Thirty years ago, Dr. Dan German started an orthodontic practice which became one of the largest privately held practices of its kind in the country. He served on the faculty of the Ohio State University where he trained post-doctoral residents and was an attending clinical doctor until 2016, when he founded orthobrain™. Dr. German is well known throughout the dental world for treating and educating professionals on how to correct the entire spectrum of malocclusions, all while rendering exceptional service. Dr. German is devoted to solving dental problems using new and better solutions. He helped develop systems for an easy and precise way to place braces without any lab work.
Dr. German pioneered the use of Clear Aligners for orthodontics. His techniques
have been taught around the world.
For more than 25 years, Dr. German has shared his knowledge and insight about orthodontic diagnoses, treatment plans, and appliance design with specialists and general practitioners. His articles have been published in major dental and orthodontic journals and he has presented at national association conferences. Dr. German has traveled the world as a keynote speaker, teaching the clinical aspect of orthodontics and practice development to specialists and general practitioners. He recently participated in a two-week teaching tour starting in Australia where he lectured at the National Orthodontic Society, the University of Sydney, and the Equilibration Society in Chicago. He also presented at the American Association of Orthodontists annual, international meeting, which attracted nearly 15,000 people from around the world. Dr. German received the coveted Distinguished Alumni award from the University of Louisville Orthodontic Department. It is only the second time in the history of the school that the award has been bestowed.
Through the years, Dr. German’s mission has remained the same: to create raving fans while transforming the way dental healthcare is delivered.
Dr. German is most proud of his role as a dad and grandpa, raising seven children with his wife, Teri. Fitness, learning, and teaching are his hobbies.
VIDEO - DUwHF #1022 - Dan German
AUDIO - DUwHF #1022 - Dan German
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Howard: It is just a huge honor for me today to be podcast interviewing Dan German of Orthobrain. Thirty years ago, Dr Dan German started an orthodontic practice, which became one of the largest privately held practices of its kind in the country. He served on the Faculty of the Ohio State University where he trained post doctor residents and was attending clinical doctor until 2016 when he founded Orthobrain. Dr German is well known throughout the dental world for treating and educating professionals on how to correct the entire spectrum of malocclusions, all while rendering exceptional service. Dr German is devoted to solving dental problems using new and better solutions. He helped develop systems for an easy and precise way to place braces without any lab work. Dr German pioneered the use of clear aligners for orthodontics, his techniques are being taught around the world. My gosh. Thank you. I'll keep reading. For more than twenty-five years Dr German has shared his knowledge and insight about orthodontic diagnosises, treatment plans and appliance design with specialists and general practitioners. His articles have been published in major dental and orthodontic journals and he has presented at National Association conferences. Dr German has traveled the world as a keynote speaker teaching the clinical aspect of orthodontics and practice development to specialists and general practitioners. He recently participated in a two week teaching tour, starting in Australia, where he lectured at the National Orthodontics Society, the University of Sydney, and the Equilibration Society in Chicago. He also presented at the American Association of Orthodontics Annual International Meeting, which attracted nearly fifteen thousand people from around the world. Dr German received the coveted distinguished alumni award from the University of Louisville. Orthodontic department. It is only the second time in history of the school that the award has been bestowed. Throughout the years Dr German’s mission has remained the same - to create raving fans while transforming the way dental healthcare is delivered. He is most proud of his role as a dad and grandpa raising seven children with his wife Terry. Fitness learning and teaching are his hobbies. Seven children. You have to be Catholic or Mormon. Which one is it?
Dan: One more guess Howard.
Howard: Jewish. Really?
Dan: Yes. Shalom.
Howard: Now is that as common to have seven children in the Jewish faith as it is Catholics and Mormons?
Dan: Absolutely. The more religious and traditional a Jew is, the more children they tend to have.
Howard: Yeah. You know what's funny because I have four kids and people think that's a big family, but I grew up with seven kids and my ex grew up in a family of seven kids. So to me four kids is a small family.
Dan: Right. It's so much more fun around the Thanksgiving table...
Howard: Oh, I know.
Dan: .. and all the life cycle events. You just can't beat it.
Howard: Yeah, I know my kids and grandkids, that's 80% of life and everything else is just a footnote.
So your name is German, but it's spelled like German. So if you're listening to this, if you're trying to spell Germann, it's just German. So how, how did you take the word German and pronounce it German?
Dan: We'd have to ask the folks that were working at Ellis Island in 1919 when my grandparents came over on a boat from Poland in the Ukraine. And a letter got dropped and you end up with Garman
Howard: Well, one of the things I want to do, and I might take a break from the podcast now, I love your website and you have a like five videos on this, would you mind emailing a youtube file or some type of a file that we could just insert them into the podcast right now, so they could actually see what you're doing and then we'll talk? Because you’ve really got some nice videos that explain.
Dan: Offering orthodontics in your office is your business. Helping you get great outcomes with a diagnosis, treatment plan, appliance design and support during treatment is our business. You send us photos, x-rays and impressions, we send you a personalized proposed diagnosis, treatment plan, appliances, and whatever supplies and support you need along the way. See our website for more details on services we offer to help your team and your patients look their best.
Do you have orthodontic relapse patients? One to three teeth that need corrected? We can teach you to competently treat patients using aligners or braces. This is a great way to accommodate patient’s desire to stay with you and your trusted team. Patients save money while you are paid handsomely. Visit our website to view our quickstart guide with photo examples of ideal first patients.
In Orthobrain, written diagnosis and treatment plan will be branded for your practice to add confidence and awareness to your patients. The written report will include pictures of models and abnormal findings. Each treatment objective will have a color coded prognosis to help you and your patient feel good when expectations are met or exceeded. The thoroughness of the detailed personalized treatment plans will give your team and your patients confidence and trust.
The video of a proposed diagnosis and treatment plan is intended to help you learn orthodontics directly from an expert orthodontic specialist, that is reviewing your patient. We carefully look at all of the photographs and x-rays to help you create a comprehensive diagnosis and treatment plan. Our video should help you learn orthodontics while giving you the confidence to make you and your patient look good. By means of an example, let's look at the midline difference between the upper and lower arches. You'll note that the lower midline is to the left of the upper midline. This is the result of several factors. Looking at the occlusal view of the lower arch you can see that there is more crowding on the lower left than on the lower right. Therefore, the lower right teeth have drifted over to the left, giving us the midline difference. Another factor contributing to the midline shift is the crossbite between tooth number ten, the upper left lateral incisor, and the lower canine. As you know, crossbites can oftentimes contribute to shifting of the jaw. Finally, looking at the upper arch relative to the face, you can see that the upper arch is just a little bit to the right of the facial midline. So combining those three factors gives us a significant shift in the upper and lower midlines. The video would continue to diagnose each of the different problems that we see and then also provide a proposed treatment plan to resolve all those issues. Doctors tell us that our diagnosis and treatment plans give them the confidence to treat more orthodontic patients.
Orthobrain helps you get the best possible outcome for your braces patients by providing digitally fabricated, ready-to-bond braces trays and wires with instructions. Our expert orthodontist revises the digital setup and braces placement to create the best possible smile and bite for your patient. You have confidence that an expert specialist is helping your team and your patients look their best.
