relax and we look for that. We let patient relax and we find that we don't have to push so much or try to ask patient to [retreat 00:18:23] to the maximum possible position.

 

Howard:

I've always read that a zero degree incline teeth is so much ... patients prefer that so much more than say, a 30 degree incline teeth.

 

Kamsiah:

Exactly.

 

Howard:

You're saying occlusion is better if it's less inclined teeth.

 

Kamsiah:

Yeah, especially on the lower flat regions. It's really, really difficult to have those kind of possible inclined teeth so I would go for sensory occlusion rather than sensory relation.

 

Howard:

What percent of your cases ... or when do you think a dentist should switch to full mouth impressions and mounted on an articulator with a face bow transfer? Do you do that on all your major cases or do you think that's overkill.

 

Kamsiah:

Overkill. Overkill. Especially digital smart design. You can have a digital face bow. You can immediately take the photo of your X-ray and put it into your computer to see where you have the line the inclination right or wrong. It's very fast. Then if you use the semi-adjustable, it depends on how you practice and even if you can do it, even if I can't do it, I can find a [lad 00:20:02] who can do it. I'm not going to stress myself anymore. I used to when I was younger. I used to try to do all my cases that way, but after some time, I said, I will follow up what the technician can do.

 

 

What the technician can do, then I try to go along and we see from there. [inaudible 00:20:30] you know? It's aesthetically pleasing, patient can chew, it's stable, there's retention, there's stability, there's aesthetic, that's fine.

 

Howard:

Would you say that when you switched to Digital smile design, you basically stopped using a face bow transfer and a semi adjustable articulator?

 

Kamsiah:

No, no, I still use. It will help immediately. Immediately meaning that when you have the [inaudible 00:21:02] in their mouth and you just take a photo and suddenly you realize even a neat line [inaudible 00:21:09] or the [red string 00:21:13] is not balanced. The back [inaudible 00:21:16] you can't see properly or it could be just a straight line instead of following smart curve. But the actual mechanics of doing, [inaudible 00:21:28] you know? You still need to have an [inaudible 00:21:31] you can't be on, unless you have a completely digital set up. You have a digital lab, you can do it complete and just all digital.

 

Howard:

Okay I agree. That's interesting. If someone's listening to you and they say, "I want to learn more about digital smile design." What would you tell them?

 

Kamsiah:

I'd say go for it. Look for them and bring your computer and learn from them.

 

Howard:

Where would they learn this on their computer?

 

Kamsiah:

Well, they have to attend proper process and now it's not [inaudible 00:22:10] to do it from Brazil. There's so many other agents of that who are teaching [inaudible 00:22:21].

 

Howard:

What would you say to ... you're talking to a lot of younger people we're in our 50's and they're ... most people listening to these podcasts are young people under 30. If they didn't learn orthodontics in school, what would you recommend they do? What should they learn?

 

Kamsiah:

They can go to Dental Town.

 

Howard:

They can go to Dental Town? Oh thank you. You're too kind. They see all kinds of different courses. Out of London they see Tiff teaching [MN Aligner 00:22:57]. They see 6 month ortho, 6 month braces. Ryan Swayne, Rick DuPaul, Richard Lead. There's so many courses. Are there any camps of orthodontics or courses that you like or would recommend to some kid trying to get into a little more othodontics?

 

Kamsiah:

Over here the one that is very popular is the one from Taiwan. Many Asian dentists from Singapore, Cambodia, Indonesia, we will go to Taiwan and learn.

 

Howard:

Who is that by?

 

Kamsiah:

Dr. Chris Cheng.

 

Howard:

Chris Jang?

 

Kamsiah:

Cheng.

 

Howard:

C-H-E-N-G? Is he a friend of yours?

 

Kamsiah:

Yes, yes, he is.

 

Howard:

Is he on Dental Town?

 

Kamsiah:

I don't know, I should ask him. He travels around the world.

 

Howard:

Can you e-mail me, howard@detaltown.com and CC Chris Cheng and we'll see if he can get some courses on Dental Town?

 

Kamsiah:

Yeah, he's good. He's video, there's 5 million viewers and patients would actually bring that video and ask me, "Can you do this?" A class three patient who asked 'Can you bring back the jaw without having surgery? Can you do what Chris Cheng is doing?"

