Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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786 Dental Talk Show with Nick Peters : Dentistry Uncensored with Howard Farran

786 Dental Talk Show with Nick Peters : Dentistry Uncensored with Howard Farran

7/26/2017 2:09:51 PM   |   Comments: 0   |   Views: 214

786 Dental Talk Show with Nick Peters : Dentistry Uncensored with Howard Farran

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786 Dental Talk Show with Nick Peters : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #786 - Nick Peters

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AUDIO - DUwHF #786 - Nick Peters

Having a successful career in the dental industry for over 20 years Nick Peters has had all-encompassing roles from being a dental technician to working for some of the biggest dental companies in the world Dentsply, Danaher and Ivoclar Vivadent to name but a few.

Currently Nick is working for BTI biotechnology institute which is based in Spain, a leading organisation in bone and tissue regeneration and the latest stem cell research. In his spare time, he is the creator and leading presenter for the dental talk show, an exciting new resource for anyone interested in the latest dental or facial technology.

In his spare time, he loves world travel, science, gadgets, rugby, beer and learning about new technology. 

He looks forward to growing the dental talk show into a leading informational resource for the dental industry.

Howard Farran: It is just a huge honor for me today to be podcast interviewing Nick Peters, all the way from London, United Kingdom. He's had a successful career in the dental industry for over 20 years all encompassing roles from being a dental technician to working for some of the biggest dental companies in the world like Dentsply Sirona, Danaher, Ivoclar Vivadent to name but a few. Currently Nick is working for BTI Technology Institute, which is based in Spain, a leading organization in bone and tissue regeneration and the latest stem-cell research. In his spare time he is a creator and leading presenter for the Dental Talk Show, an exciting new resource for anyone interested in the latest dental or facial technology. In his spare time he loves world travel, science, gadgets, rugby beer and learning about new technology. He looks forward to growing the Dental Talk Show into a leading informational resource for the dental industry.

I called him up because I love his YouTube channel, The Dental Talk Show.

So, Nick, tell us about your journey. First of all, you've been in dentistry 25 years?

Nick Peters: Yeah, as soon as I left school. I had a weird ... Well thanks very much, first for letting me on the show. Because I'm following Tony Robbins, I was a bit nervous They guy that invented public speaking.

The way that I got started was really weird. It all started with horror films, believe it or not. I was a huge horror buff in my day. You can probably see behind me I've got some statues of Texas Chainsaw Massacre and things like that. So, when I was at school, I was really good with my hands and I was really into special effects, so I had a load of latex but I also had impression-making material that I borrowed from a local dentist. And so, I had a bigger makeup kit than most girls I know at school. So, when I left school, I thought a dental technician was quite a good fit because I was into making molds and casting and all that sort of thing, so it was quite a bit of a weird way to get into dentistry, but that's how it all started.

Howard Farran: Wow! So, where was your first start?

Nick Peters: In a laboratory in my hometown in Shropshire. I did that for many years. Being a dental technician was great because, back in my day, you could do apprenticeships so you could learn on the job. So I did that for many years, but it wasn't until later that I actually went and got the qualifications.

Howard Farran: So you were making what? PFMs, gold crowns, partials, dentures, what were you making?

Nick Peters: Yeah, that was the good thing about learning when I did because a lot of dental laboratories I visit now, they're very production line so you're sort of stuck in one role. If you were good at maybe dentures, that's the job you're going to be doing. But back when I did it I did crown and bridge, I did orthodontics, I did dentures. I wouldn't say I was brilliant, hence why I'm doing the stuff I'm doing now and I'm not a dental technician anymore. But I covered a lot of areas, I was just vaguely okay at all of them, I was never spectacular.

Howard Farran: I wish every dentist, if they could use a lab locally, they should. Because when they go in there humble, and ask the dental laboratory technician, who's getting impressions from a hundred different dentists and say, in a humble way, "How is mine?" then, how many of those dentists could you have helped do better dental laboratory procedures if they came in there and asked for help on how they could be better?

Nick Peters: Oh, yeah, absolutely. We used to be so scared of ringing the dentist. Especially if the impression was off slightly and it wasn't quite fitting, to ask them to get the patient in again. We'd all be picking straws, basically, who was gonna make that phone call because we know we were gonna get an earful because no way was it gonna be the impression. It was gonna be down to something we did wrong.

