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AUDIO - Thamer Theeb - HSP #129
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VIDEO - Thamer Theeb - HSP #129
Learn about how Dr. Theeb's practice succeeds, what the market is like in the Middle East, and about BAIRD: the British Academy of Implant & Restorative Dentistry
Dr. Thamer is a senior boarded dentist, who specialized in the field of cosmetic and implant dentistry. He runs Doctor Thamer’s Smile Studio and Dentallounge Clinics in Amman- Jordan. Dr. Thamer lectures extensively in the field of Aesthetic dentistry. He was a part-time lecturer at the University of Jordan. Dr. Thamer is an active member of numerous dental societies and he conducts many lectures and media shows dedicated towards public awareness in the field of cosmetic dentistry.
-Jordanian Board of Prosthodontics
-MSc. Fixed and Removable Prosthodontics.
-BDs. degree in dentistry, University of Jordan.
-Vice president of the Jordanian Implant Dentistry Commission 2012-2013
- General Secretary of the British Academy of Implant and Restorative Dentistry.
-First place winner: I Love My Dentist Award 2011, 3rd Aesthetic Dentistry MENA Awards.
Howard: It is a huge honor for me to be doing my first podcast with the first dentist from Jordan I've ever had the honor to podcast, Dr. Thamer Theeb. I've heard about you in so many places, you were part of the BAIRD Group, I mean I see you all over social media, Facebook, I mean you're a rock star buddy. It was an honor that you would give me an hour of your time. It's 12 O'clock noon, I'm on my lunch hour in Phoenix, what time is it in Amman, Jordan?
Thamer Theeb: Actually it's 10 in the evening.
Howard: 10 in the evening, so you're 10 hours ahead. Well thank you so much for coming on today and ...
Thamer Theeb: My pleasure.
Howard: What would you say your main focus is, cosmetic dentistry?
Thamer Theeb: Yes exactly.
Howard: How did you get into cosmetic dentistry and how was that market in Amman, Jordan?
Thamer Theeb: Actually to be honest this is a funny story. In my area in career I was some kind of a lost dentist. I practiced endodontics, periodontics, implantology like anyone else. Many times I tried to switch my career even to quit dentistry because it's for fresh graduates, it's frustrating, it's very difficult. I thought of becoming a pilot, then I thought of becoming a singer, okay. Somehow I found myself in to cosmetic dentistry, it's creating the smiles for the people, you see the effect you create, how you change their lives, the effect you get in a daily basis, how you change their lives, how you change the way they look to theirselves. Actually when I found myself and that's what that starts.
Howard: Well I think one of the keys to happiness is always do what you love and if you do what you love you'll do it a lot and after about 10,000 hours which takes about 10 years you'll be a rock star at it and trading time for money, doing something you hate to get money is going to lead to disease, depression, drinking, escaping, weird behavior. I feel so fortunate that at 52 years I don't think I've ever given anyone a day in my life for money. I guess I've just loved it.
Thamer Theeb: That's exactly.
Howard: We get about 5 to 6000 views alone on this each episode on iTunes and then there's Dentaltown and YouTube. About 80% of them are Americans and so first thing Americans are probably thinking is how many dentists are in Jordan?
Thamer Theeb: Actually we have around 8000.
Howard: 8000, and what would be the population?
Thamer Theeb: About 7 to 8 million I think.
Howard: 7 to 8 million?
Thamer Theeb: Yes.
Howard: I'm just curious you're a worldly man what do you think ... Americans are probably wondering what's it like practicing dentistry in Jordan. I mean is insurance a big part of the equation? Is insurance from government or a private sector or is there basically no dental insurance it's mostly just pay your own cash?
Thamer Theeb: Actually surprisingly it's the same. We have insurances, we have private practice, we have government self services. The only difference between us and the American dentists is the price, we have the same material, the same equipments, we do the same procedures, the same pictology, we have up to date, we have everything we need, but because of the taxes and maybe a little bit the cost, are a little bit reduced here in Jordan or in the Middle East in general. I think we provide the same service to some extent for a lesser amount of money.
Howard: Now if you have a license to practice dentistry in Jordan, do you get to practice in other countries nearby you, because I think I've seen you and some of your posts practicing in Saudi Arabia or London with the BAIRD Group. Do other countries recognize your license or do you have to go country by country?
Thamer Theeb: Actually it's you have to go country by country but most of the time in the region which is the Middle East and North Africa, the procedure is simple. Do some sort examination, maybe an interview and that's it, and you can get it easily, you don't need to re-study or just an exam or an interview and that's it.
Howard: Is the exam written or do you have to do a live board patient, do you have to do procedures online?
Thamer Theeb: Sometimes both of them, it depends on the country.