Orthobrain helps you get the best possible outcome for your Clear Correct patients with two options. One, our expert orthodontist revises the digital setup to create the best possible smile and bite for your patient. The other option to help you, is by our orthodontists creating a video that explains what should be altered with the digital setup. You submit the changes to Clear Correct, while learning from our personalized coaching video. Either way, you have confidence that an expert specialist is helping you and your patient look their best.
Orthobrain helps you get the best possible outcome for your Invisalign patients with two options. One, our expert orthodontist revises the digital setup to create the best possible smile and bite for your patient. The other option to help you, is by our orthodontists creating a video that explains what should be altered with the digital setup. You submit the changes to Invisalign, while learning from our personalized coaching video. Either way, you have confidence that an expert specialist is helping you and your patient look their best.
Howard: So I'll just ask you, what is Orthobrain?
Dan: Excellent question. Orthobrain is a group of really smart and really dedicated people that are working in conjunction with a really sophisticated but easy to use software platform, that allows dentists of any experience level or no experience level, to provide great orthodontics. The idea is that we want to radically expand the orthodontic market, so we're not looking to take orthodontics away from the orthodontist, we're looking to to get orthodontics around the world at a much greater level. We believe that the orthodontic market can grow exponentially and we feel that it should and we feel the fact that it hasn't happened yet to be shameful. The profession could sure do a whole lot better and now with the digital revolution we're able to scale this whole concept of transforming the way orthodontics is delivered.
Howard: Well, you know, the Wall Street boys, they just have a better way of looking at the world than most of all the people in the heartland and they think the orthodontic market can grow ten x when they're talking about the share price of Invisalign. I was born in '62, when I was little all these big Catholic families, five to ten kids, just the most crazy malocclusion would get treatment. But now fifty years later you see forty year old women with just a slightly crooked tooth and she wants ortho. So when you start looking at the expectations of the cosmetic and beauty market, everybody wants a better smile even though fifty years ago, all these people go... half the people getting invisalign today wouldn't have even been a candidate for ortho fifty years ago. Do you agree that the fine tuning of teeth is just going to keep growing and growing and growing?
Dan: Yes, and I think the ten times growth is a gross understatement, that we're only treating a fraction of a fraction of a percent of the world population. At last count, there were about seven and a half billion people roaming around. Seven and a half billion! Profit, in his famous textbook, tells us that 66% of the population would benefit from orthodontics. 66% is high. General dentists peg that number at 55%, and the public's only at 35%. So there's a huge divide between the orthodontic specialists who are really keen on recognizing the problems and then to the public. And even though you have all these folks that are nitpicking, using your phraseology, they're right, they have malocclusions. And one of the most fascinating things that has come out, is that worldwide people judge the book by the cover. So in other words, when somebody meets you and they see your smile, it affects the way they rate your intelligence, your leadership ability, it's going to affect your chance for success. And it's a fact. This is all published in the American Journal of Orthodontics. This is not low level findings and anecdotal findings, it’s now research. And so from a success standpoint, an opportunity standpoint, we know that we have the ability to help people achieve success. And even when you go into places, small countries in the Middle East, which is where some of the bullying research was done, we found that if you have a malocclusion, you're much more likely to be bullied. So from that self esteem and opportunity for success, the people who are seeking treatment are right on. What just came out this past week from the American Journal of Orthodontics and for general dentists who might not frequent that journal and have occasion to read it, it's probably the most difficult journal to publish in, certainly an orthodontics, really high level research that comes from around the world. And in the April issue, there's an article, prospective study, that shows that if you have crowding or spacing of the upper or lower anterior teeth, you are much more likely to have progressive periodontal disease. And the general dentists, all dentists are hip on the idea that there is an impact on your systemic health, as well as the consequences of periodontal disease, so from a medical standpoint and from an ability to succeed in life, the people who are seeking treatment, they're right on. They're helping themselves. It's a great idea. And so yeah, the side effect is from a vanity standpoint, they might feel better, but it's going to help them.
Howard: So many of those journals, they always talk about oral health, dental health, but oral health and dental health has more to do with mental health. More people are concerned about what their teeth look like than if they have periodontal disease. I once read an article in the Economist and I didn't believe it. I thought, “Nah, this is wrong.” It said that female, Chinese women spend 40% of their disposable income on hair and beauty and makeup and beauty stuff. And I thought, “No way, 40% of disposable income.” And then Ryan and I went and lectured, you know I lectured in China, Indonesia, Malaysia, Cambodia and every one of those cities, you'd be at a hotel or a restaurant or a bar and the waitress would have Invisalign and I'd say, “How much did that cost?” and then they’d tell you in US dollars and it's like, “Oh my God,” this girl's... her teeth are fine, she's gorgeous, but she's spending a huge chunk of money on just making her teeth slightly prettier and then you put her in the makeup and the shoes and the purse and all that. So mental health has far more consequences related to dental health than any journal will ever talk about. Everybody just wants to look younger and more pretty and more beautiful. It's a crazy market.
So I want to first ask you about the four hundred thousand million pound gorilla in the room or the elephant in the room, and that is orthodontists don't like anybody teaching general dentists ortho. Can general dentists use Orthobrain?
Dan: Yes. Yes, absolutely. So most of our clients are general dentists. And you're spot on. You're exactly right. Orthodontists tend to get militant when anybody treads on our territory. I'm an orthodontist. I'm a short hair orthodontist. I wear a tie or a bow tie and starched shirts. I'm a traditionalist in the sense that I look and act like an orthodontist in many regards, but I have never felt that it is a territory that we own. So from the beginning of my career, I've always been out there helping the local general dentists nearby office provide orthodontics. I view dentists as we're all colleagues. I'm a dentist. I happen to specialize in orthodontics, but I am a dentist and so I believe that primary care ought to be able to do a broad scope of dentistry and I find it shameful and embarrassing that in my profession, we don't educate dentists on how to do orthodontics.
Now, when you went through dental school, it was probably a similar experience as to what I had. Most of the dental schools, there are exceptions, Howard, I'm certain there are exceptions, but for most of the dental schools, when you take the orthodontic course, you're asked to bend a wire. If you go to the Ohio State University, maybe they're going to ask you to bend the script ohio. That's not an easy thing to do, so you've already scared probably 90% of the dental students away from doing orthodontics because they can't bend the script ohio. Then you go into the classroom and we learn growth and development, which is important, everybody should learn that and then we throw this cephalometric analysis at people and we start defining these anthropologic landmarks and the names and the measurements and the calculations and after the dental students hear the courses, they're scared, they don't think they can do it, they don't think they're smart enough to do it, and I happen to think that dental school is a great time to learn how to do orthodontics. Why? Because you're there for four years, so in four years you have the opportunity to make some diagnostic records your first year, get some patients going, you don't have to rush through it. Many of the residencies are two and three years long, which is about how long it takes to treat a comprehensive patient. You don't even have time to treat a two stage patient where you do an interceptive stage and then a full treatment as the resident. In dental school you're there for four years, you've got abundant opportunity to learn how to do it. And honestly, we could do a heck of a better job, but we act like a guarded guild where we only let a small number of residents into the programs each year. And we have states that don't have any residencies and there’s some selection bias. So I think it's grossly unfair and... look before our time, you and I are the same age Howard, before time it was hard to do orthodontics. It really was hard. You had to be an incredible technician. So I'm old enough that early in my career I had to weld attachments onto bands and sometimes I even made my own bands and I had to (18.18 sounds like sodder) and we bent wires from a spool. So you had really know how to bend wires and you had to know how to create the braces. And when you put a band on every tooth, it's hard, and the only thing harder than putting a band on every tooth is taking the bands off of every tooth and leaving all the teeth in, you know, it can hurt. So orthodontics used to be technically very difficult to do. It isn't anymore. And so it's much more of a cerebral game. It's a cerebral activity. And that's the idea behind Orthobrain, is that you're able to take orthodontic specialists brains, and there's only eight to ten thousand of us in the whole country practicing orthodontics with a specialty education, we can't possibly take care of all of the people that are in need. However, if we take our brains and we leverage our brains, we can reach out around the world and orthodontists can provide care remotely like I am, so that orthodontists are working with Orthobrain to be able to touch people in areas that otherwise wouldn't receive the care. So I believe that we're really offering a great opportunity to orthodontists to be able to find an alternate way to earn a living into practice and to leverage their knowledge that they have and the experience, especially when you get guys our age who have abundant experience. You can't learn experience from reading a book. So we're really able to offer something to people around the world using our minds because now with aligners, whether it's Clear Correct, Invisalign, or any aligner company, the technical process is not nearly what it used to be. So let's take advantage of it and make the world better.