 

Howard:

He's out of Taipei Taiwan?

 

Kamsiah:

No, he's probably about 100 kilometers away from Taipei. He's in the Silicon Valley of Taiwan. He owns the Apple Store.

 

Howard:

The apple store? Does he?

 

Kamsiah:

Yes.

 

Howard:

That's awesome.

 

Kamsiah:

Yeah. He's not only a famous orthodontist but everybody in the immigration knows him as the owner of the a Apple Store.

 

Howard:

Is that right?

 

Kamsiah:

Yes.

 

Howard:

That's fantastic.

 

Kamsiah:

He would be awesome. He would be really, really awesome to be in Dental Town. I actually learned, the Damon System from the Damon Center in Anaheim. I went to Anaheim to learn about the Damon System.

 

Howard:

The Damon System? The D-A-I-M-O-N?

 

Kamsiah:

D-A-M-O-N.

 

Howard:

Tell us what the Damon system is.

 

Kamsiah:

This is the self ligating system.

 

Howard:

Self Ligating system?

 

Kamsiah:

Yeah.

 

Howard:

Who sells that? I Damon owned by Kurr or is that it's own company?

 

Kamsiah:

Own company.

 

Howard:

It's right there in Anaheim, California?

 

Kamsiah:

Ormco actually.

 

Howard:

Oh Ormco? Ormco is owned by Kurr owned by Sybron, owned by Dan Herr so it's their Damon system is a... you said it's a ... what did you say? Ormco.

 

Kamsiah:

Ormco.

 

Howard:

Tell us about the Damon system. The self ligating system.

 

Kamsiah:

Well, I find that the basic ligation, it doesn't cause so much pain to the patient and we're not using rubber bands and it's more hygienic. It's easier to use. They have taught for every case like if you are on a class 2 cases they use a lower taught and they have taught for all the upper interiors, upper [inaudible 00:26:54] the upper K9 to K9. They have [inaudible 00:26:58] and you can see a result very fast.

 

Howard:

How long have you been using this system?

 

Kamsiah:

Well, since about 5 years ago.

 

Howard:

5 years ago?

 

Kamsiah:

Mm-hmm (affirmative).

 

Howard:

You really like it a lot huh?

 

Kamsiah:

Yeah, I like it a lot but it's quite expensive actually.

 

Howard:

It's expensive?

 

Kamsiah:

It is.

 

Howard:

Tell us about that. You're in Malaysia. That's 30 million people so that's the same number of people as California or Canada. About 80% of my podcast viewers are from the United States and the other 20% are from about 134 countries but you've been all around the world. What is Malaysia like and what is it like to be a dentist in Malaysia?

 

Kamsiah:

It depends. As you know, as a dentist, it depends on how much dentistry you want to practice. If you want to be a part time dentist or you really want to be a full time public domain, you can do that. [inaudible 00:28:14] to be a dentist is a really great job. It's a good job because we continually have something new to learn. There's always something new to learn. I think it helps our mind to be active. I find me sticking to prosthodontics or [inaudible 00:28:45] by doing orthodontics, by doing  [inaudible 00:28:50] and then doing [inaudible 00:28:52] Aligners. Understanding DSD.

 

 

It's very challenging. You read a lot, you research a lot, you find out more. When you see the differences in your work, you can see what you do before and what you do now and how you improved yourself with the continued education. How you [inaudible 00:29:18] yourself. Now the Internet, even the first years today, they can see a dissection. They can see a beautiful adenectomy from internet. We have to go to live [inaudible 00:29:35]. We have to spot the books, find the books, buy the books, things like that but now, people can always learn.

 

 

I can always go back to my [anectomy 00:29:45], to my physiology to pharmacology just from Internet. In fact, I've met so many young dentists are lazy to read. They say, yeah, just go to YouTube. Is it already on there? Is it on Youtube. I say, "No you have to [inaudible 00:30:03]." So it's not free. There are free ones are a teaser. Just a teaser but the real one, if you want to learn, really learn, you have to subscribe and you have to pay and one of the great sites is Dental XP. The digital small design. They don't have to be so much on YouTube because they make people pay to watch their online reveies.

 

Howard:

That's true. You've got to have a business model and it's hard to have a business model on the Internet because everybody on the Internet expects everything to be free.