Howard: That is it, I cannot wait to visit your country someday, my goal is to let you ...
Thamer Theeb: It's a lovely place you have.
Howard: My goal, my bucket list, my main vice is I love lecturing in other countries as a dentist because if you go to another country as a tourist, you are going to stay in a hotel like in the United States and you're going to do some curio shops. What's really fun is go to another country to go lecture because then real dentists pick you up and you get to see the country with your friend's point of view and then I just love it. Hopefully I'll get to lecture there someday and meet you in person.
Thamer Theeb: Hopefully soon Howard, we are on it. I think we are in the process of associating with some academics and maybe with Dentaltown also to organize courses between the Middle East and the US also.
Howard: Now I associate you and first heard of you through the BAIRD Academy. Explain to our viewers, that's a big thing in London, I don't know if probably half of our viewers have never heard of it. Explain the BAIRD Academy in London and how did you get involved with that and what's all that about?
Thamer Theeb: Okay BAIRD stands for the British Academy of Implant & Restorative Dentistry. It started almost 5 years back by Professor Marcos Esposito and Dr. Hassan Maghaireh in Leeds in England. When they started the idea of establishing a new academy, they asked themselves what's the new we are going to provide, what's the new about it? We focused and we searched what we have, the courses everywhere, the dental education, it's almost the same everywhere. Our original idea was to establish dental education on an evidence based dentistry.
We will provide continual education, post graduate education but conditioned by it should be an evidence based knowledge. This is the idea of BAIRD. They start in England bringing this idea we are based in this but because we have a huge demand for dental education in the Middle East, in Jordan, in Saudi Arabia and the Gulf Region so we established many, many courses in many different countries in this region specific.
Howard: You said there's 8000 dentists in Jordan, of those 8000 how many of them place dental implants?
Thamer Theeb: Maybe it's roughly speaking 1000, 1000 and a half.
Howard: 1000 what in 8?
Thamer Theeb: Yes.
Howard: It's amazing how some countries like United States, 95% of general dentists have never placed an implant but in countries like Korea, Germany, Italy, 3 out of 4 dentists place implants.
Thamer Theeb: Yeah surprisingly I don't know maybe the people here are ... I think in view as maybe the career is little bit more controlled, you have more restrictions. You have insurance you have to pay, you have made a different style of practice but here the market is open anyone can learn. The restrictions are much lower than that in the US. Okay so it's ... I think it's easier for general dentists to practice and to learn implants and he can start placing implants the next day. I think it has advantages and disadvantages, it's not always advantages just to get the course and place implants immediately.
This is the idea of we need more education, more dental courses and we have to move to work harder on that.
Howard: So in Jordan are you allowed to advertise your services, some countries like Hong Kong say no advertising, other countries, it's pretty wide open. What's it like in Jordan?
Thamer Theeb: Actually it's an interesting question, in Jordan it's prohibited okay but we found a space in advertising through the social media, through the e-marketing let's call it. So by the law ...
Howard: So you're not allowed to do print marketing or mailing or what are you not allowed ... You're allowed to do digital marketing on Facebook, and Twitter and Google?
Thamer Theeb: Exactly but it's not ... Let's call it it's not a proper marketing for example I have a Facebook page, I have more than 2 million of followers all around the region.
Howard: 2 million?
Thamer Theeb: Yeah.
Howard: Oh my God! 2 million! See I said you're a rock star right out of the gate you have 2 million.
Thamer Theeb: Sort of.
Howard: I mean that is amazing.
Thamer Theeb: Yeah it took us maybe 5 years to get that number for the whole region, it's not only from Jordan, we have from North Africa, from Middle East, some European countries, even some in the US they are following us because Facebook, Instagram, Twitter they opened spaces that never existed before. I think this is the main source of marketing for us nowadays and it's not that controlled actually.
Howard: What specific times of advertising are illegal, are you talking about mailing a flyer or a sign outside your building, what can you not do?
Thamer Theeb: Actually you cannot advertise in TV, on the newspapers, on the magazines, you cannot have let's call it a proper ad when this is my clinic, this is ... You're allowed to advertise yourself the first time you open your practice, it's only allowed for once.
Howard: I noticed.
Thamer Theeb: Yeah so ...
Howard: I'm 52 years old, I was born in '62, how old are you and what year were you born?
Thamer Theeb: Actually I'm 33 years old.
Howard: What year were you born?
Thamer Theeb: '83.
Howard: '83 that's interesting because it was that way in the United States until 1973 and it was actual I lived in Phoenix Arizona there's actually two attorneys in Tucson, Arizona who were lawyers, well lawyers can advertise anywhere and they took it all the way to the Supreme Court and said that it violates free speech. The United States was like that way till 1973 but what's funny is I get out of school in '87 and when I start doing advertising, when I was 24 all the older guys that were my age oh my God they thought it was just horrible and I was demeaning the profession.