Howard: A lot of these dental schools are public institutions paid for by taxpayers. A lot of these dentists graduate from dental school, a public dental schools, they complain about their student loan debt. But what they don't realize is that the waitress at the waffle house picked up half the tab and it's okay for half of America, where half of America lives in a hundred and forty seven metros with all nine specialties, but when you go to those nineteen thousand and eight towns, these kids were sent back from public institutions to a town of fifteen hundred with no orthodontic training and that's not fair to the rural people. The rural people always get the short end of the stick, they pay half the taxes, but every time they build a museum or a stadium or a dental school or anything, it's always in the urban. And I just think it's unfair when these farmers are picking up half the tab of these dental schools and then the kid that comes to practice dentistry, the mom's asking at six years old “Is my kid's teeth okay?” And he's never even done a RPE, he doesn't know anything. And all he can say is, “Well, you know where the airport is, two hours away from here, where you catch Southwest Airlines? There's an orthodontist over there and you need to drive two hours to go see the orthodontist.” So it's not a good story.
Do you think digital has changed this whole world. I mean you were talking about when you and I were little, yeah we used to bend stainless steel wires and then they came out with nickel titanium. But what do you think has been more powerful? NiTi or digital technology?
Dan: Digital technology is not part of an evolution. Digital technology is a revolution. It will change the entire face of dentistry, not just orthodontics but all of dentistry. And so I think it's a quantum leap bigger than NiTi. NiTi was a nice improvement. It was convenient or it still is. It took the place of some of the really small steel wires that we used. We used to take really thin steel wires and they were woven together and you would put them in and they worked. I mean, honestly, they worked quite well, they're not as slippery as a NiTi, but NiTi was a great improvement. Those are part of the incremental improvements in orthodontics. Incremental improvements were improvements in bracket design and arch wires. And then big improvements, I think, are things along the lines of bonded brackets over bands, and then what Larry Andrews did with putting the straight wire appliance together. That was really brilliant thinking. But the revolution is digital. It's on a whole nother level because now it opens up the ability to deliver orthodontics, and really good orthodontics, to any dentist with no experience or with abundant experience to be able to expand the scope of their practices. And it allows us to reach around the world. So there is no area that should be without care because honestly, you know, I'm telling you because we're best friends now that we've spent forty minutes together, this system would work very well with mid level providers. We're not advertising, we're not seeking that. I liked the model of working with dentists and in that format, I believe in that format everybody wins. Patients get great outcomes, dentists get to deliver the care, patients feel the comfort of being with their trusted dentist and not having to leave the trust dentist office, orthodontists have work doing diagnosis and treatment planning, which is a core part of Orthobrain, and so there are no losers. Everybody wins. Even the vendors because we're making more supplies, so it's all good.
Howard: Okay, so how are you different than being an Invisalign provider? What is Orthobrain doing that if you were an Invisalign provider? Because Invisalign, Aligntech owns Invisalign, but they also bought iTero, and so you can orally scan and send them in and they'll give you a treatment plan and all this. What do you do differently?
Dan: Well, it's an excellent question and for a lot of dentists that are not orthodontic specialists it's really confusing. So let's get into it. Invisalign is a laboratory. They manufacturer aligners, so as a laboratory they do not provide a diagnosis and so every patient that receives orthodontic care ought to go through a certain number of steps. So to talk about a few of those steps and just in list form, there ought to be charted clinical findings, there ought to be high quality diagnostic records, there should be a written problem list of all the things wrong with the patient, there should be treatment objectives, there should be a prognosis for each objective so that the patient knows whether or not it's reasonable to have a certain expectation, there oughta be a summary diagnosis, and once you have that, then you can create a treatment plan and a treatment plan includes sequencing treatment. At what stage do you do carries resolution? When do you involve perio? Do you do the grafting for a lack of attached gingiva before, during, or after treatment? When do the restorations take place? Do you put a temporary on for all these adults that are seeking treatment? How do you sequence all the treatment and collaborate with the other doctors. And then once you have all that Howard, then you get in to what I call appliance design. Appliance design is what you do when you interact with Clear Correct or Invisalign or a braces vendor. So for any of them, you have to have all those other pieces of the puzzle in place, then you can go in and you can look at what Align or Clear Correct proposes as a sequence of aligners and teeth movements. That is a design of appliance, but it isn't the treatment plan. So a treatment plan, when you send a bridge, impressions for a bridge and the lab goes to wax it up, they're not making a treatment plan for you, they're making a bridge. Align and Clear Correct, they're making aligners. There is no orthodontist that is diagnosing, treatment planning, and designing those aligners. There's a big room with a lot of computers and technicians. They make the models pretty. The software makes the teeth straight. They throw it at the dentist, the dentist looks at it, and the stats I've heard, and these are not factual, are that 80% of the time the dentist accepts it and says, “Well, I guess that's what Align thinks is going to work best.” But those plans, those teeth movements, don't take into account the boundaries of teeth movement. They don't take into account what's going to happen from a perio standpoint. They don't have the ability to take all that into consideration. Now maybe there'll be some AI, artificial intelligence, in ten or twenty years, but right now that doesn't exist. You need a doctor to create a thorough diagnosis with the objectives and the prognosis and a specific treatment plan, and then after you do that, you can design the appliances, whether its braces or aligners, and then when you're in treatment you need progress records and you look at the progress records because you have to rechart the course. Every time you see the patient you have to evaluate how you're proceeding and whether or not you need to change the tact a little bit in order to get the appropriate outcome and when you get to the end of treatment and you have a raving fan, in terms of a patient, then you design a retention plan that's appropriate and you make another set of pictures, records, and you do an assessment to evaluate what's been done so that you can communicate to the patient. All through that there are things such as informed consents and documented notes that need to take place. We're not beauticians, we’re dentitions. And so if we count on Clear Correct and Invisalign and whoever it is that you use to design your braces, hopefully it's Orthobrain, to come up with the treatment and run the whole treatment, you have no differentiation between the dentist providing care and mail order dentistry. Because that's essentially mail order dentistry. When dentists take things from the vendors, from the labs and deliver them to the patients and all they're doing is taking it out of a box and handing it to a patient, you're essentially doing mail order and you're a middleman for the mail order. If you want to differentiate yourself and provide some real doctoring, then you need all those things and that's where Orthobrain comes into play. We give you all that. So once we have the photographs, x-rays, impressions, then we can create all those things because we have the education and the eye to do it and I have the time. Your time as a general practitioner is going to be much more productive if you're doing crowns and bridges and placing implants and doing your dentistry, so you outsource to an expert in order to create all those different pieces including the appliance design. So Orthobrain will design the braces, will put the brackets right where they need to be on the teeth and send you ready-to-bond trays, with instructions.