 

Kamsiah:

Exactly. Nowadays, if you have an iPad and you have an iPhone, you can even, even though you [inaudible 00:30:54]. You can read your tape, the whole video, even they are making it difficult by not allowing people to double click or to have a simultaneous click or people sharing their e-mail. But usually people can still record it.

 

Howard:

That's true. There's an app for everything. You also have a degree in Gerodontology. Is that geriatric dentistry? Gerodontology.

 

Kamsiah:

Yes. Geriatric dentistry. In Scotland, they have a lot of elderly people, they have a lot of [inaudible 00:31:40] people so I was working in a [inaudible 00:31:45] hospital. I was doing my research on [inaudible 00:31:47] dentures and my professor is quite known for his replica technique. He replicates dentures so that those [inaudible 00:31:57] and they will always lose their dentures. The English, the Scottish, they like to have tea and [inaudible 00:32:03] and they will boil their dentures together when they have tea or they will throw it in their laundry bag so they came up with this replica technique. It happens to be the best thing that I learned because after that, what I learned implants in Gerodontolgy at that time, we were doing mostly on a completely denturless cases and you must have a good understanding in constructing good dentures before doing any kind of [inaudible 00:32:38] implants by doing other dentures. If your dentures are not good, you must have a good denture and enhance it by doing one or two implants.

 

 

In a way, my learning curve has been quite small because somehow from mastering accompanied cases on the geriatric population, my implant was mostly on fully dental of cases and [inaudible 00:33:14]. Only in the year 2000 the first time we bring single tooths and to perfect the technique was much later like, until recently. Until recently, you know about the biological [inaudible 00:33:35], the popular, how to [inaudible 00:33:39] popular. Before that there wasn't so much of information.

 

Howard:

Are you mostly doing implants for dentures or are most of your implants in fully dentured people who are just missing a single tooth or two.

 

Kamsiah:

Fully denturless.

 

Howard:

So most of your implant cases are fully denturless cases?

 

Kamsiah:

Yes and until transition, those people who are scared to move from their [inaudible 00:34:18] to wear complete dentures. So this is the market. We have a big market of people who neglect their hygiene, neglect care and then suddenly they realize that they have no charts. They're only going to have either wear complete dentures and they're afraid of wearing complete dentures.

 

 

There's a market segment on full dentured moving [inaudible 00:34:48] where a patient doesn't want to wear dentures.

 

Howard:

Do you like to remove all of their teeth and let them adjust to dentures first and then go back and add implants or do you like to remove the teeth and do implants immediately and go from all your teeth to on all on four?

 

Kamsiah:

It depends, as I said, most patients they don't want to wear dentures unless it's from, I find that now, most patients wants everything fast, fast, fast. Fast Internet connection, fast dentistry. Everything, one day, one hour. Something like that. We have to care about [inaudible 00:35:41]. You have to learn. You have to cater to the market.

 

Howard:

Are you doing mostly all on four implants or do you do implants with a hader bar or a dolder bar? Do you ever do mini implants? Talk about the different type of implant scenarios that you like to do.

 

Kamsiah:

I don't do mini implants.

 

Howard:

You do not do mini implants?

 

Kamsiah:

No I don't do mini implants. The over dentures, when I was teaching, two implants over denture, bar attachment, bar but clips always giving problems. I would cover them to fit anyway or I would just complete them, just do a few more. If they wanted it too, I think I would rather do one. We could even do one over a denture. One implant over a denture bar attachment. You don't have to have two. Why have two when you can have one and you can have one?

 

Howard:

Just sort of right down the middle?

 

Kamsiah:

Yes.

 

Howard:

Do you think that's better than two?

 

Kamsiah:

Yes.

 

Howard:

Why is that? Just because it can rotate easier?

 

Kamsiah:

This was a research done by Professor [inaudible 00:37:28]. They did a long-term study and they found that one implant is better than two.

 

Howard:

That is amazing. Would you mind starting a thread on that? In Dental Town we have 51 forums and one of them is implantology. Would you mind going under implantology and posting that study? I think that would be a great discussion because where I'm at in Phoenix Arizona, I don't know anybody who's ever placed one. I don't know anybody.

 

Kamsiah:

Exactly.