They just kept scolding me but the problem was I was getting 100 new patients a month from it and the cash was ... The patient flow was just so awesome. The only part I think that point to yours it's that way in Jordan in 2015.
Thamer Theeb: It's exactly the same.
Howard: It can change tomorrow.
Thamer Theeb: Actually we are working on it, it's exactly the same the people are afraid of the career being more of a business than a medicine. They are afraid that the dentist will focus on just the business part of it. They are for all about what we are, learn to be ... The ethics of dentistry, so this is our main fees but I think we are going there, we are going there. The idea is media sometimes is misleading even for the patients nowadays because the market is more open, the country is free, you can advertise whatever you want.
The people, the patients they just hear and listen about different things of the same difference with different prices. For example some of my patients they come ask for Hollywood smile and New York smile and designer smile and lumineers or gland smile and for God's sake its all dental veneers. I think it's not going to be that often but it has ... As anything else it has some advantages and disadvantages.
Howard: Tell me this when you are in like say England the people, when you are staying and you are talking to non dentists at hotels and restaurants and bars and all that stuff and you say, "well what do you think about American teeth" They are just start laughing and say they are too white, you bleach them too white and you guys look like clowns. In a lot of countries, they don't want to have an American smile because it's just too white, it's too bright, it's too in your face.
What does Jordan and surrounding Middle East, North African countries think of an American white smile, veneers, ear to ear and all that stuff?
Thamer Theeb: Man you are invading the work. It's unbelievable even supreme white, snow white colors they are not satisfactory for our patients. This is not white I need whiter.
Howard: So they just want white, white, white, white?
Thamer Theeb: It's crazy sometimes I tell them what you see in TV because of the flashes, the lighting they have, your teeth are whiter than Kim Kardashian for example. They still insist no I need whiter, I saw whiter on TV, on television. I think you are controlling the ...
Howard: I think Kim Kardashian everybody makes fun of her but I think she's a lesson for every dentist, I'd like to podcast interview her because she's the first person who's famous just for being famous. I mean she never did a single thing except market herself, she has no resume, no credentials, no accomplishments and she's a household name from Kansas to Kathmandu, from Phoenix to Jordan and she hasn't done anything. If every dentist could just be a little Kim Kardashian to get their message out because that's what dentistry has to do.
The consumers are going to spend all the money they get and all they can put on their credit cards and all they can borrow. Every earthling is going to spend more than they'll ever make in their life and die in debt. Our goal is to make them spend their money on dentistry and keep their human body healthy and so they spend less on coke and cookies and chocolates and trips to Disney Land and music downloads on iTunes and you know.
Thamer Theeb: Howard it's all about this and actually this is what I tell my students, you have to put yourself in focus, advertise yourself, put your work, advertise your work. This will keep you and just thinking providing the best quality you can have. You will keep learning, you will keep try to get the best you can have to offer. I think putting yourself in this field in front of the people try to market yourself and you have to believe in the power of each one of us. I believed in myself, I thought okay I can make it, I can be a rock star, I can do whatever I want. I'm not less that anyone else so I have to believe in this and just to find a way to work it out.
Howard: So Thamer you said you are 32? How old did you say?
Thamer Theeb: 33.
Howard: Okay you said you are, 33 when I go around the countries like say Kathmandu and Nepal, I hear older dentists saying that when they were just out of school in their 20s everyone drank water and it was extremely common for a 6 year old kid to come in and never had a cavity in their life. From over the last 20/30 years they switched from drinking water to drinking coke and Pepsi and now actually it has a cavity almost for every year oldie. A 6 year old probably walks in with 6 cavities, a 10 year old with 10 cavities, what is that like in Jordan, has Jordan switched from drinking water to drinking soda?
When you talk to older dentists that are my age do they say, "hey Thamer I mean there's twice as much cavities in kids today than it was 25 years ago or are you not really hearing it?" What is the diet like in Jordan?
Thamer Theeb: It's just exactly the same Howard, it's fast food, fuzzy drinks, it's exactly the same. Maybe because of the education nowadays people are somehow they go to periodontist, they check on their teeth in early stages on early age. I think we have better health standards but the dental problems are still increasing.
Howard: Do they use fluoridated water in Jordan or?
Thamer Theeb: Yes.
Howard: So they fluoridate the water?
Thamer Theeb: Yes.
Howard: Is that common in the Middle East to fluoridate water like it's Cairo fluoridated, or are we hot Saudi Arabia or?
Thamer Theeb: Yeah it's common, I think most of the countries they do it nowadays.