Howard: Your website is yourorthobrain. Beautiful. So what does this service cost?
Dan: Because we offer service to any dentist of any experience level and to orthodontists, we have a variety of different options to meet their needs. Our company is designed and built to serve our clients so that I have raving fans. So for most dentists, who are just getting started, they need everything. They're gonna want a comprehensive diagnosis and treatment plan and they're gonna want all the attendant instructions and the collateral materials to give their patients, and they're going to want me to design the braces or the aligners, and have all that delivered to them so that they're ready to put glue on the back of the braces and have the team glue the braces on. If you think it would help for you to see any of that stuff, I can actually show what some of these things look like.
Howard: Right now?
Howard: Go for it.
Dan: What would you like to see? Do you want to see braces?
Howard: Show us. Show us everything.
Dan: Okay, so these are…
Howard: So you're not making the clear aligners though, right? Or are you making them?
Dan: This is something I make. This is from Orthobrain and these are ready-to-bond braces inside of trays.
Dan: So you and your team put the glue on the back of the braces and you slide this on the teeth and now you have put the braces on more accurately than I can, without the computer and the digital setup. So if you've been to Clear Correct or Align to do aligners, you know how you make the teeth straight. We use the same kind of software to make the teeth straight and perfect the position of the teeth. Then we put the braces on and Howard these trays are all printed, so there is no lab work associated with this. I'm only showing the model so that our viewers can appreciate how they put these on the teeth, but there is no model. So that's how we do the braces and when the braces arrive they come with written instructions and they come with a bag and the bag says wire number one. So when the treatment plan says place wire number one, you're going to know which wire to place. And if you don't take the time to read my notes in the treatment plan, we include notes with the wires so that you can look inside the bag and get some user instructions. And after you're finished with wire number one, you're going to use wire number two. And so everything is clearly labeled and everything has instructions. Instructions are actually on the treatment plan. The treatment plan is available on our secure software, so we have the secure software platform, and so when a dentist has a report to review, they get an email notification to go on to their dashboard, their Orthobrain dashboard, and they view the report and the report is all branded for them. There is no mention of Orthobrain because we're not marketing Orthobrain, we're marketing our dentist. The dentist is my client and so I'm doing everything I can to make the dentist become a success, a huge success. This is an example. The reason why I'm showing you this case is because this is the first time the dentist ever did anything with orthodontics and we sell a camera system with instructions where the first time you ever used the camera you ought to get pictures like that. And I know it's astounding, but what we do, is we try and make everything is easy as we can for the dentist. So we have a camera system and you can buy the camera system and it comes with instructions and so if you flip this around, you'll see that there are instructions that come with this that tell you the two settings that are on the camera so that you can make pictures the first time with the first patient that are predictably good like this, and we do that with every clinical procedure so that the dentist is going to have success. I want my dentist to do orthodontics to the same type of quality that an orthodontist would do. It's a big goal, but we're going to do everything we can to accomplish that and we're going to show the dentist, using colors, what the prognosis is for each of the treatment objectives. So this is a super easy patient to treat because the dentist has never treated a patient before with orthodontics. So everything is green. He's going to win. If we don't think it's going to work… If the treatment objective is not going to work, say a patient is a full grown adult and they're a full class two, and they're not going to have jaw surgery, they're not going to fix the class two and we'll just tell them you're going to make straight teeth, but you're not going to fix the class two. And then when you get down to the treatment plan, and this is what I think you'll like the most, is there's a lot of writing there, but you can see that there are links. So when we tell you to do something, there's going to be a link that gives you instructions on how to do the procedure, whether it's putting a wire in, taking a wire out, what to tell a patient in terms of instructions.
So we have written instructions and we have video instructions that make up a big part of our programs. So without education and instruction, it's not going to work. The company is founded on diagnosis and treatment plan because that is the foundation. There was a great man, who is still alive and he was and is a giant, his name, you'll be able to guess, he has a famous line, he’d say, “A failure to plan, is a plan to fail.”
Howard: I just posted that yesterday.
Dan: For pete's sake, it's Pete Dawson.
Howard: Well it was actually Benjamin Franklin.
Dan: Well, yeah. Well, I think Benjamin Franklin might've come before Pete, he’s a mature guy, but I think Ben was first. It's a brilliant line and I think one of the problems that we've had, one of the difficulties with aligner therapy is that orthodontists and general practitioners forget everything they know when they receive an aligner, and they think there's some magic medicine in the aligner and in the aligner company and it's all on autopilot and they forget all the four systems that they learned as orthodontists and his general dentists. Sometimes they forget to do things that they know they're supposed to do, like probe the patient before they start treatment and create a real thorough diagnosis and treatment plan. If you're going to do that for a restorative or (36.23 sounds like proths) case when you're very experienced, why wouldn't you do that even more thoroughly when you're going into uncharted waters. If you're going to treat an orthodontic patient and you haven't been to school for it, you ought to go slowly and take your time and make sure you get all the details right. And we're there to provide it for them.
Howard: Okay, I got a couple of questions, I got to go back from what you've already said. When you were talking about align technology, Invisalign, it's like a lab, it's like your crown and bridge guy making a bridge, they didn't make the diagnosis and plan. So then what is your expert opinion of align technology, buying a 17% of Smiles Direct and bypassing the orthodontists and wanting to set up stores in malls where a technician scans you on their iTero scanner, and the next thing you know, they're delivering clear aligners. What do you think of this move to just bypass a dentist and orthodontist altogether and go directly to the customer?
Dan: Well, Howard as you accurately predicted at the beginning there are probably orthodontists that are not happy with me and this will make them really unhappy, because I think it's brilliant. Do I like it? No. Do I wish they hadn't thought of that? Yes. Do I think it's a brilliant idea? Absolutely. That I turned down an opportunity to participate early in the game. Yes, I did. I walked away from an opportunity to be involved with them because there's a better way to do it. Why are they doing it? Because we haven't done our job. We haven't been able to reach all of the people. There's such an unmet need for orthodontic care and as a guarded guild, we haven't done a good job of taking care of all the people, so we created this incredible opportunity and so you have some brilliant minds, these are Wall Street minds by the way, those types of minds get together and they say, “Hey, there's an unmet need.” Smart people that are in business, they're looking for a need, they're looking for an opportunity. And so they saw abundant opportunity and I agree with them in the fact that there is abundant opportunity. It's unmet opportunity. People our age do not want to go to the orthodontic office and sit in a room, were seventy to 85% of the patients are little kids. Like that's not what we want do. We don't want to take our lunch hour and we're dressed up, we're going in there and now we're going to have PVS impressions with a bunch of kids sitting around us. We're not into that. We'd rather do it at home. We'd rather do our own impressions at the mall.