Nowadays, thankfully, I think a lot of dentists work very closely with their laboratories and they're the most successful ones, really, because they've got to take the credit, especially in this digital age with everything going CAD/CAM.

Howard Farran: You know it's the same spiel at home and work and with your labs, if people are afraid to bring you bad news, because you'll shoot the messenger, then you're not gonna get very far in life. I mean, your children aren't gonna tell you their problems, your spouse isn't gonna tell you problems, your employees aren't gonna tell you problems. Everybody's afraid of you and then you wonder why you're failing miserably. And very few people make everyone feel safe to bring them bad news.

Nick Peters: And also, we found that people would not tell us and they'd just move lab. So, before you knew it, you'd go, "Oh, they've not sent any work in the past couple of weeks," and the you'd ring them up and they'd go, "Oh, no, you cocked a job up, they've sent the work elsewhere," and you're like, well, if they'd come back, and actually discussed it, we could have found a solution and maybe found what was at fault and then alleviate that fault. But we'd find that they used to just go elsewhere and that was when you there was something bad happened. You wouldn't even hear sometimes that anything was wrong.

Howard Farran: It could have easily been very bad because they were sending you the worst impressions of everyone you were working on.

Nick Peters: Yeah.

Howard Farran: Do you think that dentists today are more humble than they were 25 years ago?

Nick Peters: Oh, well, I wouldn't say humble. We've got some people in our industry, especially in the UK, it's amazing ... that's why I love bing in the UK, there's quite a lot of dentists and people in the dental community but it is a community, everyone knows everybody else. When I go to the parties or go to shows it's all the same people and when you've been in the industry as long as I have, you get to know so many people and party with these people and so it's a lot easier, now to communicate. I think there's no reason not to, now, because with mobile phones, you can take picture in the chair of what the problem is and send it to your technician. If a technician's got a problem with the company I'm working with now, one of the components, or something, they can just take a snapshot, so things are a lot simpler now, that's for sure.

Howard Farran: Yeah and I can't believe in my lifetime, that I saw the death of the PFM. That was the hot new thing when I was in the 80s and now it's all replaced with CAD/CAM.

Nick Peters: Yeah, this is why I've started my Dental Talk Show, really because I'm quite into new technologies and things and the best way to find out these new technologies is to go visit the people. But to have an excuse to visit these people, I needed some sort of show. I thought of having a dental talk show 'cause I get all my information now from YouTube, I don't read much now, I tend to not have the time and people have just got five minutes in their lunchtime so I thought what if I do a little video of the latest things going on, that people can watch in their lunchtimes.

So that's the way I found out about these new technologies is that I've got this excuse now of The Dental Talk Show where I can go talk to people about the latest things, the latest CAD/CAM. And it's good for people like me, because I'm a complete nerd as you can probably tell with my sword behind me and things like that.

Howard Farran: If anybody's listening and the want to explode their YouTube videos, just start a thread on Dentaltown and then when you go to post, when you go to your YouTube channel and you click share, it gives you a link, but if you click the next button over, it says 'embed' you can pick up the whole embed and then you go to the Dentaltown post, click the YouTube button, drop the embed in there and now your whole YouTube video's right in that post. So, they can watch it, it's free marketing and then it takes them right to your YouTube channel so you get a like, but then they can subscribe to your YouTube channel. I love your YouTube videos.

Nick Peters: Thank you.

Howard Farran: Mostly I just love listening to your accent, but I like the information too.

Nick Peters: Cheers, man! I appreciate that. But, those first couple of shows were probably terrible. It's amazing how many ... I didn't think I'd made I until I got my first troll, you know, saying how crap I was!

But, I think you have to start somewhere, so, obviously the first couple of shows, I was getting used to the editing and I've got the luxury of doing jump-cuts, unlike this interview we're doing now, where I could just cut all the rubbish out. Because I shoot it in my office and it's just me there and you feel so stupid talking to a camera on your own in a room in the house and I get it wrong so many times. So those first few episodes, anyone who watched those, please forgive me!

Howard Farran: How many videos have you made?

Nick Peters: 60 so far. The last one was maybe about a month ago and that one was quite interesting, that's about facial aesthetics ...

Howard Farran: Plasma Facial Rejuvenation, PRGF.