Howard: Speaking of marketing you know what I wish you would help me do, I think a lot of the BAIRD Institute people over in London, I mean London is arguably probably the most international city in the world. I mean the British empire used to ... You got flags in 68 countries and I don't think a lot of them over in London realize that Dentaltown has 200,000 registered dentists on it. I think the best marketing make or do is put some of their courses on Dentaltown just to expose people to the BAIRD.
Thamer Theeb: Yeah Howard what you are doing is just amazing thing, you are sitting here and you are chatting with someone in different country. You are bridging the gap between dentists, you are bringing the dentists closer so this is amazing. What you are doing in Dentaltown it's lovely. I think we should bring ... We should work this closer and work harder on it, we have to.
Howard: I mean I would like to make some of you BAIRD instructors a household name with 150,000 American dentists because the material you have is just amazing. Let's go through that what is the main thing you are teaching at BAIRD Academy?
Thamer Theeb: We have sort of, we have short courses and long courses. We focus mainly on implant dentistry and on the other hand we focus on restorative and aesthetic dentistry.
Howard: Let's go ... I'm going to try to nail you down on some specifics, so the people listening to you is most likely going to be 5 to 6000 and 80% of those are Americans and 20% it's about 150 other countries and in this American market 95 out of 100 general dentists have never placed one implant. So they are driving to work right now, they are listening to you on their iTunes and they are Bluetoothing it in to their car and they are listening to you and they are saying okay let's get to specifics. When I go to the dental convention in the IDS meeting, in Cologne Germany every 2 years that's the biggest dental meeting in the world, 100,000 dentists show up.
There were 145 different implant companies, how does an individual dentist pick between 145 different implants when they are all made out of titanium. So how would you answer that, and I always try to estimate questions that the listeners are saying. Listeners are probably saying well ask Thamer what system does he use and why?
Thamer Theeb: Actually there are many factors that can interfere here, first of all the services, you have to work with strong companies so you can be comfortable using their products. The name of the company is of real importance of course, for example it's easier not to start with the new companies, new household, you have to start with maybe original implants companies okay this is important. The second thing is how easy is that system? I think for a beginner those things that he should focus on, how strong is this company and on the other hand how easy is that implant system to start practicing in dental history.
Howard: What system do you use in Amman, Jordan and what system does the BAIRD Institute use in their training courses?
Thamer Theeb: Actually BAIRD we don't focus on a specific system, because our idea or our thoughts is to advertise evidence based practice not to focus on a specific implant system or specific companies, we are open to all the systems. We make sort of collaborations from time to time with different companies but it's not our real thing. Our real thing is to learn to teach evidence based implant dentistry not to sell implant systems.
Howard: What evidence do you think that you focus on that these younger dentists should be focusing? When you say that you like to focus on the evidence, what evidence are you looking at that's making you do certain clinical decisions, do you have any?
Thamer Theeb: Yes for example how many studies this implant system they did for example to start with. I'm talking about young dentists in specific, I'm still a beginner and I want to start practicing implant dentistry. This company did they do early research, did they have any articles, are those a random based trials or just case reports? What are the studies they are conducting? I think working with companies that focus on the scientific part it will help a lot.
Howard: Do you think the average dentist who goes to a BAIRD course or gets an implant, like in the United States 95 out of 100 crowns are done one tooth at a time, a patient just comes in one broken tooth it gets fixed. 95 out of 100 implants placed are just to replace one missing tooth. I think when I look at the press and the cases on Facebook it's always that 5% it's a full mouth, it's a round house, it's all that. The reality is 95% of the market is one tooth dentistry.
My question to you is I want you to weigh in on a huge controversy in the United States and that is if a dentist is getting in to implantology some people say well get a CBCT and get a surgical guide because you can snap that thing in to place and basically anybody could draw a hole through the guiding tube and place implant. The older guys like are like my age or maybe oral surgeons and periodontists who have placed 1000s of implants maybe 10-30,000 implants will say to me "hey that's like putting training wheels on a bicycle, that's like a 3 wheeler, you need to be a real surgeon." We are talking about a single placed implant, you got a tooth in front of tooth and that you should lay a flap, look at the bone, be a real surgeon.
My question to you is if this woman dentist is listening to you on the way to work right now and she wants to place her first implant, would you recommend that she did it with training wheels and a surgical guide? Would you recommend her just a suck up buttercup and lay a flap, look at the bone and be a surgeon?
Thamer Theeb: This is very controversial actually Howard it's ... I think every implant practitioner they should have the basic knowledge to be let's call it a small surgeon okay. Endodontistry is a general practice, it's not only for a dental surgeons or orthodontist, or periodontist. Nowadays we have universities that they teach their students to place implants in the big graduate school, so we cannot say that implants should be done only for the surgeons or periodontics or periodontist or [prosto 00:27:29]. No any general dental practitioner with the minimum knowledge possible he can place implants.
