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VIDEO - DUwHF #769 - Kaveh Baharvand
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AUDIO - DUwHF #769 - Kaveh Baharvand
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Kaveh Baharvand DMD, MSOL graduated in 2011 as the valedictorian from Debrecen University School of Dental Medicine in Hungary when he was only 22 years old. Thereafter, He applied for the international programs in the United States. Dr. Baharvand started his Advanced Standing Program in Boston University Henry M. Goldman School of Dental Medicine (BUGSDM) in 2012. He practiced as a general dentist in Fall River and Dorchester, Massachusetts before attending the orthodontic program at Jacksonville University. Concurrent with his orthodontic training he was enrolled in a Master Degree program in Organizational Leadership at the Davis College of Business. Dr. Baharvand is a member of various honor societies in the United States such as Omicron Kappa Upsilon (OKU), Phi Kappa Phi (PHP), Omicron Delta Kappa (ODK), and Beta Sigma Gamma (BGS). Upon graduation, he hopes to pursue opportunities in both academia and the private practice of orthodontics with his wife, Dr. Julia Kang.
Howard Farran: It is just a huge honor for me today to be podcast interviewing Dr. Kaveh Baharvand. He is DMD, MSOL, graduated in 2011 as a valedictorian from Debrecen University's School of Dental Medicine in Hungary when he was only 22 years old. He then applied to the international program in the United States and started his advanced standing program in Boston University Henry M. Goldman School of Dentistry and Medicine in 2012. He practiced as a general dentist in Fall River and Dorchester, Massachusetts before attending the Orthodontics program at Jacksonville University.
Concurrent with his Orthodontic training he was enrolled in a Master's Degree program in organizational leadership at the Davis College of Business. He is a member of various honor societies in the United States such as Omicron Kappa Upsilon, Phi Kappa Phi, Omicron Delta Kappa, and Beta Sigma Gamma, and upon graduation he hopes to pursue opportunities in both academia and the private practice of orthodontics with his wife Dr. Julia King who is in the same orthodontic residency that he went to and they just celebrated the birth of their first child. Congratulations on the birth of your first son.
Dr Baharvand: Thank you very much Howard. It is my pleasure being here. I've been listening to Dentistry Uncensored for the past, I think, one year or two years, almost every day driving into work, coming back home. My wife and I enjoy listening to you. Thank you for inviting me.
Howard Farran: And it's so neat. When you look at marriage/divorce study data, it's so interesting. The countries that have arranged marriages like India, they have a 10% failure rate divorce, in a country like America where it's a love marriage it's almost 50/50. But when you mine down the data in the United States, if the man and woman both have a Master's Degree in the same thing they have only a 10% divorce rate, so since you and your wife have so much in common intellectually that is a probably a 90% chance you guys will ride it out to the end so congratulations. Every time I lecture in dental school I always tell them "Before you leave dental school find your spouse." You know, it's the best advice ever.
Dr Baharvand: That's what I did. We're in fact, classmates back in Boston too. We've been sharing classes now for now over five years.
Howard Farran: How long have you been an orthodontist now?
Dr Baharvand: I'm still in my orthodontic residency. I'm graduating this year. I started my residency two years ago. It's a two year program in Jacksonville. The clock is ticking now for my graduation. In fact, it's next month on July 7th [inaudible 00:02:53] United States.
Howard Farran: You're in the second year of the ortho residency?
Dr Baharvand: That's correct. Yes.
Howard Farran: The second and final year.
Dr Baharvand: Yes.
Howard Farran: Your wife is in the first year of the residency?
Dr Baharvand: Yes.
Howard Farran: What are you thinking? Do you think you and your wife will start a [Denovah 00:03:11] orthodontic practice and work together? Do you think you'll each start your own? What does it look like for you? What are your pros and cons of your future business model?
Dr Baharvand: It's a very interesting question. We've been entertaining different ideas, my wife and I. Ever since we started orthodontics and maybe even before that when she was a general dentist. There was cons and pros for everything. Maybe before the birth of my son, I was very much leaned toward either purchasing an existing practice, or as you mentioned starting up, but with the baby now ... I love my family. I spend a lot of time playing with him. It's one of the greatest things ever to happen to me. I don't believe time wise it would be the right time for me to add the stress of running something. I'm a big believer in owning a business, but I think at this very moment is not probably the best time for me.
It is on the list, and I think eventually Julia and I will be sharing practices, but I don't see it in maybe not in the next two, three years.
Howard Farran: You make a great point. When you buy an existing practice, there's so much less risk. It costs more to buy than to build from start, but when you build it over from scratch, you have to wear all the hats. You're a young family, a young father. You've got to wear all these hats that they didn't train you in any of your education.
When you buy an existing practice, there's no risk because you've already got a management team. Obviously if there were two orthodontics practices for sale and one the average employee had been there 10-12 years, they could replace you with a droid. They could buy R2D2 or C3PO if they did ortho, you know what I mean? If there's two practices for sale and one had the average staff had been there 12 years, and the other one the average staff had been there two years, obviously the one with the average staff had been there 12 years is running on autopilot and in my opinion would be twice as valuable as the one.
If you did go buy an existing ... Like at my dental office, we got staff that have been there 10, 20, 30 years. We still have our first dental assistant. Not one person on my team would ever need to talk to me again. If somebody bought that, they wouldn't need to talk to that person either. You have nothing but options.