Howard: Isn’t another big macroeconomic problem with orthodontics is that every year, every decade they get faster, they get easier, they get higher quality, but they never go lower in price. That $6,500 for ortho, it's like they're doing everything faster, easier, higher quality, but one thing they're not giving up is the price isn't coming down. Like when I bought my first DVD player, it was $800 and it was horrible. A decade later they’re $35 and they’re perfect. Do you think this trend of bypassing the dentist and the ortho is to make ortho more affordable and that eventually their price will start coming down from sixty five hundred to maybe five thousand to maybe forty nine, ninety nine. Do you think..?
Dan:Yeah, it's an excellent question, Howard, and the answer is yes and no. So now we're switching hats because a lot of orthodontists ask me to advise them. And I think there's a lot of room in the orthodontic market at the high end and I think there's a lot of opportunity on the value end, which is low end. Value and low fees tend to mean the same thing. Those two ends of the marketplace are wide open for specialists and for general dentists. Orthobrain is a much better solution for getting lower cost treatment out there with the benefit of having a doctor supervise the care and having an orthodontist and a orthodontic team that are passionate about doing great care, supervising it. So earlier, about forty five minutes ago, you mentioned something that was exactly right. You said people in rural America are being cheated. They’re subsidizing the universities where we’re educated, but then they don't have the opportunity to reap the benefits of our education by doctoring them. There's another market that's also missed and that's the urban market. Research showed that 60% of all the children in urban Detroit never had the opportunity to get dental care last year. Couldn't even go to the dentist, let alone the orthodontist, just to get their teeth cleaned and an exam. 60%! So you have the urban markets and you have the rural markets. Everybody in the middle has pretty good access. So yeah, I think the fees need to come down, but they don't have to come down for everybody. There's going to be a place for people who want the high touch, high level service, the concierge type care, knowing that they're going to a true expert that has an unbelievable reputation, who's going to be available for them, on call twenty four seven if they have an issue or their child has an issue. That's a different level of service than somebody who's doing mail order orthodontics. I believe there's room for all of them. And that as professionals, if we ramp up and we start taking care of more of the population then it minimizes the need for Wall Street to come in and skip us, because we can do a better job than mail order.
Howard: So another question that came up is when you were ... by the way, if you're listening to this on iTunes, you might really want to go to YouTube, go to Dentistry Uncensored and subscribe to the show, or if you type in the link, it's youtube.com/dentaltownmagazine. But when you held that up, on the treatment plan you mentioned use Clear Correct for this, Straumann which sells more dental implants than any other company on earth, actually bought Clear Correct last year for $150,000,000. Do you mostly work with Clear Correct or did that dentist that sent that in, was he the one who said I use Clear Correct?
Dan: Right, so I'll work with any of the companies. Clear Correct happens to do a fantastic job. It’s an aligner company and they give great support, I think very, very highly of them, and I think that Straumann’s only going to put more wind in their sails. So, look, Aligns been out there for quite a long time and they have a really sophisticated software program to go along with their aligners and I think each of the vendors has some benefits over the other. I wholeheartedly support Clear Correct and I'm a big advocate of theirs and I really liked the way they trim their aligners. I think that there are aligner trim is actually superior to the way Invisalign trims their aligners. So yeah, there are advantages and disadvantages. The Clear Correct can be more economical for full treatment. I'll work with any of the aligner vendors.
Howard: Did you see my podcast with the CEO of Straumann, Marco Gadola, it was podcast eight thirty nine?
Dan: I will write it down and watch it…
Howard: He is an amazing man, I mean an amazing man. And I also think the most amazing dental companies, the CEO makes a religion availability. I've always noticed, like Stan Bergman of Henry Schein came on. I've had so many, Bob Gangly of Ivoclar, the head guy at 3M..., but I can't even get the CEO of a Invisalign to return an email, which makes me wonder. I don't get it, But Straumann is a …, Marco Gadola he’s an amazing man. I also want to ask another thing. When we talked about digital, you said it's not an evolution, it's a revolution. Do you think these dentists should…, in working with you, is it better to get into an oral scanner? I mean, Align Tech bought iTero, do you think the days of an alginate or a polyvinyl siloxane impression, mail it to you? If some kid was listening to you, would you recommend getting into the digital oral scanning technology when they're getting into clear aligners with you?
Dan: I think it's a great idea to use an intraoral scanner. One of the things that many orthodontists appreciate is the importance of the turnaround time to get your patient into treatment. So when your patient says, yes, you want to be able to deliver, and it really slows down the process when you send pvs impressions, it adds days on that front end and it also adds additional work on the receiving end. So when you go visit Align or you visit Clear Correct, when you're in Clear Correct offices, you'll look and you'll see shipping and receiving, all these boxes of impressions coming in. They get the impression, they've got to clean the impression, sterilize it, they make a photograph of the impression, then they scan the impression. It's a big ordeal, whereas with an intraoral scan, you can actually get a setup back within a day and get your patient aligner design going. It's more accurate. I'm a big advocate. I've done extensive testing of various machines. So yeah, it makes sense. It may not make economic sense for somebody who's opening a practice from scratch and they just don't have the volume. For us it was a real simple economic proposition. We did a search on how much we spent for PVS impression material per year and realized that it costs less for us to use an intraoral scanner than it did the buy PVS material. So I think what I suggest …
Howard: But does that include the $200 a month software support agreement? I mean the software agreements are twenty four hundred a year.
Dan: They're getting crazy with the software agreements and it's… so it's a volume driven question, you know, how much work are you going to do? And I like the machines that can do the restorative and (46.23 sounds like: pross) and implant planning, as well as with the aligner planning. If you can do all of the above with a scanner, then you've really got something. So for workflows, I really like it, but you have to have the volume. I don't suggest that the dentist who's trying to make a go of it, do it for the novelty or even for the marketing. Do it when it makes economic sense. Right now is a great time to be out there looking for a scanner because unless you're married to Invisalign, those three shape scanners, used 3Shape scanners are on the market for … They’re all over.
Howard: Yeah, one of the most overlooked things on Dentaltown, is we have free classified ads. There's like sixty five hundred classified ads. You know the value of buying a car, one year old with five thousand miles on it, how much you save. There are so much savings to be made on those free classified ads. And a lot of you dentists listening, if you would go back to your lab, which is your lab / Dental Museum of all these toys that you bought over the years and you don't use anymore, and someday you could spend an hour on Dentaltown’s free classified ads, posting all that stuff for sell and make bank... I had one dentist, just told his dental assistant, “You put all that on the classified ads, you sell it and I'll split the money with you.” But it sounds like you're... there's 3Shape TRIOS out of Copenhagen, Denmark, there's 3M True Def out of Minneapolis, St Paul, but you mentioned 3Shape twice. So is that your favorite? Is that your go to?