It is the standard of care that he should do the CBCT, the surgical guide, maybe the prosthetic guide but I think there is a minimum of surgical expertise they should exist before placing an implant. We can say okay its a general practice, any general dentist can place an implant okay but there is ... Okay nowadays to practice is much easier we have different technologies helping us a lot. Still there is a need for basic surgical skills to place implants properly, you cannot do a job only by having a CBCT or a surgical guide, it's not that simple.
Howard: What percent of the cases in your practice that when you placed implant do you personally use a surgical guide?
Thamer Theeb: Actually I'm more in to the less maybe 35%.
Howard: 35% and would that be more likely to use a surgical guide for a single tooth implant or for multiple implants?
Thamer Theeb: For multiple implants.
Howard: So would you say that you only use surgical guides for multiple implants and you almost never use one for a single?
Thamer Theeb: Actually for every case it's different okay but mainly when we have the suspicion about the bone quality, the bone graft, the angulation of the implants so here we call for a surgical guide. I think it's the standard of care to have a surgical guide in every procedure but not all of the patients they can afford this, it's not always affordable. I think sometimes we can't escape it, it is the standard of care but at some point you have to use it.
Howard: How do you make your surgical guide, do you make it off the CBCT file and exporting the data for a model? Do you make it off the CBCT or do you take impressions in the mouth and make it on a model?
Thamer Theeb: Actually both of them. Nowadays we have companies like Simplants, like Treaty Plan Master, we do impressions, we prosthetic guide and sometimes we combine both of them, we do both.
Howard: Tell our listeners something you think they might not know or something they should focus on to help them in their implant placement?
Thamer Theeb: Actually it's all about knowledge Howard, the more knowledge you get, the more confident you will be with yourself placing an implant. I always tell start with an easy system, with an easy case or take a different system and take an easy case to start with for someone who's forgiving person. Once you place ... for example my first implant was for my mom.
Howard: My first sinus lift was for a mother-in-law.
Thamer Theeb: So once you place your first implant I think it's the beginning, it's the key. It's the knowledge, when you have the knowledge you'll have the confidence and it will tag along, everything will tag along.
Howard: Brilliant and when you said an easy case, you said easy system but you didn't name a system, you said an easy case and you didn't name a case. I assume you are saying an easy case would be ... You're a cosmetic dentist so nothing visible, you wouldn't want to place your first implant where someone could see it. You'd want to be on a second bicuspid, first floor.
Thamer Theeb: Yeah good bone quality.
Howard: On an old ugly guy like me who cosmetics wouldn't matter.
Thamer Theeb: No.
Howard: Well I know I'd be the perfect cosmetic patient because I don't show any teeth so I want to switch to implants and cosmetics and that's obviously your expertise. I've seen a gazillion of your cases and you are like [beethoven 00:31:56] with the playing titanium you really have amazing cases. I look at so many of your cases you just think wow that is truly remarkable, marvelous, wonderful. Give them some tips, let's say someone's listening to you in the States and they've done 10 or 20 they are thinking about placing an implant.
Let me give you a scenario, a good looking lady walks in your office and she's 50 years old, she's got a hip lip line and her front incisor had a root canal and a crown and broke, had perio, had to be extracted. How would you handle the tissue because that's the whole game upfront because if you're putting implant and she looks at the mirror and she sees some post coming out of her jaw and a tooth on it she's going to hate it. How do you handle that tissue so that looks pleasant on a good looking woman with a high lip line?
Thamer Theeb: Yes for me Howard those are the most critical cases okay. I always tell my student not to start with these cases except that you are a real expert. Those are our let's call it a red line okay so once you are an expert you can work on the aesthetic zone. For me you should prepare yourself for a bone graft and a soft tissue augmentation. I almost do that for 90% of the cases in the aesthetic zone.
Howard: What is your bone ... how do you bone graft and what did you and a soft tissue augmentation?
Thamer Theeb: Yes connected tissue graft, none are there sometimes.
Howard: Can you kind of explain that procedure how you do it?
Thamer Theeb: Which kind of procedure?
Howard: What you do for a standard bone graft, what is your standard bone graft? I mean how do you place it, using a ...?
Thamer Theeb: I use a synthetic bone graft okay I use a synthetic bone graft. Usually it's 2, 3, [inaudible 00:34:01] how we are going to manipulate the [inaudible 00:34:06] amount of [bone 00:34:07] available. Most of the cases in the aesthetic zone we find ourselves in need for augmenting the case with the synthetic bone and also augmenting the soft tissues.