 

Howard:

I mean, everyone always does two or four. They usually do Two with a ball and O-ring or they'll do four with a bar. I don't know anybody who's ever done one. Have you done one?

 

Kamsiah:

My professor in Australia, he did. He's the one who's doing it. I learned it from him. If patient has a really, really limited among of money or very old patient, frail, you can just do them a great service by just putting one implant.

 

Howard:

My brother just moved to Australia. He moved from Kansas all the way to Sydney Australia and he, oh my gosh, is he loving that. I don't think he's ever going to move back home to Kansas. I think he's got my mom and all my sisters sad because I don't think you could move from Kansas to Sydney Australia and then go back. It's kind of a one way street.

 

Kamsiah:

I lived in Perth for a while.

 

Howard:

Oh now Perth is my favorite in Australia. On the one coast is Melbourne, Sydney, Brisbone, Gold Coast and then clear on the other side, just out in the middle, clear on the other side about a 3 hour flight from Antartica is Perth and I think that is the coolest city on earth. Did you like that?

 

Kamsiah:

Yeah. Of course. I love it.

 

Howard:

Would you rather live in Kuala Lampur or Perth?

 

Kamsiah:

Perth.

 

Howard:

Is that right?

 

Kamsiah:

Yes.

 

Howard:

How come you don't live there then?

 

Kamsiah:

Well, I have my mother, I have my family here. I was married at the time.

 

Howard:

See, that's why I want to go to Perth so I'll never, ever have to see my family again.

 

Kamsiah:

You bet. Would you bring Ryan with you?

 

Howard:

Would I bring Ryan with you. Get over here and say it. Oh my God. I always tell my 4 boys that they're the only 4 mistakes I ever made.

 

Kamsiah:

Oh, poor thing.

 

Howard:

I'm just kidding. I'm a big teaser. Okay, we talked about the single implant which I really wish you would post that study or post a case or what have you. You know another reason why I really want you to do an online CE course on Dental Town? You know why I really want you to? We have 210,000 dentists on Dental Town, 50,000 downloaded the app on their phone. How many podcasts have we done Ryan? Today we've released our 300th podcast.

 

 

My number one complaint that I always get is from the dental schools. They always send e-mails. They always say, "How come every time you publish an article it's by a man? If you published an article by a woman it's a hygienist or a dental consultant. How come every time you interview someone, if it's a dentist it's a man, if it's not a dentist it's not. If it's a woman, it's not a dentist?"

 

 

I think that, in this country, you go to many countries and the majority of dentists are women. So many countries, you'll go to their country and you'd walk away thinking all dentists are women. But in the United States, 25 years ago it was mostly men and now it's half women and I think they're starving for women role models and I think young 22, 23 year old girls in dental school don't want to listen to a bunch of short, fat, white bald men. They want to hear it from ... like I say, I think your work is actually world class. Hell, you've gone all around the world learning this stuff.

 

 

Let's go back to implants. Do you do the all on four?

 

Kamsiah:

Yes.

 

Howard:

Can you explain what that is? There are some kids listening to this that might not understand what the all on four implant system means.

 

Kamsiah:

All on four doesn't mean just four implants. It's a concept. Basically, the concept is immediate loading and using the Palo Malo protocol. But nowadays there's a lot of people who modify the [inaudible 00:42:29] not using these protocols and claim failures. That's why I prefer to learn from the person himself.

 

 

When I learned DSD from Coachman, when I learned the single tooth over denture, I learned it from actually Hendry who invented it's design. When I had to learn about all on four concept, I learned from Palo Malo. When you go around the world, you see all on four cleanings but they're using internet hacks. They're not using the protocol and they're having problems so it's unfair if you are not learning properly and you have problems and blame it on the technique. Just because you can angle the digital implant doesn't mean that all system, you can do it that way.

 

 

If Palo Malo can do it as an immediate loading it's because he has his protocol. He did 1,000 or so cases before he published all this and I've seen how he worked. He'd use left had for the left implant, right hand for the right implant and he doesn't use any guide. He goes in he says, "Oh, I see a [inaudible 00:43:53] design. Where's your guy?" It was silly, now I just ask him, he says, "Oh we shall see. We shall see." So I said, "Okay." And I look and I see that the way they put implants like, very systematic if they know that they can get enough loading or the AP spread. They put 5 or 6 on the use of [inaudible 00:44:19] implants and their oral hygiene protocol is very strict. The design is also very strict.