Dr Baharvand: Very interesting point regarding the risk and benefits and being knowledge and being literate about the business of dentistry. Let me tell you this. In 2011, when I came to the United States, I landed in Los Angeles, I was so uninformed. I was so illiterate about how the financial system runs in the States that this friend of mine Dr. [Kaserie 00:06:09], now she has a practice in Colorado. She took me to this Chase bank that was in Korea town Los Angeles. She took me to the chase bank to open a bank account, put my money in there. I couldn't keep it in my bag. They were explaining things. Maybe half an hour explaining the difference between a checking account and a savings account.
A lot of things living in the States take this as granted that, "Oh God, everyone knows. Even a five year old knows the difference between a checking account and a savings account." But in a lot of countries, including Iran or maybe in Hungary, there aren't really checking. There's only an account. It's a bank account. Not only that, in a lot of countries, there are no credit cards. There is no credit line. They call their debit card credit card.
Entering into United States with such a sophisticated financial and economic system, I knew I'm way behind. I learned a lot. That's why I personally would be agreeing [inaudible 00:07:08] business when I came here in Jacksonville, I needed to learn the basics, not only the higher level things, but also the basics. I'm very glad I pursued it. I feel more confident now doing something independently on my own. I think it was very important.
Howard Farran: I see so many dental schools where you have to option that not only can you get a dental degree, but at the same time, you can get a masters in public health. It's like, "Why don't you just go get them at the same time get a PhD in Biology, Algebra, Trig, and a million other things that you'll never use in your entire life unless you're a teacher or researcher.
I wish all the ... If everybody that graduated from law school and medical school and dental school at the same time had an MBA, the congress wouldn't be insane, the healthcare system wouldn't be. In fact I remember ... This is before your time. We had a president a while back. It was Bill Clinton. One of his campaign deals was he was going to put 100,000 more police officers on the street. I wrote him letter after letter saying, "Why don't you put 100,000 MBAs in government? Why don't you commit to taking 100,000 people out of their jobs across every agency in America and make them spend a two year sabbatical getting MBA and then send them back to the department of motor vehicles and it wouldn't take you 30 hours to get a drivers license."
So you're born in Iran. How old were you in Iran before you moved to Hungary?
Dr Baharvand: I was 16 years old.
Howard Farran: So you're all fluent in [RC 00:08:50] and everything going into Iran. Then you lived in Hungary from age 16-22?
Dr Baharvand: That's correct.
Howard Farran: Then you've been here from 22-28?
Dr Baharvand: That's right.
Howard Farran: You are like ... This about that. Think. If you had been born 500 years ago, your name would be Marco Polo. Not many people ... I think you become so intelligent when you live in three different tribes because so many people ... Like Americans. When you meet an american and they have a bad attitude towards socialized medicine. "Socialized medicine, it's like Scandinavia."
It's like, "Dude, have you ever been to Scandinavia? You live in Oklahoma okay? Oklahoma would be the armpit of Denmark, Norway, Sweden. Not one person in Denmark, Sweden, Norway, Finland would move to Oklahoma. Why is it a bad thing that it's socialized medicine from Scandinavia?" It's funny.
I think you are beyond smarter than you realize because when you grow up in one tribe and drink the purple cool aid, you don't know what's real and what's not, but when you've already lived in three different continents and three different civilizations, your wise beyond your years.
It reminds me of my favorite endodontist [inaudible 00:10:13]. He was from ... went to dental school in Nigeria. When he was my instructor at UMKC, I used to say, "Why are you just so smart? Is it because you're cynical? What is it about you?" He goes, "Well, there's three camps. There's Germany. They affect all Europe. We're talking about Dentistry. Japan, all of Asia, and United States all of North America." If you're born in one of those three camps, you believe whatever they tell you, but when you're growing up in Nigeria and Nigeria isn't one of the camps, they always taught us, "The Japanese think this, the Germans think this. The Americans think that." Then they would triangle and figure that the truth is somewhere in the middle.
You've already had a triangle between Iran, Hungary and the United States. That is so darn cool. Wat would you say to a kid? Podcasters are very young. About 20% of them are still in dental school. What would you say to a kid in dental school who was thinking about going to orthodontic school? How hard is it to do the orthodontic residency application? What would you say to a junior who's thinking, "I kind of want to be an orthodontist." What would you say to that person?
Dr Baharvand: That's a very good question. Honestly, I think a lot of dental students, not only in the United States, but also abroad internationally are having the same question. What does it take for me to be an orthodontist in the United States? What does it take to get into an ortho residency? I had the same exact question. The difference was I really had nobody to tell me. I just got into the States. I started my advanced studying at Boston University. It was just about the time I started making friends. No family, no connections, nothing. I had to establish everything from zero and also answer this question at the same time.
Let me take you back a little. Going back to the previous topic you mentioned about the importance of being multi-cultural, meeting different people from around the world, it all started with my father's vision that when I was younger, I was 14, 15, he said, "Hey Kaveh, I'm thinking of sending you to London for a summer." I'm like, "London, that sounds good, but it's out of blues." "Yeah, but I want you to meet people from different countries, from different cultures so that you know how things are outside of Iran. Then you'll make your decision whether you'd like to stay here or you'd like to pursue your education elsewhere."