Howard: So you use synthetic bone ... I always try to use autogenous bone, why do you like synthetic bone instead of autogenous bone?
Thamer Theeb: The main reason is because it's easier, we do not bring our patients to another surgery, to more difficult procedures. I think that's what we call the [evening 00:34:58] stage practice. They did many studies comparing autogenous bone and the synthetic bone. I don't want to generalize but at the end to some point they can almost work the same.
Howard: What type of synthetic bone do you use, is it a certain company, the name ...?
Thamer Theeb: I use many types with the ... I heard you talking about the MegaGen bone it's very good, the MegaGen bone graft, we use the Bio-Oss, the Inferno-Oss. To be honest it's not that of a difference, it's a synthetic bone as long as it's well established company with a good reputation. At the end to some extent they almost work the same.
Howard: On this 50 year old lady, this case we are talking about, would you do the bone graft and then have her wear like a removable partial flipper for a while while that heals or would you do all the bone graft and place the implant at the same time?
Thamer Theeb: Yeah Howard of course it's a case dependent but most of the time we believe that we should place ... If we have enough primary stability we'll do a temporary ... A sort of immediate temporization, maybe a rochetter. If we have enough primary stability sometimes we immediately load the implant to establish the soft tissue profile. No we are not in to flippers or removable dentures but we always recommend to do a rochette or an immediate temporary crown, it will help a lot.
Howard: Yeah it depends on where you're placing the implant we think it will twerk out and be stable enough. What other cosmetic tips could the legend share with our listeners? Let's talk about just the basic, basic, basic, teeth bleaching, teeth whitening, are you a big fan of doing that in your office or do you just take impressions, make trays and have them do it at home? What's your standard go to when a woman walks in and says I want to bleach my teeth?
Thamer Theeb: Actually Howard before talking about bleaching I think believing in the teamwork it's the key to success. For example in my practice we have a periodontist, we have an oral surgeon, I'm a prosthodontist so for every single case you will have 3 dentists working on the same, at least 3 dentists working on the same case. To start off for maybe this kind of life or every type of dental procedure, it's a team work, we don't have super dentists anymore. If you believe in this, I think this is the key start to success, it's the teamwork. For bleaching you asked me about bleaching I believe in doing just both of them.
Howard: What do you ... Like when someone comes in to your office, so a 40 year old lady walks in and says, "hey I want to bleach my teeth," what would be your go to, would it be in office or would you send her home with trays?
Thamer Theeb: Actually my principal goal is to do both of them because most of the patients ... I think many dentists they think that spending 2 hours bleaching the teeth in office this would cost a lot of money and this is sort of waste of time. Actually this is not true because today's patients they want to see immediate effects. This is what they cannot have using their home bleaching phase only. The wow effect they should give it in the clinic. Okay so it's very important that they go home with white teeth, this is my philosophy okay? Patients when they have their bleaching on days, or on weeks, they don't see the difference.
Thamer Theeb: Yeah so I think we should establish sort of primary improvement in the office and to boost this up and to keep the result we advise them to use the home kit. I do almost 3 to 4 cases a day for the bleaching and I think this is my I think 4th office and home bleaching. Even sometimes I do the home bleaching for free, I believe it's all about the home bleach.
Howard: Right and not to light.
Thamer Theeb: It's not the light of course it's not the light but ...
Howard: Do you use a light on the patients?
Thamer Theeb: Yeah they just like it.
Howard: I know it's the only thing I feel I really don't feel right about. I mean I kind of feel dirty because when they are with the office bleaching and I know all the research is light doesn't do anything but every time I see the patient, we don't use the light because it's not necessary they don't believe you. Now they are like well I don't know I think I'm going to try this laser bleaching so it's like I can't explicate 7 billion earthlings so just we have the ... We do the light even though I believe that it has no impact.
Thamer Theeb: Actually Howard I always tell my patient before I start you have to know 3 or 4 things about bleaching. First of all we are dentists we don't control the results, it's all about your teeth. No dentist can control the results of teeth whitening. Number 2, most of the patients they come with very high expectations, I always tell them what you see on television it is not bleaching. I always tell my patients it's all about your teeth, your oral habits, so it's reversible. You have to keep doing this all over and all over again.
This is why I always emphasize after you do the office bleach you have to supplement it with an in-home kit.
Howard: Let's go to the enter teeth, do you ever do direct bonding to do a smile makeover or do you always prefer indirect porcelain veneers?
Thamer Theeb: Yeah actually I'm more of an indirect person, I think the culture and the community plays a role here. Nowadays we have superior composites, we have superior cases that deal with direct restoration direct bonding. I think maybe it's the case here in Jordan or the Middle East but I think the hygiene, the habits, the composites are maybe not helping me regarding the heeding the analysis they get at the dental office. So I'm more in to the porcelain laminate veneers. I still do direct bonding for some cases but whenever I have the chance no I'll go for indirect restoration.