Nick Peters: Yeah, so my day-job (my Dental Talk Show is my hobby, really) is to work for the Biotechnology Institute. We're based in the Basque region of Spain. If you like Rioja wine, that's why I work there, because it's right in the Rioja region! But it's an amazing institute that does a lot of research and development in the use of blood plasma. And it was founded by a dentist called Dr Eduardo Anitua and he's like a pioneer to do with the protocols to do with Plasma Rich in Growth Factors.

Howard Farran: Does he speak English? Is he Spanish or English?

Nick Peters: He's Spanish but he speaks brilliant English. And he travels the world now.

Howard Farran: I'd love to have him on the show. Fix me up with him.

Nick Peters: I will fix you up because he's an amazing guy and he's the guy that pioneered the technology but I can sort of parrot some of the information because I work for the company, but basically the idea has been around for about 50 years. So, when you cut yourself on your arm what is it that heals it? It's the growth factors that are in your blood, specifically in your plasma. So, that idea had been around for a while and somehow a way of using it has been around for about 50 years but the protocols have been very long-winded. You used to have to take tons of blood and then the results at the end of it were 'meh', okay. So, this is where Eduardo sort of streamlined the protocols to where we are now with them, where you don't have to take very much blood, you do one cycle in a centrifuge, it's very simple and you've got a control and also you've got about four hours in which to play with it. And also, we've done over 200 index studies with PRGF so it's a proven thing to work, whereas before it was ...

Howard Farran: So PRGF, Platelet Rich Growth Factor?

Nick Peters: Yeah, that's correct.

Howard Farran: And how much blood to you need? Because one of the things that dentists don't like to do is start an IV. How much blood do you need and is it still drawing blood like a ...?

Nick Peters: It's four 9cc tubes is the average you'd take. And from that you can get a really good graft and a really good membrane and maybe even a little bowl of liquid that you can collect bits of bone in, so when you're drilling, we also do a very slow drilling protocol with no irrigation at about rpm and any bit of bone that we get on those drills we stick back into the plasma and it acts like a glue and glues it all together into a really nice graft. But, the hardest part is always taking the blood. Me, you could throw a dart and you could hit a vein with me, but other people ...

Howard Farran: What I do is I do all of my surgeries at night, when it's dark and I have a vampire from a horror movie come in and draw the blood!

Nick Peters: Exactly, when I'm doing the training, I'm usually going, "One for you, one for me!"

So, the protocols have evolved now so it's four 9cc tube on average. That's enough to do a couple of extraction sockets. If you're doing a big sinus lift and ridge expansion, you'd probably need a few more tubes of blood but not really that much, maybe eight. Four 9cc tubes are equates to about two tablespoons so it's not much blood.

Howard Farran: 9cc's is two tablespoons, or four 9cc tubes is two tablespoons?

Nick Peters: Four 9cc's is two tablespoons.

Howard Farran: Two tablespoons. See the American's, we have messed-up metrics, we don't have metric or anything, because we inherited the system from you guys.

Nick Peters: Yay!

Howard Farran: We still measure things in feet and inches and hands.

Nick Peters: We measure it in pints.

Howard Farran: Does the UK, did they switch to metric?

Nick Peters: Well, we'll see with Brexit, we might switch back, who knows? We've got the elections today, so we don't know what we're gonna wake up to tomorrow. We might all go back to ...

Howard Farran: You know the most interesting piece of history about America was when they created the Constitution, they voted on the language and English only beat German by two votes and Imperial Math only beat metric by one vote. So America was three votes away from speaking German using the metric system. And the reason there were so many Germans is because most of the people who came here were religious groups fleeing the Catholic Church and the Lutherans, Martin Luther was out of Germany. There were just so many German protestants protesting against the Catholic faith but we were almost a German metric, but now we're an English Imperial Math.

So four 9cc tubes is only two tablespoons. A cc is just about the volume of a nickel, an American nickel, right?

Nick Peters: Yeah, I've got a packet here. Hang on, let me open it up and I'll show you on the camera.

So this is like a packet that you'd get and this is for a patient so it's got everything you'd need in it for a patient. So that's one 9cc tube. Can you see that?

Howard Farran: Yeah.

Nick Peters: That's one 9cc tube up to there. I don't know what that is in ounces.

Howard Farran: And if you want to get more information on these guys, I always retweet your last tweet, 'cause they're all driving to work, they can't write everything down. So you're Nicholas Peters @dentaltalkshow so, I retweeted @dentaltalkshow which is you, Nicholas Peters and then I also retweeted your company, BTI Biotechnology which is @BTIBiotech. Of course the Biotech all of those are in Spanish but remember on Twitter, there's that little light blue translate and the last tweet was Course: Clinical Applications of Technology ENDORET @PRGF. Just amazing, amazing technology.