He sent me to London. I lived in London for three months. It was awesome. It was very good. It was beautiful, a very good experience. I came back and I told my dad, "Dad, sign me up for my next levels somewhere abroad." UK didn't work out. Long story. A lot of things happened and I landed in Hungary. It was where I met a lot of people, different cultures, people from Israel, from US in fact, from Canada, from Iran, from Middle East, from Africa, all coming together under the roofs of an educational institution which was Debrecen University which I think is the most beautiful thing ever. Everyone is together for a good reason, for learning, for becoming a better person.
I moved to the States because I believed in the so called American Dream. I was listening to your podcast. You were talking to the founder of [Pisco 00:13:38]. I believe he was a Korean chemist if I'm not wrong. He mentioned I think one of the best examples of the American Dream. A person with zero, maybe I think he said $50 in his pocket as he moved to the States in San Francisco and he build a company of such great success. Stories of that was what motivated me to move to the states. I thought if I moved to the United States, if I contribute to the society I lived in, if I worked hard, the American Dream would let me become a successful person, to be somebody important.
I came. I went to Los Angeles first. I lived there for eight months before I moved to Boston University. I served in Boston and then I faced the question that, "Okay, now I always wanted to be an orthodontist, but what does it practically take to become one?" It takes a lot because ortho residency is very competitive. I think the orthodontists are highest by number, the most common specialists in the country. I think last time I checked there are close to 196,000 dentists in the United States and 10,000 orthodontists.
It's a big number, but although it's a big number, it's also very competitive to get in. What's the formula, what's that secured ingredients to become an orthodontists? It's different for every school. It's definitely doable, but it takes a lot of hard work. It's very important where you in your class you stand. Based on what I see in different schools, a lot of schools have a filter that if your GPA falls below a certain level, you don't even qualify for the next stage, for the review of everything else. I think the grades are very important.
I had difficult time back in Boston because the schedule was very, very compact. It was very difficult time wise. I literally had no personal time whatsoever. I still had to manage getting straight As and other stuff. Next thing is research. They like people with research backgrounds. There's a lot of ortho programs, they come with an MSD. They want you to have some experience before you start. I had zero experience, none. Back in Hungary, nobody told me. I never thought research would be important. Things are different in the states. People value research a lot more. Academically, it's pursued a lot better, so I had to find a research project where I could be involved in.
I was getting rejections after rejections, all for the same common reason that you're an advanced standing student, and you cannot commit time. The minimum was ten hours a week and I didn't have ten hours a week of person life, so for research time. Luckily, I managed to start a research project where Dr. Judith Jones at BU. It was about the quality of life in orthodontics. It was very successful, very well. The next things comes, if you're doing a research project, you want to make sure if you can get it published or present your data at different places.
If you will keep on doing the research and not really publish your data, as if it never happened. The knowledge will not be shared. You have to share your knowledge with the rest of the people. I shared the knowledge I had, the results of my project in Charlotte, North Carolina. It was interesting to study. You might actually like it.
What I did, I was also at the same time I was working as an orthodontic assistant on Saturdays. There was one thing we realized with my Mentor Dr. [inaudible 00:17:34] working in her office that a lot of people that were sending for approval for MassHealth which is the Massachusetts medicaid were getting rejections. We're wondering what's going on? Why is it so difficult? Kids who were [inaudible 00:17:51] they had malocclusion, it's severe. We think they definitely need orthodontics, but we're getting the letters back with the rejections.
I used the data from BU, Boston University to see if there's a correlation between the Index Massachusetts in MassHealth uses and the most [inaudible 00:18:10] indexes. Let's say for example one is the US UHS in England or by another index that was available at BU. It was interesting to notice that one out of four, meaning one out of four Medicaid patients that walked into your office would be rejected although they had severe malocclusion. For one reason, the index that was used by MassHealth and the scoring they had, it didn't match with the other indexes. I found it very interesting. I felt bad for the teens. They subjectively and objectively needed orthodontic treatment, yet they were rejected.
That's anther thing. Research something is important to apply for ortho. Good grades, rank is very important. Some of the schools are easier, some of the schools are more difficult, but rank always tells you where you've been in your class. And consistency I think if that's key to be seen in an application. You want to show that you've been persistent and you've been consistent in your persual of orthodontics. When you sometimes look, it's very interesting. I'm getting a lot of emails with personal statements, CVs, they want me to ask to proof read them.
There was this one occasion where I looked at the person's statement. Not even a single time the word ortho or orthodontist or orthodontics was mentioned in the personal statement. I sent her an email back and like, "Is this for ortho or something else?" It's very important to be very consistent with your purpose.
There is other stuff that kicks in. I don't know if you're aware of the pass application. There's a match application. With the pass, there's a lot of little things that people miss that really impact immeasurably. With the pass application for example, the simplest thing I can say is the photo you attach to your pass. It's just very interesting for me because last year, I did interviews for this year's applicants. I also interviewed the fellows for the Jacksonville University. Two rounds of interviews. I noticed a lot of times people would crop their photos like the ones from Facebook, especially girls because they'll look cute in that photo. They'll crop it from their Facebook or whatever else. It could be Instagram and put it in the pass application. That questions me. Orthodontics is all about details, the smile, paying attention to details and the little things.
When you don't pay attention to details like this, when at this very professional level, you use your social media photo, that ticks me off, or other people who are reading your application. You might have worked real hard, but not paying attention to these details and the very competitive application cycle that you're entering might put you down rank.