 

 

The amount of [inaudible 00:44:30], all that are taken into consideration. Some people are using internet hacks or they mix it. It's a big issue everywhere. Everywhere I go, I see how people present or condemn. I think that's not fair and it's not cheap to learn from Palo Malo as well.

 

Howard:

He's in Lisbon Portugal right?

 

Kamsiah:

Yeah, one of the clinic's in Lisbon.

 

Howard:

Is that where you went?

 

Kamsiah:

Yeah, I went to Lisbon a couple of times.

 

Howard:

Did you know that was the first city I ever went to outside of the United States? You know why I went there?

 

Kamsiah:

Mm-hmm (affirmative).

 

Howard:

In our high school, they would rent a 747, they filled it up with about 500 Catholic high school boys and they would fly them to Lisbon Portugal to spend 2 weeks at Fatima because every time they did that trip they could talk about 15 to 20 boys of not coming back home and going straight into the seminary to become a Catholic priest. I got a free trip to Lisbon Portugal and they didn't get a free Catholic priest out of me but I sure did have fun in Lisbon Portugal. That is a beautiful place. Are you good friends with Dr. Malo? Dr. Palo Malo?

 

Kamsiah:

Yes, yes.

 

Howard:

Can you introduce us too? Do you think we could get him to do an online CE course on Dental Town?

 

Kamsiah:

I can ask him.

 

Howard:

I think that would be an amazing course because I think the all on 4, that was started with Noble Biocare wasn't it?

 

Kamsiah:

Yes, and he presented the course himself.

 

Howard:

Like you say, there's a lot of people who are doing different versions of the all on four but what your saying, it's not the same protocol with the same success. Is that what you're saying?

 

Kamsiah:

Exactly.

 

Howard:

I think it would be world class to hear from the horse himself on a course in Dental Town, what his protocol is.

 

Kamsiah:

Yes exactly.

 

Howard:

I think that would be amazing. And he's got a big audience. There's 210,000 dentists on that site from all around the world so it would be a great introductory platform and then if people could watch that and they wanted to learn more they could fly to Lisbon Portugal and who knows? Maybe they'll learn how to place implants and become a Catholic Priest at the same course? Does he do that on the side? Does he have an implant catholic priesthood course where it's a mix?

 

Kamsiah:

I know that he has a wine factory or some orchard. You could use his wine.

 

Howard:

I think all Catholic priests drink a lot of wine. I don't think I've met one that doesn't. What percent of your practice is All on 4 implants? Is all on 4 the majority of your implants or is that just one treatment protocol that you do?

 

Kamsiah:

One treatment protocol. It depends on cases. I prefer to do all on 4. I like to do all on 4 compared to other cases. I don't like to do ...

 

Howard:

Now in his protocol, do you have to use Noble Biocare implants?

 

Kamsiah:

Yeah, he has his own Nobel Speedy. It's almost like the old [Bronomar 00:48:15] implant but he came out with Nobel Speedy.

 

Howard:

Nobel what?

 

Kamsiah:

Speedy.

 

Howard:

Speedy? Like S-P-E-E-D-Y?

 

Kamsiah:

Yeah.

 

Howard:

That's your favorite for the all in four?

 

Kamsiah:

Yeah, that's his implant.

 

Howard:

That's what you use?

 

Kamsiah:

Yes.

 

Howard:

You also trained with Dr. Brandmark?

 

Kamsiah:

The first time.

 

Howard:

He just passed away last year.

 

Kamsiah:

Yeah.

 

Howard:

What was he like.

 

Kamsiah:

Not last year, the year before.

 

Howard:

What was he like?

 

Kamsiah:

Hmm? I can't really remember in 1990. He came to Malaysia in '94 or '93 I think.

 

Howard:

How many countries have you trained in? You've trained in Sweden, in Portugal, in Australia, in Malaysia and Anaheim. You're ...

 

Kamsiah:

Taiwan.

 

Howard:

Taiwan. You're a world traveler. Do you do that because you like to travel or you like to learn or you just like to mix them up and travel and learn?