Nick Peters: We have people from all around the world. We've got an office in North America as well, but we have people from all around the world visit our institute and learn about the use of Plasma Rich in Growth Factors because the sort of results we're getting and the applications you can do, it saves you on doing bone grafting.

We have been doing a lot of stuff, and I did one episode on my show, with Kings Hospital on BRONJ patients, so Bisphosphonate-Related Osteonecrosis of the Jaw. It's basically when the patients are on bisphosphonates, there's neovascularization there and so these are real problem-patients. You've got bone that just drops out, really, you don't even have to take it out, it just drops out because there's neovascularization there. It stinks, as well, so that's really bad because you've just got dead bone in your mouth. So the use of PRGF can be used as a prevention in terms of using it in socket preservations and things like that, you're never going to have a dry socket. But also there's a treatment, after you've taken that bone, you pack it with the PRGF gel that you've made from the patient's blood and you can get fantastic results. We've done many studies in these sort of applications but we can get Eduardo on the show and he can explain it probably better than me.

Howard Farran: I would love that because one of the problems we're having now is, now there's been so many millions of implants placed and in five years, 20% of them have Peri-implantitis and people are trying to figure out what are predictable ways to clean Peri-implantitis. Can you flap it, can you grow bone around it? Are you guys having any luck using this treating Peri-implantitis?

Nick Peters: Yeah, we are. In fact, Eduardo has written an entire book on Peri-Implanitis.

Howard Farran: 'Peri-implantitis: A new approach for prevention and treatment' ... then, raise it up a little higher, by Dr Eduardo Anitua, MD, DDS, PhD. Unbelievable, man, tell him he's got to come on my show and write an article for Dentaltown Magazine and put an online CE course on Dentaltown. It'd be the fastest, free-est quickest way to hit 225,000 dentists in 220 countries ... 

Nick Peters: That'd be great.

Howard Farran: Because implants ... When I got out of school in the 80s what was happening is there was a materials revolution making all these new materials, which lead, at the dental office, to the cosmetic revolution: bleaching, bonding, veneers. And then the 90s started this digital revolution, which allowed for CBCTs, digital x-rays and now it's moving so fast, between the greater materials, the faster computers, like CAD/CAM. They were actually building Cerec when I was in dental school, in France, but the problem with the Cerec machine is that the computers were so slow and the RAM memory was so limited, that the programmers, the constraints were the size and speed of the computers. But as the Intel micro-processor got faster and faster, Cerec got better and better until finally it was an amazing piece of technology.

But right now, don't you think implants is the fastest growing part of the clinical dentistry spectrum? Would you say it's implants?

Nick Peters: Yeah, but getting back to what you were saying about the failures, we're seeing a lot of failures here in the UK and Peri-implantitis is a big problem. We've actually invented a product which would extract implants by fitting into the internal thread of the implant. So, you can basically torque the failing implant out using this device, rather than trephining the whole implant and all of the bone with it.

Howard Farran: So instead of trephine around it ... you avoid trephine around it?

Nick Peters: Yeah, you basically counter-torque it at 200 Newtons. We've got these different ends that fit internal or external implants. That unfortunately, well, fortunately for us, but unfortunately a show of the trend is that we sell a lot of these because there's a lot of implants falling out. Just this week, I've been to two cases where implants are failing and it's nothing to do with the implant, per se, because the implant companies were very well known, respected implants. But in the UK, we've got a problem with people going abroad and getting their implants done cheaply, which is okay, some of these surgeries are really great and state of the art, but it's the aftercare, the post-care after they've had their implants. If the implant abutment comes loose, there's no way of screwing it in ...

Howard Farran: You're talking to a dentist and if a crown doesn't fit, it's the lab's fault and if the implant doesn't work, it's because you went home and started smoking and drinking and eating ice cream, so it's always the lab and the patient's fault, would you agree with that?

Nick Peters: I would totally agree with that.

Howard Farran: Well, also, when you get more comfortable with a procedure, you get a little more aggressive, you start placing them in people that smoke a pack or two a day, that you know are daily drinkers, that you know don't do anything right. I mean there's a lot of stuff going on in these failures.