Personal statement is very important depending on who reads it. An issue with personal statement is that contrary to the fact that it's personal and it needs to be kind of what you like to write, but a lot of times it needs to be tailored to your audience, to the person who's reading it. There's very different programs because it could be a young person like me reading it. It could be a more experienced orthodontist. It could be someone who doesn't even read the personal statements, but if I have to say one thing about the person statement which needs to be, is the first paragraph.
A lot of times, the interviewers are reading hundred applications. They're not going to read all the personal statements to the dots, so your first paragraph needs to be so strong that interests them to read the rest and interests them to get into your application and know more about you. Your CV is extremely important. It needs to be very organized, very easy to read to. I've seen very wordy CVs which are not good. That could be a problem too.
One interesting thing that's interesting to know how ... it's a new thing. It's called a ADAT exam. Have you hard of it? ADAT? The advanced dental admission test? It's a new thing. We have the national board exam, NBD part one and part two. Years ago, they got rid of the grading. It's only a pass and fail now. They got rid of the grading because of reasons they have. They start adding other exams that are graded. You have to have a measure of knowing how people do. It's hard to know their academic performance when there's no grades whatsoever. My guess is that's the reason they added the ADAT. It's an exam you take when you're in third year or fourth year of dental school, or you can take it after of topics such as research, or I don't know, clinical questions. It's a new exam that's graded.
Luckily, there aren't many programs that mandate ADAT in orthodontics. It could be there for broader specialties. I think to the best of my knowledge, there are nine programs. Actually there are six programs. I'm checking it right now. There are six programs that they require ADAT. That's a new thing. If you're applying to those six programs, you must have ADAT. There are eight or nine programs that accept ADAT. Meaning, you're not required to do that, but it would probably help you to take the exam and basically apply for those schools.
It's a new thing. I don't really understand the reason behind it and a lot of other things, but I find it difficult for someone who's been already a general dentist elder for a couple of years to go back and now take an exam which is probably based on the stuff you learned in dental school. I personally believe a person who has been already a general dentist can be a better orthodontist just because of all the knowledge they gain by being a general dentist.
That was a good question. I think I gave a long answer to your question, but it takes a lot. Persistence is very important. You need to show when people are reading their application, they must feel that this person has been working hard for this. I know there's a saying that they give the job to the person who wants it the most, not to the person who's best at it.
Howard Farran: Do you think it helped you getting into orthodontics school being very competitive that you had a masters degree in organization leadership from the David's college of business?
Dr Baharvand: I did my masters after I got into ortho. The business program is a couple of steps from my ortho program. When I got into JU, that was the time I found a great opportunity for me to learn something more than just dentistry, more than just orthodontics. It just the fact that the schools were so close, I thought I could attend night classes. That's what I did. I wish I had the masters before. I think it helps. How much it helps, I don't know. I think it depends on who reads your application, but this organizational leadership masters I did purely was for me. As I said, I didn't know anything about how finances or economy works in the states. I learned a lot throughout years but I was behind. I needed to learn a lot about the law, about economy, finances, about strategies and a lot of other things that I'm very glad I learned at least the basics.
Howard Farran: A lot of people always think the sky is falling and they always think times are so bad, blah blah blah. They just haven't read a history book. Look at the United States. 1962, a million people were killed in a civil war, a million when we only had 30 million people. Then we had World War I, World War II, Depression and all that stuff. In the last century ... it's 2017. We're 17 years into this century. The first 17 years of the last century, 5% of the planet dropped dead during the Spanish influenza. One in ever 20 people died. Today, we have all these vaccines. It's so crazy when you hear all these movie stars talking about they're not for vaccines. It's like, "If you want to go back to the Spanish Influenza, knock yourself out."
I was wondering ... I think you and your wife are in ortho grad school. Do you think in 2117, 100 years from now there will be massively less malocclusion? What causes malocclusion? When you talk to the anthropologists, they say this is a new deal when our diet changed, when we started eating with knives and forks and cutting up our food and eating refined grains that were discovered in the fertile crescent. Before that, there was no malocclusion because babies were chewing hard things. They were eating roots and beats. The forces of mastication were off the charts. Now you have a baby son and now a days, babies switch to little apple sauce out of a jar. If they have any difficulty nursing, they switch to a sippy cup and a bottle.
Right now, it seems like we're still in this ... You said that orthodontics was the most. That's absolutely true. If you cut the state of Texas in half, each half of Texas would be larger than the second biggest state of Texas. You cut the number of orthodontists in half, each half would be bigger than the second and third which is oral surgeons at 5,000 and periodontics which is 4,000. The reason they're so damn many orthodontists is because you don't nurse your kid for a couple of years. You switch it to a bottle, a sippy cup, and feed it refined crap out of a jar and he never gets any facial forces.
I was wondering this. Is your school, are they even starting to address it? Look, this is a completely new disease that just started when we changed our diet. Do you think in 2117 the trend will be trying to prevent your baby from needing orthodontists when it's 12? Let's prevent your baby so it doesn't need four bicuspids extracted. Was there any talk about that in your program?
Dr Baharvand: That's a very great point you brought up. You made it ... You said it correctly. A lot of people believe orthodontics is a disease of modern society in a sense that ... It goes historically going back, there was an orthodontics, maybe one of the pioneer orthodontics Dr. Beck who came here to the States. He was trained by the father of orthodontics [inaudible 00:29:45]. He went back to Australia. He went and looked at the aboriginals in Australia and New Zealand. He noticed that they had perfect teeth. All teeth were aligned very nicely. The malocclusion rate is very, very low.