Dan: I like a lot of them. If people frequent any of the big conferences they can go out and try the different scanners. They’ve become so easy to use. Even companies that I had never heard of, there's one called Dental Wings, and I went and I saw their scanner and I thought it was fabulous. It was very inexpensive and it was easy to use, essentially I didn't feel like I needed any instruction. They gave me the wand and I did a scan. So there's fantastic scanners that are value priced, that do a really good job. You want to be a smart shopper, so you want to know exactly who you like to work with, which labs you work with and how easy it is to transmit the scans. So some of them have a closed platform, where it’s not so easy to take the scan and send it to all the vendors. So you want to do your homework before you buy a scanner. I'm a huge advocate of scanners. Howard, I had all three when I had my private practice, I had all three iTero’s in my office at one time. I had the first one that they made available, I bought the second one as soon as it was available, I bought the third one as soon as it was available, and they make huge leaps in terms of the quality and ease of use of those scanners and someday dentists are going to say to their kids that go to dental school, “You know, we used to make imprints using silly putty kind of stuff.” And the kids will say, “Why? Why wouldn't you just do a scan.” Many of the dental schools are using intraoral scanners, so impressions are slowly going away. And I think that it'll probably hockey stick, that hockey stick curve where all the sudden it just is a switch, it's a flip, where people just get them and that's the way we do things.
Howard: So Dental Wings is out of France. Have you gone to Lyon, France and visited those guys?
Dan: I have not been to their offices. I do tend to visit when I travel, I visit famous dentists and orthodontists when I go to… I know you mentioned the Rock and Roll Hall of Fame. When I went to see the Rolling Stones in Barcelona, of course I went to a famous orthodontist in Barcelona to learn all about the Italian secrets…
Howard: They always say that deep down inside women love to shop because it's therapy, it's retail therapy. They just like to go and relax and get a mani, pedi shop. Whenever I go to any foreign country, me and Ryan, and my boys we go into every dental office. I did a lot of… when we were in France last year, we did two or three podcasts from France. It's just an amazing country. Do you thing Straumann, Align Technology owns Invisalign, bought iTero and part of Smiles (50.30 inaudible). Do you think Straumann will buy an oral scanner?
Dan: I haven't gotten word of that. It's a great question. I'll probably have a chat with some of the folks I know over at Clear Correct to see which way the winds are blowing. I know that they integrate really well with many different scanners, so they haven't really articulated what a favorite scanner is in their mind and whether or not they're going to expand. I just, in my own mind, I'm wondering what Straumann's going to do in the orthodontic space, now that they've got a footprint in the orthodontic space, where they’re going to go with it, are they going to integrate other aspects of orthodontists. They’re such a powerful company when it comes to education and I'm really anticipating that the biggest change we see out of Clear Correct is that they ramp up the educational opportunities. It's fantastic because as soon as dentists find out that they can provide great quality orthodontics without going to years of courses, easier on their body, they're not bending over all day. You know that orthodontists, we often act as conductors in our offices because we leverage our time with our staff. We're able to delegate so much of it. We know that our patients have confidence and trust in us. They love our general dentist offices. It's no secret that orthodontics is very profitable. We've done some sophisticated calculations and we know how much revenue a dentist can put in their pocket by integrating orthodontics into their practice, even paying all the fees to Orthobrain. So yeah, I think Straumann has a lot of opportunity and them getting out into the educational field is going to help dentistry, if they do it in the same way they've done it in other aspects of dentistry
Howard: Well, you know the (inaudible: 52.23) market is incredibly maturing and going from a commodity to a... I mean there's just so many strong players, Straumann, Nobel Biocare, Megagen, BioHorizons, Implant Stryker, it's getting massively competitive now that you see Zimmer telling Wall Street they want to spin off their implant division. So that's basically saying they better just focus on hips and knees and all their other stuff because just the dental part alone is something that's so huge. I want to ask you about… this is dentistry uncensored, so I like to talk about the controversial stuff. There's dentists in Taiwan, I don't know if you got to see my podcast with a gentleman, Chris Chang out of Taiwan who's a DDS and PHd, but there's a lot of Taiwanese people that are treating these complex ortho cases, where Americans would do a Le Fort surgery, you know, where they're cutting jaws and there's a lot of Taiwanese that’s thinking you can do this without a Le Fort surgery. Are you aware of that? Are you seeing that? What are your thoughts on that? Do you think they're on to something where a lot of these orthognathic surgery cases can be treated nonsurgically?
Dan: Absolutely. Absolutely agree. Howard, you and I went into practice and it was the heyday of insurance paying for jaw surgery. So early in my career, you'll be astounded, but we did fifty orthognathic cases a year in my practice …
Howard: And what were they paying an arch back then?
Dan: For the orthodontics?
Howard: For the orthognathics?
Dan: Oh, for the orthognathics.
Howard: For the orthognathic surgery. Per arch?
Dan: Our fees in Dayton weren’t this high, but as an educator, I have to know stats. It was sixty to $80,000 by the time you walk out the door, and Dayton used to be a gigantic general motors town and it was automatic approval, so if anybody had any form of malocclusion, braces, nine months, jaw surgery, then another nine months of orthodontics, get a retainer, live happily ever after. We were doing jaw surgery all over the place. And the surgeons are quite terrific, but I felt it was really oversold by a lot and so the longer I practice the fewer jaw surgeries I did. And we found that the happiest patients that had jaw surgery were the ones who really wanted to have it. That they were enthused about it, there was something that they wanted to change with their appearance, their facial skeleton, again, going back about an hour now about how people want to look, particularly of that population you mentioned, where there’s a desire sometimes to have a face that looks like maybe they were born in a different country. So yeah, there was a place for the orthognathic surgery, but it was oversold. And so I think that one of the ways we're avoiding surgery is by using aligners to correct certain malocclusions where the aligners work better than braces. There are a malocclusions where you can do a better job with aligners than you can with braces. And an anterior open bite is one of them. The other adjunctive therapy that really changed our ability to avoid surgery are called the temporary anchorage devices, little mini implants. So those are placed and we use those as kind of an anchor or a pin to grab onto, to move teeth further than we were able to move them before. We have some surgical procedures that we think now can expand the boundaries of teeth movement. You've probably heard the term Wilckodontics, named after the Wilcko brothers?
Howard: I wanted to get them on a podcast so bad. One’s an oral surgeon, one's a periodontist, right?
Dan: Right. Brilliant, brilliant stuff that they've done over the years and it's been shown to move teeth faster for a few months, which is maybe have some benefit, but if you can expand the boundaries of teeth movement with the surgical procedure and with using the temporary anchorage devices and maybe even using aligners, some other surgical procedures, corticotomies, where you move an area in mass. Howard, this is radically different than mail order orthodontics. This is the other extreme. So there's a place for using Cone Beam images to see where the roots are and how they're positioned in the bones and what other adjunctive therapies, over and beyond braces and aligners, can really do great things for patients. So there's a need for orthodontists, mail order can not and will not replace us. You need a specialist that has abundant knowledge and depth of knowledge across the different specialties so you know how to integrate and do true interdisciplinary care. So yeah, I'm glad you brought that up about the ability to avoid jaw surgery, yet still get a good result, and a good stable result.
Howard: So are you on Twitter?
Dan: We have an account but I have not been active yet. Are you ready for me?