Nick Peters: Implants is a big area in the UK market but it's not as big as a lot of people think it is, because everyone that's got a garden shed is starting to manufacture their own implants and they come to the UK thinking it's a booming market but people are going to stick to their traditional, well known implants because there's quite a lot of 'here today, gone tomorrow' companies out there. Plus another thing that we've got that's a challenge in the UK is the NHS, in terms of people aren't used to paying for stuff and implants aren't covered on the NHS. So, you've got three bands, basically. You've got band one, which is x-rays, a scale and polish, which costs you about £20. Then you've got band two, which is like fillings and root canals. And then you've got band three which is £244 and that covers crowns, dentures, bridges. So can you imagine the quality of the dentures people are getting for £244.00, after they take out the dentist's fee.

Howard Farran: Okay, so band one is how much?

Nick Peters: £20.60.

Howard Farran: Okay, £20, and do you know what £20 would be in US?

Nick Peters: It's about $30, or something

Howard Farran: Okay, £20 or $30, US. Band two, that's for cleaning, exams and x-rays?

Nick Peters: No, band two's for fillings, root canals, all that ...

Howard Farran: No, band one.

Nick Peters: Band one is x-rays and scale and polish, that's £20.

Howard Farran: Does that include the exam?

Nick Peters: Yeah.

Howard Farran: Okay, so band one is a cleaning, exam and x-rays for $30. Band two is how many pounds, how many dollars?

Nick Peters: £56 so it's probably about $70.

Howard Farran: And that's for fillings?

Nick Peters: Root canals, fillings things like that.

Howard Farran: So, if someone came in, in the NHS and needed a root canal, they'd pay $70 USD.

Nick Peters: Yeah.

Howard Farran: And then band three is what?

Nick Peters: £244 so, I don't know what that is, $350 I'd imagine, something like that.

Howard Farran: And band three covers what?

Nick Peters: Crowns, bridges, dentures. So, as you can see that's quite a challenge when you go, "Right, if you want an implant, that's gonna be about ...

Howard Farran: Let me get specific, what if I came in and needed one filling, band two? Would I just pay £56?

Nick Peters: That's it, yeah. That's all you'd pay.

Howard Farran: What if I needed two fillings?

Nick Peters: That, times two.

Howard Farran: So you pay $56 for each. So on band one you'd pay £20 for the x-rays, £20 for the scaling and polishing, £20 for the exam.

Nick Peters: No, £20 would cover the exam, scale and polish.

Howard Farran: And exam?

Nick Peters: Yeah.

Howard Farran: And then band two, £56, that's for each filling and each root canal?

Nick Peters: Yeah.

Howard Farran: So you get paid £56, the dentist gets £56 to perform a root canal?

Nick Peters: Yeah.

Howard Farran: And you go to Paris and Tokyo and it's about $100 USD?

Nick Peters: Yeah.

Howard Farran: And then the government is shocked when dentists say, I can't do the best root canal or filling, I can't do a root canal for $100. In America, it's at least $600, if you're not taking insurance, it's $1,200. So, that's why implants and Invisalign are exploding, because the governments in Japan and Paris and London don't control that fee, so you can charge what the market will bear and you can actually make a profit. So, they're usually using these government schemes to get a base of patients and hopefully out of their base of patients, which they can't do quality dentistry and make money, they're trying to upgrade a percentage of their practice to implants and Invisalign. Is that a fair assessment, what I just said?

Nick Peters: Yeah, absolutely, that's exactly right and that's the jump for the patient that's quite difficult sometimes. When they're used to paying those prices for their usual dental treatment, and then when they ...

Howard Farran: How many root canals, do you think, could have been done to save a tooth, but for $70 a dentist in Paris, Tokyo and London just say, "I'm not going to do that root canal on a molar for $70. I'm just going to extract it and do an implant for $1,500 US." Do you think that happens?

Nick Peters: Yeah, they do, but it's difficult for them to make that jump, really. You know, us English, we've got a bad reputation for our teeth. Unfortunately, people think we're like Austin Powers, and have those sort of teeth.

Howard Farran: Well I'm 100% Irish and we have a reputation that we drink too much, but the truth is only 38% of us Irish are alcoholics.

Nick Peters: Is that all?

Howard Farran: Two out of three aren't. So, that's a bad reputation.

So, do you guys also sell implants?