That was the conclusion that was made that today's age, as you mentioned, kids when they're very small, we change their first breast feeding rate has been decreased merely by a change of society. Kids are being breast fed less. There's a much higher rate of using pacifiers. The nature of the food has changed. It's very mushy. It's very soft. There's really no strain. There's no function over your muscular muscles and skeleton. Again, a lot of modern people believe in the functional theory that if you grow muscle, you grow bone, your bone becomes harder based on the use. If you don't use a muscle, it's just going to atrophy or it will never develop.
The child who never really bites on anything hard or the child who he or she always eats cooked carrots and never an actual carrot that is uncooked, there's no chance for the body to become stronger. That's one.
The other thing is also the respiratory system.
Howard Farran: It's what?
Dr Baharvand: The breathing. Basically your-
Howard Farran: Oh breathing.
Dr Baharvand: That we're not really letting our kids be exposed to a lot of bacteria, to a lot of microbes. The rate of allergies and breathing problems is increased. That itself will cause-
Howard Farran: The allergies, they're now saying is the same thing in modern society. When you go to very poor countries and a one year old is crawling around on the ground and the floor and playing in the dirt, they get exposed to all the antigens when they're supposed to. In an advanced society and everything is clean and washed and the baby bottles are boiled and washed and this kid never gets exposed to ant dung or mouse and then all the sudden it's 12 years old and it smells ant dung for the first time and goes into anaphylactic shock and has all these allergies. Again, the allergies and asthma is perfectly [inaudible 00:32:24] correlated to income. You get into the richest, cleanest fanatic wipe everything down with a towel and there's all this asthma.
Then when you get the people who are born crawling around on the dirt, they don't seem to have malocclusion and asthma and allergies.
Dr Baharvand: That's completely right. Asthma is-
Howard Farran: I always tease my mother. I have five sisters and a brother. When I read this, I said at home and I said it to all my sisters. I said, "None of us ever had any asthma. We al could agree that mom never kept a clean house." Mom's dirty, filthy house made all of her kids never have any asthma. Everybody thought that was funny.
Back to the chewing of the carrot, stress equals force over area. If you're going to boil the carrot and turn it to much and puree and feed it to him on a spoon, where is the stress equal force over area spreading the pallet, developing the Mandible. Are they starting to address that?
Also, you've lived in three different countries. Was malocclusion incidents different in Iran versus Hungary versus LA versus Boston?
Dr Baharvand: It's a hard question. I don't believe I have the knowledge to answer that question.
Howard Farran: That would be a neat study.
Dr Baharvand: That would be a very neat study to confirm the rate of ... I'm sure it's been done. I'm not aware of it. To confirm the rate of malocclusion, different malocclusions in different places.
There's been studies, for example the class three malocclusion when your low jaw is a little forward is more common among Asians, but that is probably something to do with their genes.
Severe malocclusion are more common, but whether crowding for example is present more in the Middle East or if it's present more in Eastern Europe, I'm not aware of that. Breathing is very important. [inaudible 00:34:22] system is very important. The more you help them, the more you train them, the stronger they'll become. That's one reason.
The other reason I think it's also apart from all the evolutionary processes is also the change in our society and the fact that we're becoming more educated about beauty. The norms of beauty are changing. Maybe 10 years ago, 15 years ago, 20 years ago, 50 years ago, a little big of lower crowding wouldn't be a big issue, but now it has become more. That's why we're seeing more treatments as well. Not only the malocclusion rate as increased, but also the treatment rate has increased.
Howard Farran: I'm going to write my own paper and publish it in my own magazine that beauty is changing and it's shifting towards fatter, balder, older men.
Dr Baharvand: That's right.
Howard Farran: I think that's where the trend is going. I want to ask another thing. Pretty much from the airplane, from Wright brothers, pretty much to my lifetime, an airplane, they get bigger, they get wider, they get longer, but every flight I've ever flown on from age 16-54, it still goes 555 miles an hour. That's kind of the way ortho was. It was always 24 months, but finally you see ortho now saying it doesn't always have to be 24 months. There's accelerated ortho. Now there's a lot of orthodontists saying that they're finishing a lot of their cases in only one year. What do you think about this accelerated ortho? Is it hype? Is it real? It is fantasy? Is it fiction? Is it marketing? Or is it still just the old airplane going 555 miles an hour?
Dr Baharvand: That's a very good question. Honestly, I think it's a very controversial topic, even in orthodontics. It depends on who you're asking this question from. If you ask this question from an academic, a person who does research and gathered the research results, they will probably tell you that yes, accelerated orthodontic works real good for the first three months only. The research data that is in front of at least me at this point tells you that yes there's going to be an accelerated movement caused by informative processes for the first second and third months. After that, basically starting at the fourth month is the same. You have to repeat what you did.
I'm talking merely about propel and basically periodontal accelerated orthodontics. If you ask the same question from a clinician who has been practicing it, they might answer you differently. Some of the people that I'm trusting as orthodontists, they're my mentors, they highly believe in some of the companies, some of the systems out there.
Yet some of the other systems that have been advertised, I can't be very specific, but they're not as they've promised. They're not delivering as they promised. I believe accelerated orthodontics is true. I believe-
Howard Farran: Slow down a little bit. You keep saying accelary orthodontics-
Dr Baharvand: Accelerated orthodontics is basically-
Howard Farran: You're saying accelerated orthodontics?