 

Kamsiah:

I did like to learn. I didn't actually travel for fun. Most of the time when I travel ... in Malaysia, yes, yes, I travel a lot for fun. Just travel with my kids, things like that. Now, when I travel, it's because I'm attending a course or I'm giving a course, things like that. I don't like to travel anymore.

 

Howard:

Did you like going to Anaheim in California? Did you have fun there?

 

Kamsiah:

Yes I did.

 

Howard:

Did you get to see Disneyland?

 

Kamsiah:

No I didn't.

 

Howard:

You didn't? Oh my gosh. You might be the first person that ever came all the way from Asia to Anaheim and skipped Disneyland. I think you might be the first.

 

Kamsiah:

When I asked my husband would we go on the roller coaster, things like that, he said, no he wouldn't go so I said, "Okay, then I'm not going." When I go there, I attended the course but he was not attending the course so I don't know what he did. He probably go to the bookshop or something like that. He is studying George Washington. He studying America, my husband.

 

Howard:

He's studying there now?

 

Kamsiah:

No, no, he was. He studied in George Washington University.

 

Howard:

What is he? Is he a dentist?

 

Kamsiah:

No, he's an MBA.

 

Howard:

Oh an MBA?

 

Kamsiah:

Mm-hmm (affirmative).

 

Howard:

I have an MBA. I think I enjoy economics as much as dentistry I really, really love economics. Do you enjoy economics?

 

Kamsiah:

I listen to your MBA and it makes sense. My two children study accounting.

 

Howard:

You listened to my 30 day MBA? Did you listen to that on iTunes or YouTube? Where did you listen to that at?

 

Kamsiah:

I see your podcast.

 

Howard:

Okay yeah. I put that up on there. Back to Gerodontology. There's the extraction of all the teeth and doing the all on four implants but what else do you think our listeners should know about gerodontolgy because, elderly people ... in fact, I just read last night, the fastest growing segment by percentage only is people that made it past 110. The second is people that made it past 100 because percentile-wise, old people is the fastest growing segment of the population. What do you think general dentists should know more about when treating the elderly?

 

Kamsiah:

Well they're actually almost the same just that, you have to deal more with their family and whoever is their caretaker who brings them in. Malaysia is still fortunate. Not many of us send our parents to the old folk's home or geriatric centers and most of my patients, they are brought in by their children and I make sure that their children will understand what treatments the father or mother needs to do. If they can, they will see grampa cleaning for hygiene and if there's caries, we take care of that. If they need, I try not to make a new denture because it will be very difficult to have a new denture at at that age.

 

 

If I need to do a new denture then I will just replicate the old denture and give them a new one. You will see, the young dentists will see more of the elderly patients with teeth now than before. Maybe some areas of our population we have a lot of old people with dentures but we are seeing more and more patients with teeth nowadays.

 

Howard:

I don't have to worry about an old folks home because in the United States, only about 5% of Americans will ever live in a nursing home or an old folks home. It's only about 5% but it's almost entirely women.

 

Kamsiah:

Because they live longer.

 

Howard:

Because they live almost 5 years longer. I'm very lucky. I'll probably just drop dead of a heart attack in the kitchen and probably grabbing a piece of cheese and a beer out of the refrigerator. Just fall over dead. Those darned women, they just keep living and living and living. Yeah, you go into a nursing home, only 5% of Americans go into a nursing home and it's almost all women.

 

 

When I go into the nursing homes, and I've gone into a dozen of them within 10 miles of my dental office at home. It seems like the number one problem is root surface decay and the research is showing that when you put a lady into a nursing home in America, they get about 1 root service cavity per month that they're in there. So by the time they've been in there one year, they have 12 new cavities.

 

 

Do you see much root surface decay and what are your thoughts on root surface decay? How do you prevent or treat that?

 

Kamsiah:

To prevent is still the same. Oral hygiene, who ever's taking care of them, the brushing, the interdental cleaning, the rinsing but if there's a cavity, I just place a glass ionomer on the root surface.

 

Howard:

I think that's so interesting you said glass ionomer. When you look at GC out of Japan and glass ionomer, it's huge in Asia, Australia, New Zealand. You're in Malaysia, you just mentioned it. Yet Americans almost, they hardly ever use it ever and like most Americans, if they had a grandma in their office with six root surface cavities, they would use just an Ivoclar, Heliamolar, Tetric, just a resin composite. Why do you use glass ionomor and do you think that's better than the majority of Americans that would just place an inert plastic composite from Ivoclar?