Howard: Yeah, because I … and thank you to everyone for following me on Twitter at @howardfarran. I’ve got, I think, twenty seven thousand followers. What I love about Twitter and Instagram and Linkedin, is if you make your post, it goes to all your followers. If you make a post on Facebook, you have to boost the post and give them money to just go to a fraction of your followers. I think the only reason the current president is the president of the United States, because at Prime Time there are only a million watching CNN, there were three million watching Fox News and that guy was tweeting to twenty, thirty million people from his lazy boy. I mean he just disrupted the whole connection deal. You talked about orthognathic surgery being oversold back in the day and I completely agree. And I also completely agree that the only cases that really turned out great in working with my orthodontist or oral surgeon was it was always girls who just really did not like their appearance. You know they didn't have a chin when they smiled their upper gum showed too much, and the ones who really wanted it for beauty, again, going back to, was it oral health? No, it was mental health, they didn't like the way it looked. And those girls would have walked from LA to New York to have that done, but a lot of the guys whose moms wanted it done, and they were teenage boys, they were not happy campers. In fact, I have one that was so mad at his mom for a couple of years. But back to it was being oversold. Do you think interceptive orthodontics today is being oversold?
Dan: No. I think there are certain practitioners that oversell it and I think there are many orthodontic specialists that undersell it. And so there's great opportunity to help the children while their jaws are soft and squishy. So when the kids have half permanent teeth, half baby teeth, the jaws are really soft and squishy. You can move the jaws predictably and there's evidence based research that shows if you don't do that for a class three face, by the time they're seven, the likelihood of you avoiding jaw surgery goes down. It's evidence based research, so we're not talking about my opinion. This isn’t just Dan German said. This is in the literature and we know factually, in the literature, when they have a large overjet, if you let them go untreated until all the permanent teeth are in, you get to do the restorative because you get to repair the broken front teeth. The frequency of broken front teeth and (59.53 inaudible) front teeth with large overjet is astronomical. It's crazy. So the original researchers said, “Wow, we could wait on some of those class two division ones. You could if you were just looking at plaster models, but if you put a person on those models, there's a lot more going on with those patients than just the fit of the teeth. You've got injuries to the teeth, you've got self esteem problems, bullying. Look, every child ought to have a comprehensive orthodontic exam by the time they're seven and for those class threes and some of the big open bites, those kids should be seen younger. Posterior crossbites.. at least four of my seven children had their crossbite corrected before they had permanent teeth in. So they're in posterior crossbite, they’re biting like this, you gotta imagine that if you hold your jaw like that while you're growing, the bone structure changes and that's the new shape of your face. You're not going to fix that when they're teenagers. You can't change the morphology of the mandible when a child is a teenager, you got to fix it when the kids are young. So it's under sold by some of the specialists and it's oversold by others. So I'm pretty adamant on that because there's research. So you get beyond opinion.
Howard: You know, I always thought orthodontists and Boeing had a lot in common that was … every time Boeing came out with a new plane, seven twenty seven, a thirty-seven, forty-seven, fifty-seven, it still only flew five hundred and fifty miles an hour. In ortho it’s so high technology, but at the end of the day it was still two years. But it seems like lately they're starting to bring down the two year cycle. There's a couple of new technologies out there. Do you think it's a bleeding edge technology or a leading edge technology to start taking ortho times down from two years to one years with some of these new rapidly advance... speeding up ortho? Is speeding up ortho reality or is that still a fantasy?
Dan: With certain products it's a fantasy because the research shows that it does not move the teeth faster.
Howard: Name them, name them, name them, this is dentistry uncensored. Throw them under a bus.
Dan: Throw them under a bus.
Howard: Which technologies do you think are fantasy?
Dan: I think the ones that vibrate the teeth may have some benefits, but I don't see moving teeth faster is one of the benefits.
Howard: What about seating the tray? Some people say … when these patients put in the tray that's not being seated fully, do you think vibrating the tray into … but you're just not a fan of vibrating?
Dan: I used it for my own kids to see how it worked and I used it on a lot of patients and anecdotally we thought that maybe it was moving the teeth faster, maybe it was seating the aligners better. We don't know. We need the research to prove it.
Howard: And what are the names of those vibrating technologies?
Dan: The one that I use the most is called AcceleDent. We called it the accelerator in our office and we used it for a lot of our patients. So if a patient said, “I want my teeth to move faster,” I said, “There's a proven way and that's having a surgical procedure done to the gums and to the supporting jaws. And we know factually the teeth will move faster if you have the surgery.” They said, “Well, I don't want them to move faster that bad.” “Well then here's a newer technology and the newer technology with the vibration, it's not invasive. It's reported that the teeth move faster, but we don't know factually.” So I just like to be truthful with the patients. It's going to take a long time to find out the reality as to whether or not teeth move faster with vibrations. They may. There was some research that was done with vibrations and braces patients where they felt that the vibrations, and these are brilliant researchers that said the vibrations ought to move the teeth faster because as the wire vibrates, it jiggles inside the slot and it gets rid of some of the friction. So it may work, but it just hasn’t really convinced me from a scientific standpoint, doing prospective studies, that it's moving the teeth faster. If people want teeth to move faster, any form of surgical procedure tends to move teeth faster. Why? Because you disrupt everything at a cellular level. And you know, when you get a cut on your skin, the cells turn over really fast. It gets warm, it gets hot, it gets inflamed, and the skin grows really fast until it's healed. And I think you have a similar mechanism going on with teeth movement.
Howard: Well, what about these micro perforations where you're buying a burr and you're making perforations in between the teeth? Do you think that's bringing down the two year ortho cycle? Do you think that's making it faster?
Dan: It probably is. Something to keep in mind with surgical procedures, that if you do the traditional surgery, like a Wilckodontics type surgery to move the teeth faster. And again, from my perspective, there probably were other pioneers, but I keep going back to the Wilcko brothers, they really popularized it. The teeth move faster for two to three months and then when everything's sealed up, you don't move faster, you lose the benefit over time.
Howard: What’s the chance that you would on Dentaltown… these millennials are completely different beasts than the baby boomers and they just don't need to go to a brick building to learn. I was in Phoenix, so every time I drove to the airport, starting in 2004, I saw this University of Phoenix online. So we started online CE courses and my God, we got to four hundred, I think four hundred and eleven course, they're coming up on a million views. What's the chance you'd make some online CE courses teaching these millennials in dental school? About a quarter of our podcast listeners are still in dental school. The rest are all under thirty. They probably can't believe that you and I are still alive. But what's the chance of you making some online CE courses a curriculum? There is no curriculum on Dentaltown, A to Z, how to do a simple ortho case.
Dan: Howard, I'm a really easy guy to make a deal with. I'm going to come out and visit and you and I’ll have a little time together and you give me some sage advice since you've seen so much of the world and I'm going to find a way to make you some education to put on your site. I'd be delighted to do it. I'm an educator at heart and I'm more passionate about dentistry than I ever was. I've got a kid in dental school. My Laura is in dental school and her future husband, is Zach's in dental school, he's going to become an orthodontist. There's never been more opportunity in dentistry. I think it is the greatest profession. I love it. It's my hobby and the opportunity to teach it under your umbrella will be quite terrific because I know you have broad reach and we can learn from each other.