Dr Baharvand: Yes. Accelerated.
Howard Farran: I call it accelerated. What are you calling it?
Dr Baharvand: Accelerated. Different-
Howard Farran: You're saying it with a Boston accent, but you're saying accelerated. You also said propel. A lot of kids out there might not know propel. Explain what propel is and how that's accelerated orthodontics.
Dr Baharvand: Again, I'm not an expert when it comes to propel or the accelerated techniques, but propel is basically using little microscopes, little devices to create perforations in the areas you think you will like to change the density of the bone. You'd like to introduce some inflammatory changes. Inflammation is involved in tooth movement. If you create more cells, more factors that are causing inflammation and you change the density of the bone in the area, there's a higher chance that you can move teeth faster into that area.
Strategically, placing little holes where you think you want your teeth to move can help teeth move faster. Again, you have to be knowledge about the evidence out there. The latest evidence I've read and there might be evidence coming after this, so I can't be 100% certain is the fact that that accelerated orthodontics in the form of propel is effective, certainly for the first three months. Thereafter, it might not be as effective. It needs repeating.
I could tell you one thing. It's true with ever research that we read. That research results, so be it about propel, so be it about anything else are based on needs, are based on averages. Maybe in one patient, propel would be effective for three months, but for somebody else, it might be affective for ten months because it's the average. The results they have is the average. What they say is on average, three months, but there are people 50% of people are above the average, the other 50 are below the average. It's something that you have to learn, but with a grain of salt. That is not always three months. Everybody is different. Everybody's physiology is different, but I believe in accelerated orthodontics, especially at the periodontal accelerated orthodontics I think is true fact.
Howard Farran: What do you think of the other thing they're always hearing about, Acceledent?
Dr Baharvand: I have never used it.
Howard Farran: Ortho accel technology, developer of Acceledent.
Dr Baharvand: Yes, I'm fairly familiar with Acceledent. I've seen their ads and I know of orthodontists using it. I've never used it and I'm not a good person to comment on their efficiency. I just don't know.
Howard Farran: One last brand name I want to ask you about is Invisalign. In my lifetime, when I got out of school 30 years ago, the big brands of Colgate, Crest, and Listerine, they were all sellers, but I would say without a doubt, the largest brand name on the entire planet in dentistry has been Invisalign. They talk about that in Arica, Asia, Brasil. Any waitress that's ever served you has heard of Invisalign. What are your thoughts on Invisalign.
Dr Baharvand: In our lifetime, there are some companies where we consider them as role model companies. They do very good in their marketing. They're very successful in every aspect. Netflix is one, Amazon is one. In my opinion, Align company and Invisalign is a very successful company. They do a very good job marketing. They've developed and their progress being a much better appliance when moving teeth. When Invisalign, the plastic of Invisalign has changed, the attachments are changed, the experience of the orthodontist is changed with Invisalign. I personally am a big fan of Invisalign. There's a lot of seminars you can attend about the practice management of Invisalign, how we can incorporate it into your practice. I think it's great.
I still believe the lab fees are high. I'm not happy about that, but I think it's a great tool. With that being said, if you're knowledge, because a lot of times we use Invisalign and we're not quite familiar with the ins and outs and we get certain results like a zero open bite or early contacts in the front or many other things. With that kind of deterrence from using Invisalign we're like, "It's not what it promised." It's important to learn to use it as a tool. Like a hammer, you have to know how to use a hammer, not to make mistakes.
The same thing with Invisalign. It's a tool. I think it's a great tool, but you still have to be able to diagnose and treat it right. I love Invisalign. I can promise you I'll be using it a lot.
Howard Farran: I want to ask you a couple of controversial questions. I want to ask you the biggest controversial questions. This is dentistry uncensored. We don't like to talk about anything anyone agrees on. I love the fact that you and your wife are still in school because it's so interesting to find out what you're being taught these days. There's always extremists in every group. They're fanatics. There are a bunch of general dentists that believe that you should never extract a bicuspid. Anybody that extracts a bicuspid is ditching the face and ruining the profile and making them look ugly. Of course I am extremely against all extremists.
I see the pendulum swinging. When I was little, it's no doubt that when I was little, I grew up in Kansas. All Catholic schools, all big families, only the most messed up girl got braces. They all invested only in the messed up girl because they wanted her to get married some day and make grandkids. Now, those families that were all five, six, seven kids, now with birth control, that family is only two, so now everybody in the family gets braces. Back 30 years ago, I swear almost everybody that I knew back in high school got braces, got their four bicuspids pulled, their four wisdom tooth pulled at the same time. Then they put them into ortho. That was way, way too much three decades ago. Some people think that pendulum should swing all the way to zero. What percent do you think due to their malocclusion still need to have four bicuspids pulled? What would you say to a dentist listening that says, "I would never refer to an orthodontics that would pull four bicuspids. That's old time. He's messing up the face. I don't care about the exclusion. I want him to look pretty."
I'm telling you, there's a lot of dentists who think that way.
Dr Baharvand: You're right. That's a very good question. As you said, the dilemma between extraction and not extraction has been an ever lasting story.
Howard Farran: That probably won't go away for another 20 years.