Howard: Do you make your own in your own dental office, your own lab or do you send them out to a lab, where do you send your veneers?
Thamer Theeb: Actually I have my in-office lab.
Howard: You have an in-office lab and that must be really, be a nice luxury.?
Thamer Theeb: Yes it took me time too but to be honest for an aesthetic practice you have to own this.
Howard: You have to have your own lab for an aesthetic practice?
Thamer Theeb: Yes ...
Howard: How many ... Is that a one man show or does that take two people, three people, how many people does it take to have an in-office lab?
Thamer Theeb: Actually to make it simple at least you need a one lab attendant and one serumist.
Howard: So two people?
Thamer Theeb: Yeah for me my serumist has his own laboratory, and for aesthetic cases we have our own lab, when he come to the office and we start working on the patient. It's not enough for the dentist only to do the case own by himself. It's very important ... Again it's all about the team work even with ...
Howard: It's kind of interesting because when I got out of school in 1987 now it's 2015, so 20 years ago all the dentists I knew where I lived in Kansas they had a one man in a room about the size of a dental operatory. The same size room is a dental operatory making all their crowns, but then and this new system start coming out like that required big money to buy lots of big machines for e-max and all these different machines. It kind of priced them out of the market I think it was that high price machinery that kind of created a lot of the big labs. Now I don't know anybody, I don't know one general dentist in my area that has his own lab man, but it's kind of interesting how that you've done that. You see that in cosmetic dentistry like Larry Rosenthal in Manhattan he has his own serumist too.
I want to ask you another thing, do you ever think CAD/CAM will be making your veneers or is that just too monolithic for what you're trying to achieve, have you done any CAD/CAM veneers on good looking women on the front teeth or the high lip lines?
Thamer Theeb: For me Howard it's then we are not there to rely only on CAD/CAM. Okay we are getting better, we are having better results, we are going there. Can I tell myself okay I'll stop everything and I'll focus on CAD/CAM dentistry. I think we are not there yet.
Howard: Are you using in the posture teeth are you using CAD/CAM in the back or do you still prefer an impression on your lab man?
Thamer Theeb: We do CAD/CAM procedures because it's ... Again the affordability is always a factor okay but we still do, we do CAD/CAM dentistry more for the posterior teeth but still the main practice is taking impressions and working the regular way.
Howard: So if I came to you, if I came to your practice and I broke my first molar would you recommend for me CAD/CAM or an impression and make a crown? If I said I wanted tooth color what would you do for me?
Thamer Theeb: Tooth color for posterior teeth?
Howard: Yeah first molar.
Thamer Theeb: Yeah CAD/CAM can do the job.
Howard: Look but would you do CAD/CAM or would you take an impression?
Thamer Theeb: Yeah I do CAD/CAM if the patient can afford it yes.
Howard: Now for me in my office the price is same but since I am kind of a hyper dude, I mean I'm kind of ... I'm an upper man and I ask my ... If we are going to make it in the office they are going to be there for 2 hours and so I say to them okay here's the deal we can do one hour today and I'll prep the tooth, take an impression and you leave the temporary. Or you could stay 2 hours and I will make it here, there'll be no impression, no temporary and 2 hours you're leaving you'll be done. I mean you're not going to believe this, and maybe it's just my area but in Phoenix, Arizona 4 out of 5 people say oh I just want to leave in an hour.
I was thinking myself if I had to go to the doctor's office and sit in that room for 2 hours, I'd go crazy. I think a lot of humans are ... They're busy and they got things to do and they are looking at where they need to go and I need to go here and I got to get run this errand and pick up my kid. 4 out of 5 people say no man I'd much rather scoot in an hour we say okay. For us its the same price either I will do it here for 2 hours or we'll do the hour then come back in 2 weeks for 30 minutes same price.
Thamer Theeb: Yeah Howard yeah but you can do the CAD/CAM in your lab it's not always in clinic. We do restorations, CAD/CAM perpetrated but in the lab and it's nice that we can deliver the restoration the 2nd day. In my region we rely a lot on what we call denture tourism we have patients from all over the region and they need fast and excellent results. This is a solution we take beginner impressions and the technician or we can take digital impressions and the technician can do the job later. Still we can deliver the restoration the 2nd day it's still good.
Howard: So dental tourism usually pops up in any country that can deliver the same high quality dentistry at a lower price because of a different currency or a different economy, so what countries are you attracting dental tourism from?
Thamer Theeb: Actually we have many ... The main countries are from our region the Gulf Region, the North Africa but still we have many from Europe, from the States, we have a lot. We have a lot ...