 

Kamsiah:

One, you don't really have to isolate the teeth. If you do composite, you don't have to isolate. Imagine putting a rubber band on an elderly patient. They will probably get nervous and try to pull it off or something like that. [inaudible 00:56:47] it's easier.

 

Howard:

Do you think the glass ionomer is more anti bacterial and prevents recurrent decay more than just say a straight resin composite from 3M or Ivolair?

 

Kamsiah:

Nowadays, [inaudible 00:57:05]. What structure of the cell at the root level. You're not talking about enamel, you're talking about Cementum. It's a different property isn't it?

 

Howard:

Yes, but do you think the glass ionomer prevents more recurrent decay than a standard resin composit?

 

Kamsiah:

No idea.

 

Howard:

That's not the reason you're using it. You're using it more from the handling characteristics of being able to place it with more moisture.

 

Kamsiah:

Faster.

 

Howard:

Faster

 

Kamsiah:

Mm-hmm (affirmative).

 

Howard:

Have you ever gone to Japan? Have you ever gone to the place where they make Fuji or any of those areas?

 

Kamsiah:

I've been to Japan. I have been to the factory now.

 

Howard:

You didn't visit GC?

 

Kamsiah:

No.

 

Howard:

After I get done lecturing in Singapore, I'm going to swing by Tokyo.

 

Kamsiah:

Oh wow.

 

Howard:

Yeah, I think that would be fun. Actually, Ryan's going with me. Did you talk me into that? Was that mine or yours?

 

Kamsiah:

Is it next month? Is it next month?

 

Howard:

Yeah, yeah.

 

Kamsiah:

It's still snowing in Tokyo.

 

Howard:

Is it? Well we just had the blizzard of 2016 here in the United States and in Phoenix, it got down to a bone chilling 61 degrees. Of course you don't know what 61 degrees is because you probably use Celsius right?

 

Kamsiah:

I think the formula is 52 plus something isn't it?

 

Howard:

I think America is the only country that doesn't use Celsius. We're a little behind the times in so many things. That's our hour. That was the fastest hour I think I've ever done on a podcast. I really wish you would create some online CE courses because I've seen so much of your work. I think you're seriously amazing at what you do and I think the young women in dental schools want to hear more from the established role models like you.

 

 

In fact, I was pointed to you by a dozen different people that said, "Check out this dental diva in Malaysia, she is the bomb." Thank you so much for spending an hour with me today and maybe when I'm all the way to Singapore, who knows? Maybe I can swing by Kuala Lampur. Ryan do you want to take a flight and go to Kuala Lampur?

 

Kamsiah:

Yes.

 

Howard:

Yeah, maybe me and Ryan will hop on a plane and fly to kuala Lampur. Kuala Lampur, is that where the Petron towers are?

 

Kamsiah:

Yes, yes.

 

Howard:

Are those still ...

 

Kamsiah:

The three towers.

 

Howard:

Yeah, that is amazing. Are you close to there?

 

Kamsiah:

Yeah, quite close. I'm at a suburb, it's close.

 

Howard:

Do you go there very often?

 

Kamsiah:

Yes, that's a shopping mall. A nice place, they have a park. You would like it.

 

Howard:

Oh I bet I would. I've always wanted to see those. Thank you so much for spending an hour with me Kamsiah and again, I hope you put a course on Dental Town. Congratulations on learning dentistry all the way from Australia to Lisbon to Taiwan to America. You are such a role model of what dentists have to do and that is, when you become a dentist, you've committed a lifetime to continue your education.

 

 

You can't just walk out of dental school and do dentistry for 40 years. You just never stop learning do you?

 

Kamsiah:

Exactly.

 

Howard:

On that note, I hope that everybody listening to this today learned, unlearned and re-learned something new.

 

Kamsiah:

Yes. Thank you Howard.

 

Howard:

Thank you Kamsiah and thank you so much for getting up at 3 o'clock in the morning to do this.

 

Kamsiah:

Thank you.

 

Howard:

Are you going back to bed?

 

Kamsiah:

Of course.

 

Howard:

Okay, all right nite-nite. Goodnight.

 

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