Dr Baharvand: No it won't. There are orthodontists out there. In fact, it goes all the way back to the father of orthodontics [Angle 00:45:12] who said he was a non extractionist. There were different theories behind it. The one person said, "He treated his wife with extraction. He didn't like the profile. Somebody else said he was a very religious person and he believed that God has given you everything and you don't have to change/modify that way.
There were a lot of theories behind why [Angle 00:45:30] did not want to do extractions. Some people believed he just didn't have a good tool to move teeth, that's why he decided not to do extractions. We have different appliances now.
I can't tell you exactly what percentage of people need extractions, but absolutely certain that there are many cases that require extraction. One aspect of orthodontics planning is looking at the person's beauty, face, their soft tissue. The other aspect that you've got to be very respectful is their periodontia and their reclusion. You can make teeth meet so they're going to bite and they can chew and they can survive with an extraction or not do an extraction. It's not going to kill anybody, but you're not being too respectful in many cases to the periodontium. What about bone? What about blood supply? How about gum recession and many other stuff.
If it's truly a problem, we'll give them a full profile. That's something we like these days. At the same time, you might put roots out of the bone. I agree. The pendulum today is towards none extraction. That's where I'm standing to. I like to exercise everything I know and I can do clinically before I pull teeth out, but there are many times that you cannot avoid extractions. You'll know it from the get go. You'll know that this is an extraction case. It's just impossible. You have a fish tank, a small fish tank and you're trying to put a whale in there. How's that even possible? I believe it's not good to be in any extreme. Those dentists, so be it general dentists or orthodontics same way, who believe that you can treat every single case none extraction need education.
Howard Farran: I want to ask you this same thing about headgear. When I was little ... 30 years ago is when I got out of dental school. I'd say 40 years ago, I graduated from high school in '80, so '76-'80, so many of those people were in braces were in headgear. We used to wonder. What's more important is dental health or mental health? How mentally healthy could you be wearing headgear in high school? It's already tough to go to school when you've got acne and pimples or you're trying to find your way, but then your orthodontist is making you wear some headgear. What is the incense of headgear today? Does it still have a place? Does it still need to be done? Can you anchor it with ... What do they call them, TADS? What does TADS stand for?
Dr Baharvand: Temporary anchorage device.
Howard Farran: Yeah, a little implant. So the same question with headgear.
Dr Baharvand: It's great too. It's funny that you asked that. I had a faculty member once. He's from Mexico. He said he had a friend in Washington years years ago, maybe in the '60s or '70s that he's used fixed headgear that he used to just place it there. He said, "I don't care. I know you're not going to wear it, so we're going to do it fixed." He used to tell the parents, "Trust me. It only takes a few months, but I'll give you results." Things were different back then. People used to trust the orthodontist. It's not like now. He got results, but going back, I just a few minutes ago said I don't like to be in extremes.
When it comes to headgear or most of the extra oral appliances, unfortunately, I see myself in an extreme that I would like to avoid any extra oral appliances for as much as I can. There are many, many instances where I sit down in the diagnostics seminar with a bunch of other residents or trained orthodontists. We start talking about a treatment. "Let's do this. Let's do headgear. There's six months of this, this and that." In our treatment plan, we forget the first and the most important thing, that we're working on human beings with feelings. For me, I know I'm not going to wear headgear. I know kids don't like to wear headgear. Nobody voluntarily wears headgear. I don't believe they will wear it.
Not only it's inefficient, but also it's a waste of time. You start creating bad ... That's the start of a lot of awkward conversations with the parents. "Sally didn't wear her headgear. This is ongoing." You start having a lot of conversation normally you would like to have. I personally believe I can manage my mechanics most of the time without using headgear or most of the extra oral appliances. There are a lot of people, many people who still use it, but I'm not one of them.
Howard Farran: Now I want to completely just throw you under a bus, run over you, put it in reverse and back over you again. I want you to go into dental town. We have 50 categories. One of them is ortho. Yesterday, a 77 year old orthodontists name Teddy Rothstein DDS, PhD. He's got two doctorates. he's 77. He has created the most controversial thread we've ever had on dental town in ortho. He is putting six brackets on each side that the Canines and two bicusps on each side. He calls it orthodontics jaw wiring for weight control in the dental professionals office and people come in and they pay him $2800 and he wires their jaw shut so they cannot open their mouth and eat or chew. His patients are losing about 20 pounds a month. He's 77. He's an orthodontists.
First of all, if he had me at age 23, he'd be my dad. I'm not going to disrespect someone who's old enough to be my dad. Number two, I've only got one doctorate, he has two. Number three, I'm kind of torn on this issue because these people have feelings. I see patients go get gastric bypass surgery. I see people 10, 20 years ago taking fen-phen and getting heart bowel problems. I see people get tummy tucks and all this stuff like that. I'm seeing people do extreme stuff. I kind of think it's conservative.
Oh my God, on dental town, there's people ... The debates are all over the place. Some are saying, "First of all, this isn't in your scope. You're an orthodontist. You're not a weight loss. You're not a psychologist. They should be going to a psychologist talking to someone on why do you eat compulsively?"
I wish you'd go in there and read that thread or weight in on it because ... I don't know. I like the idea. I think of my own children. I've got four boys and two grandkids. If they come to me and said, "Grandpa. I'm either going to get a gastric bypass surgery, or go to the orthodontist to wire my jaw shut," well shit, I'd send them to the orthodontist 100 to one. You can reverse that, but you can't reverse a gastric bypass surgery. What are your thoughts on orthodontic jaw wiring for weight loss?