Howard: Does Cairo get a lot of dental tourism?
Thamer Theeb: I think so for me I'm closer to Lebanon and Jordan and yeah we have a lot of that.
Howard: My last name is Farran and there's only 86 families in America with the last name Farran, we are almost all the world's Farran's live is in Lebanon. Did you know that?
Thamer Theeb: Yeah exactly yeah.
Howard: In Lebanon Farran means baker.
Thamer Theeb: Yes.
Howard: The funny story at Phoenix is about once a year I always have a Lebanese guy and I'm always ... I know this is going to happen, I'll walk in the room and they look at me strange to go. Are you Dr. Farran and I go I know you're expecting somebody to look like they are from Lebanon but that's funny. Then are you doing any ... I don't feel like I should be asking you questions because I've seen your work and you're really a legend in my mind and many other minds. You know Ken Serota?
Thamer Theeb: Yes exactly.
Howard: Ken Serota says you're the greatest dentist in the Middle East, he's a huge fan of yours. I only got you for 10 minutes less, what do you think you could tell my viewers, any pointers or anything else they could focus on to become better dentists like you?
Thamer Theeb: Thank you first of all Howard to give me this chance, I'm honored to be with you today. I would like to thank Ken also, he supports us a lot and he's not helping us maybe to get in to viewers. I think we in Dentaltown we'll be working together very, very soon. We are working on this. As I said before first of all we have to believe in ourselves, I'm talking to the fresh graduates, you should believe that you can make a difference and you should believe in your abilities, how to improve them. As you said working on the things you love for example it's just weird how for example many dentists they like to do periodontics.
Most of us don't like treating kids and it's just their love, their passion to treat kids. So find the area that you like to work on it, improve yourself, get educated, get the power of knowledge to always say it's the power of knowledge, once you have the knowledge you will have the confidence. You have to believe in yourself and at the same time to believe in the team work, it's not only a one man's show or it's a one man job. Once you have those the knowledge, believing and the teamwork you'll have the success.
Howard: I had four kids they are all raised now, they are 20, 22, 24, 26. I got a 3 year old granddaughter but if I had to be a pediatric dentist I would tear up my license and quit. I always thought that's just the attitude, it's a mindset and for 28 years I still will work on kids trying to overcome that but my resting pulse is like 140. It's usually a child they might not even know English and they are crying and their moms stressed. When I get done doing a pulpotomy and a chromosal crown on a 3 years old kid who doesn't speak English, I just want to just walk out the back door and say you can take this job and shove it.
I don't know why I can't get over that. If I had to thank God for one thing on earth it would be for pediatric dentist and nothing else. So do you do root canals too?
Thamer Theeb: No actually we have an endodontist, he's a full practitioner with us. So we refer all of the endodontist cases.
Howard: I want to focus on, I only got you 7 more minutes I want to focus on one other area, does the BAIRD Institute and you personally, do you have a place for many implants?
Thamer Theeb: Yes actually Professor Marcos, Dr. Hassan, they've managed many literature reviews combining different studies about short implants. What they found that they have a good success and we actually can rely on short implants.
Howard: No I'm sorry I didn't mean short, I meant the diameter, the many implants being anything less than a 3 millimeter diameter ...?
Thamer Theeb: In some cases you have to do them but they are not a general practice. We do mini implants, me, myself I do not like the one piece implants but I do place mini implants that come in to 2 pieces.
Howard: Underneath a fully adentualise partial or denture? I mean underneath a denture?
Thamer Theeb: Yes sometimes underneath a denture, sometimes for lateral in sizes, for in sizes [inaudible 00:54:44] mandible. I do place mini implants but in one condition if they come in 2 pieces. I don't like the prosthetic outcome of one piece mini implants.
Howard: That is very interesting, so on five minutes to go, any other little hanging fruit? How could my listeners around the world learn more about you or the BAIRD Institute or anything, where should they go?
Thamer Theeb: Okay hopefully soon with [inaudible 00:55:25] we are available at baird.uk.com. For me my website is drthamer.com and I'm available also on Facebook on Doctor Thamer's Smile Studio. Again Howard thank you, you are doing a great job and this is a brilliant idea bridging the gap between dentists, bringing the dentists closer to each other. I'm very glad to see you, to chat with you and this is a great opportunity for me to do this with you and hopefully this will bring us more success and collaboration with you in the near future, hopefully soon.
Howard: Okay well on that note thank you so much for giving me an hour of your time, you're so generous and I had a fun time and thank you so much for doing this.
Thamer Theeb: Thank you Howard, thank you this is my pleasure, thank you again.
Howard: All right buddy bye, bye.
Thamer Theeb: Bye, bye, goodday.