Nick Peters: Yes, at BTI we sell our own implants that work with the PRGF. So it's a super-hydrophilic implant in terms of it's very sponge-like for the plasma to soak in but also, we've done a surface modification so it releases calcium ions. So, we've done a basic study where you can dip it into a bowl of blood, you leave it there for about 10 minutes and within 10 minutes, it will clot that entire bowl of blood. It's quite a cool thing to watch, it's like something's CGI'd the video.

Howard Farran: Is that the only dental implant system that comes out of Spain?

Nick Peters: Yeah, there's surfaces out there that say they have calcium, but there's not a surface out there that has the modification we've got, that releases the calcium. We've done a study up against all the market leaders in the implant world and the SLActive by Straumann is considered one of the best implant systems out there and that doesn't ... even though it's very hydrophilic and you dip that side on side with our implant at the same time, if you pull the out you're going to get some blood on the threads of the implant of the SLActive but with ours, you're going to clot that entire bowl of blood and you're going to not be able to even see the implant when we pull it out. So, that's quite a unique thing.

Also Professor Lang, who's a professor who's written a lot of articles about the SLActive, he's a bit of a Straumann guy, he's written three independent studies comparing the SLActive against the BTI implant, which is called UnicCa and we came out better in all three studies.

This is why I've been with the company for seven years because we're not very well known but the stuff we do is bloody brilliant. And it's quite unique.

Howard Farran: So Nobel Biocare is from Sweden and Straumann's from Switzerland, right?

Nick Peters: Yeah.

Howard Farran: And BTI, is that the only implant system that comes out of Spain?

Nick Peters: No, there's quite a few others. It's a bit like Italy, Italy has like a thousand implant companies, it's ridiculous! I'm glad I don't work there because I'd be batting off any Tom, Dick and Harry.

Howard Farran: Italy probably has a hundred dental implant companies, don't they?

Nick Peters: Probably, yeah.

Howard Farran: Why is that?

Nick Peters: I don't know, it's just always been the way. I think anyone with access to a titanium rod and something to mill a surface out of it ... A lot of these companies go to the same surface company. There's companies out there that specialize in surfaces and there's five or six implant companies that will send their implant to get done there.

Years ago I used to work for this German company called Oraltronics and the manager one day got marched of the premises and we later found out that he was starting up his own implant company, duplicating the implant we were manufacturing at the plant in Germany, so it's quite an easy thing for people to do, I think, so maybe that's why everyone's doing it. And the profit's quite high in terms of it costs pence to make an implant and they sell for hundreds of pounds.

Howard Farran: So how many dentists are in the UK?

Nick Peters: Good question. I'm not sure, to be honest, it's a fair few hundred thousand.

Howard Farran: Last I saw it was 19,000. My question was going to be, what percentage of those 19,000 are still NHS dentists?

Nick Peters: I'd say the majority. And the majority might even keep a little bit of an NHS contract going, so they do their NHS as well as doing their private work, a split between the private and NHS.

Howard Farran: What percentage of the dentists have nothing to do with the NHS? Set their own fees, for cleaning, exams, x-rays fillings and do not register with the NHS.

Nick Peters: I'd say about 15-20%, something like that.

Howard Farran: That's very high, 15-20%. That's one in five.

Nick Peters: Yeah, people are moving that way. I think, now we're in a general election but concessive governments have tried to get rid of the NHS stealthily, especially the Tory Party, the Conservatives in the UK, they're quite well known for wanting to privatize a lot of it. They've sold a lot of it off already and so, that's one of the big issues over here in the UK. The NHS is slowing getting more privatized so it's the way it's going.

They've made the NHS unworkable, really, so people are forced into going private because you can only get the very basic. So, if you're in pain, go to the NHS dentist, but anything that's going to look good and function well, you really need to pay private. That's the way it seems to be, really because even if you wanted a filling, they're going to use non-precious metal. It's going to be the worst quality thing you could possibly get.

Howard Farran: I know, I've been in dental offices in Tokyo and Paris and London where they get, basically $100 for a root canal and the files that do the best root canals are seven, 10, 12 dollars a piece. To do a perfect case you couldn't even go through seven files and you wouldn't even get your money back to pay for the file.

Nick Peters: Yeah. I tell you what else is a really big area for dentists now is facial aesthetics ...

Howard Farran: Don't tell me ... Is what?

Nick Peters: Facial aesthetics.