Dr Baharvand: It's very interesting. I haven't read that, so I'm very curious to sit down and read it tonight.
Howard Farran: I'm going to forward you the thread. It's on dental town. Go to orthodontics. Brian, will you forward that email? We should email that thread around your ortho school because I guarantee you, I can't find any source for this, but I'm pretty sure somebody was doing that before Teddy like 50 years ago. I'm pretty sure when I was a freshman in dental school in 1983, I kind of remember someone talking about some other guy doing this. I don't think he invented this. He's done the most. He's publishing it. He's talking about it, but again, humans are extremely complex. You said it first. These people, these teeth are actually attached to a human with a lot of feelings. I wonder of the 30,000 suicides each year, how many of them might have even been related to they were overweight ad couldn't lose weight.
There was one on the news the other day. Some boy committed suicide and they linked it back. This girl kept calling him fat, fat ass, fatty, I don't know. I think it deserves a lot of debate because obviously obesity is a rising epidemic. I'm not just talking about in my chair. I'm talking about in countries all over the world. It'll be interesting. It'll be fun to see if you get any of your classmates to talk about that.
Dr Baharvand: I'll read it and watch it first, read it and then share it with the rest of my classmates. It's very interesting. You mentioned that as you said, it's as controversial as it can be. If you ask me a question, is it effective to lose weight? It is effective because you're losing weight. I'm sure people not being able to open their mouth, they're going to lose weight. Are they able to lose weight? That's the question. Is it a correct way of losing weight, then my answer is going to be negative. As you said, these people probably need psychological help rather than an orthodontist's help. I need to read it. It's very interesting that now 2017 that all this social media that's going on around us, someone is brave enough to do this. Interesting, very interesting.
Howard Farran: Last thing. You promised me an hour of your life, and I've only got you for four more minutes. I'm so grateful. I just want to ask you one last controversy. I want to keep asking you questions. No matter what you answer, you'll piss off half the people listening. That's why I call it Dentistry Uncensored. Let's talk about what they don't agree on. Some people do not agree that there is a benefit to two phase treatments. Some people think it's a scam. Some people say there's nothing you can do to a six and seven year old that you couldn't do one time at 12 years old. You just want mom to give you $1500 now when she's little because you don't want to wait six years and have her come back and give you $6000.
My succinct question is there are a lot of dentists who think, "My pediatric dentist is doing that on all these kids, giving them a rapid pallet expander and all this stuff. He's saying he's fixing the skeletal now when he can and the orthodontics will fix the teeth." Bottom line, some people think ... Some dentists think it's a scam. Some dentists think, "No, you have to treat the skeletal between six and eight, then you can treat the teeth from 12-14. My question to you is is there a reason why there's a lot of two phase orthodontic treatment or could you basically treat everything 12-14 in one phase?
Dr Baharvand: That's a great question. I think there are absolutely some occasions for the two phase treatment, mainly because of growth. The set of malocclusion that might negatively impact their growth. I do believe in two phase treatment, but I do believe in another fact too that if you ever decided to do phase one, you must have a very, very important reason for it. My experience has showed me two phase treatment has either been used too much or too little in different practices. Those who are actually believe in two phase, they use it a lot, or many a lot of cases that they should be just using. A lot of times a patient might [inaudible 00:57:32] transversely with no shifts, with no other issue, to put an expander there, is it going to hurt? No, it's not going to hurt, but is it necessary? I don't believe so. A lot of people put function appliances too early before even the growth spurt. Is it going to hurt? Again, I don't think so. Is it going to be affective? The answer is negative too.
I think you must have a very good reason to get in early and also you must know before you start when to get out. We're all here. Around us there are those kids who have been in treatment for four years. By son's been in treatments since he was in fifth grade or whatever. It's all because they started phase one. They didn't have a clear end and they went into phase two and phase two took longer too.
Does phase one always lead to phase two to be easier or shorter in time? The answer is not always. Sometimes, mainly when it involves growth and negative effects on the growth, I think you need to do phase one. My indications are usually very narrow, like something like anterior cross bite, shifts, and some of the others, but mainly function or growth related. That's when I like to get in.
I see a lot of phase twos that have been used for not a good reason. That typically happens in the same office. Some people use it a lot. Some people just don't use it as much.
Howard Farran: That was the fastest hour podcast I've ever done. I can't believe we already did an hour. I just want to tell you that it's a Friday afternoon and you decided to come on my show and talk to my homies for an hour. It was so amazing to talk to somebody who's in ortho grad school. I just want to tell you that thanks for writing that article in ortho town magazine. That was amazing. Thanks for coming on the show. Good luck with that marriage. Good luck with that new baby. I hope you have a rocking good weekend.
Dr Baharvand: Thank you very much Howard for inviting me. As you said, I can't believe one hour is over. I wish it was ten hours. Thanks very much.
Howard Farran: Do email that orthodontic weight loss deal. I'll tell you what, if you ask me, what's the bigger market in America? Whiter, brighter sexier teeth, or weight loss. You know it's got to be weight loss.
Dr Baharvand: Weight loss it is.
Howard Farran: Don't you think?
Dr Baharvand: Yup.
Howard Farran: I'm just curious if this will be a big trip. Email that thread around and see if you think this is going to be something that explodes in dentistry. Have a great day.
Dr Baharvand: Thanks very much.