Howard: Well, I'm Howard Farran, so I'm firstname.lastname@example.org. The guy that does all the online CE is Howard Goldstein in Bethlehem, Pennsylvania and I'm sending you two an email as we speak because these kids are dying for this ortho education. They tell me they walked out of dental school... I mean, I can't believe these dental schools are charging $100,000 a year and I had two kids over on a podcast the other day, one of them did not do a root canal in school, other on a (1.07: sounds like: typer) the other one did one. As far as ortho, zero training. And it's our job to use technology to make this stuff better, faster, easier. Ryan type in there, tell them about how to make an online CE course. So th micro perforation, okay, you talked about that, you make an online CE. I think that would be amazing. I mean, I think you could be... right now on the Internet, there's not very many places, there's nothing on Dentaltown. We have a quarter million dentists in all two hundred countries on earth and it's embarrassing that they just can't log onto Dentaltown and watch a ten part series on a orthodontics, a to z. I think it'd be really good for the two million dentists around the world. I think it'd be really good for these kids coming out of school that are half a million dollars in debt after they had their undergraduate student loans then about... You know, these dental school, so many of them are seventy to $100,000 dollars a year, and I just meet kids all day long. They’re a half million dollars in debt and when they come out of school they don't even know how to do an Invisalign case.
Dan: Well, Howard, the irony is they borrow all this money, they have abundant debt and when they go to dental school, they're taught to refer everything that would help them pay the debt off.
Howard: Right. Right.
Dan: You have to refer the big surgery and (1.08.51 inaudible) orthodontics.
Howard: And the dental schools don't let them do the cases because they're also selling a grad specialty program. So all the endo gets shipped to the endo grad, all the ortho gets shipped to the ortho grad. And I'm telling these young kids and they say, “Well, what dental school do you think is the best?” And I say, “The best dental schools are the ones that don't have any grad programs and if you can find a Creighton university that isn't teaching you how to be an endodontist, periodontist, (1.09.17: inaudible) and all that stuff, you'll actually get to do those cases.” And that is a huge benefit. Man, I can't believe we already passed an hour, we’re an hour and a half. So I want to ask you, are you still loyal to the Cleveland Browns after…
Howard: They didn't win a game, dude. You must be hard core.
Dan: Isn’t that the definition of loyalty? Lood, as a kid, with Jim Brown, Otto Graham, they were the team.
Howard: Oh yeah.
Dan: And you know what? I don't know if you know this Howard, but I come out to Phoenix every year, multiple times. I have a brother out there who's a brilliant attorney, Steve, and my brother Rick, who’s an amazing fitness instructor. And then my sister-in-law, Betty Schindler, who’s probably the best endodontist I've ever met. And they’re all in Phoenix, Scottsdale area. So I'm there …
Howard: Well, you need what you need to do? Next time you come to town, bring them over to my house, we got our own inhouse podcast studio. We’ll all sit around the table and my God, that'd be an amazing podcast.
Howard: Yeah, bring them all.
Dan: That would be terrific.
Howard: That would be so much fun. And I also wanted to ask you one thing. It was Edward H. Angle who started the first school of orthodontics in 1901, he is considered the father of orthodontics. What do you think he would think if he came back alive today? What do you think he'd think of orthodontics?
Dan: You know, the first blush answer would be that things have gone awry. The original orthodontists felt that orthodontics wasn't even part of dentistry. They felt that orthodontics was a specialty of medicine. And we're really old, we're the second oldest specialty in all of medicine and dentistry.
Howard: Wow, what’s the oldest.
Dan: I believe it's surgery.
Howard: Okay. Oral surgery then orthodontics?
Dan: General surgery, then orthodontics, we’re the oldest specialty, I think in dentistry and the second oldest in all of medicine and dentistry. Not a fact, but that's how I remember things. So Edward Angle, these guys were real formal and they were really studious. I'm a generation removed from the original founders of orthodontics. These were incredibly brilliant forward thinking, people that really did amazing work. I think very highly of them. And you would say at first blush that they would go crazy seeing (inaudible: 1.11.42), that the idea of Orthobrain teaching everybody how to do orthodontics. At first blush you would think they would get upset, but these were forward thinking, people that were original thinkers, out of the box thinkers, and I think they would love it. I think they'd be thrilled that their specialty is now available worldwide and I believe that that would outweigh the territorial feeling that you see right now in orthodontics. So, I hope that they're smiling and I'm going to do everything I can to make them proud.
Howard: Well, doctors just can be territorial because it's the same thing with doctors and manufacturers and insurance companies - we’re all treating the same patient. And a lot of dentists think the insurance companies are all bad people. Well, they're... hell, they're getting the employer to subsidize treatment. That doesn't happen when an American buys a car or a house or an iPhone. And same thing with specialists. We're all treating the same patient and we got to have a team approach and work together. I just want to have one final rant on Cleveland. I love Cleveland, man. I love the Rock and Roll Hall of fame. I did not realize, you might not even realize this, you live there, do you realize that that building is shaped like a phonograph?
Dan: Yeah. They had a real famous architect design. My research team, while we were talking, found out that the HBO showing is on Saturday, May 5th at 8:00 PM, 6:00 PM in Arizona.
Howard: Oh, you’re too good. Ryan, can you see on HBO if we can forward that and tape that? It's my favorite show of the year because I'm always blown away, because you think you know everything about music, if you're a big music fan, and they always surprise you of some legend that you really didn't understand or you overlooked or you didn't appreciate. The most amazing one was a few years back when it was just some some lady and it's like, “Well, how do you get into the Rock and Roll hall...? I never even heard of you.” It turns out she was a backup singer. Did you see that one? And then they made a movie, a honor, ‘ten feet from stardom.’ Did you see that movie?
Dan: Great stuff.
Howard: Oh my gosh. It was just amazing. And basically what it was is the real high self esteem musicians would let these backup singers just walk away with the song. And then the low self esteem, one hit wonders, they would chastise that you're singing too loud, you're overdoing me, read from the script and the real high self esteem ones like Mick Jagger and David Bowie, that if lady just started going crazy they would literally quit singing and take five steps back from the microphone and let her just take over the show. And they played some of David Bowie's greatest songs without his backup singers. They were lame. And then you replay it with his backup singers, and it was always these African American girls from these Bible church, where they were singing in the choir every Wednesday…
Dan: Gospel singers.
Howard: Gospel singers, and they gave one of them The Rock and Roll Hall of Fame. That was amazing. But hey man, I just love everything you're doing. It was just a huge honor that you came on the show. I hope you make us some online CE. You need to get a Twitter, as soon as you get a Twitter account, email me at @howardfarran on all four, make a post, make any post and I’ll forward it to twenty five thousand people on Twitter and thank you so much for all you do. And next time you’re in Phoenix, you got to bring all the family, all the other dentists and your family tree. Come to the house and we'll sit around the table and just talk dentistry. It'll just be awesome.
Dan: I'm looking forward to it. This has been a real pleasure. I've had so much fun doing this and I appreciate all that you do bringing dentistry and dentists together so we can collaborate and just elevate the profession, take great care of our patients. When you get down to it, that's what it's all about, is taking great care of the patients more. The more we're talking to each other, the more we collaborate, the more education out there and this digital platform that you’ve created, the better it is for everybody. So thank you.
Howard: Well the honor and privilege was all mine. Ryan, thanks for doing the show. We got in last night for at midnight from actually, from where you were in Louisville, and we got in at midnight and good old Ryan was able to wake up dad. It took a few shakes and kicks, but he got me up without having to douse me with water. So thank you so much for coming on the show. I hope you have a rocking hot day.
Dan; Right on. Thank ...