Howard Farran: Facial aesthetics, I was going to stop you and say I bet you're going to say sleep apnea, but it's facial aesthetics?

Nick Peters: Very true, that's growing but it's still just coming in now because it's been quite a gray-area legally for a while but that hoop has been hurdled through, so sleep apnea is very big.

Howard Farran: So, facial aesthetics, you mean cosmetic dentistry or do you mean Botox?

Nick Peters: Botox and fillers. And this is an area where my company is growing as well, it's the fact that you can use the blood plasma as a way to fill out wrinkles. Essentially we're making these gels that you used to graft with, but if you inject it in liquid form, into the tissue, you can actually plump out the wrinkle, you can add a lot of hydration. We get a lot of good results with scar tissue and dark circles, which I need!

Howard Farran: How old are you?

Nick Peters: I'm 42.

Howard Farran: You're too young, I'm 54. By the way, I just want to say one thing for the record. Everybody always accuses me of doing Botox and fillers and getting my pictures photoshopped but I want to tell you, this is all natural! I am all natural, nothing fake about me.

So, is this taking off? Is it more you're selling this to dermatologists or ar you selling this to dentists?

Nick Peters: Dentists. Dentists are really getting into this now because in the UK ... actually, in Spain you're not allowed to do it, but in the UK, a dentist is allowed to infiltrate anywhere, as long as he's done the relevant course you can do it but in Spain they can only do around the mouth. The good selling point with the PRGF is it's natural, it's holistic so you're not going to have something foreign in your body. Also the fact that you get very good skin luminosity and the fact that you look natural. You're not going to look like Nicole Kidman after it. Your friends are going to notice you look good but they're not gonna go, "Oh my god!"

Recently I've done a Dental Talk Show on a lady called UK Barbie. She wants to look like Barbie, like a doll, basically. She's taken facial aesthetics to the wrong end of the spectrum, she's really overdone it. This was going to be for a TV show on Channel five in the UK, where they usually get people who are a little bit freakish. There's a guy who wants to look like a Ken doll on there. But we did a PRGF treatment on her because she's had so much Botox, so much fillers and things, we just can't ethically treat you with more Botox or more fillers, so we did the PRGF and the skin looks amazing afterwards. This is another big area for us.

Another thing we do is, like you said, the sleep apnea. That's a huge part of the market at the moment. The first time I saw sleep apnea was actually when I was in the States. I went to a conference in Washington DC, my missus was over there at the time and, being the nerd that I am, rather than go and see the sights, I went to a dental conference about sleep apnea.

Howard Farran: Now, you used to work for Dentsply and Dentsply is in York, Pennsylvania but they just got married with Sirona, out of Germany. What city are they in, in Germany?

Nick Peters: Hanau, something like that?

Howard Farran: You also worked for Danaher which is headquartered in Washington DC, so were you going to Washington DC when you worked for Danaher?

Nick Peters: No, just as a trip when my missus was working over there and I went over. But I have been over to Orange County and you had offices over there with Dentsply, sorry with Danaher. I've had a good opportunity to travel quite extensively with my company.

Washington DC was the first time I saw sleep apnea. I assumed ... because there was about 100 people in this room to listen to this conference, you try to get 100 people in a conference in the UK it's quite a difficult thing, so I was quite impressed. I thought it was down to obesity, I was quite naïve I thought that sleep apnea was really big in America because obviously you're well known for being a bigger people, there's quite a lot of larger people, let's say.

Howard Farran: We lost our number one status at the World Health Organization. We were the most obese country, we were always the winners and now we fell to second place and get the silver. You know which country beat us?

Nick Peters: Us?

Howard Farran: No, our neighbor, Mexico has 100 million people and their obesity rate is now higher than the United States.

Nick Peters: Oh, wow!

Howard Farran: I know what that feeling is because being Irish we're number two in alcoholism, we're number two to Russia. Either Russia's got to sober up or the Irish need to drink more if we're ever going to be number one.

Nick Peters: Well, my brother's getting there as well, he does those eating competitions. He's like a speed-eater.

Howard Farran: A speed-eater? Your brother is?

Nick Peters: Yeah. But his tactic for eating at these competitions is just to eat normal. And he ends up winning. Go figure!

Anyway, getting back to sleep apnea, I went to this conference and I thought you had to be fat but since I've been learning about it, I've met people as thin as sticks and that are very fit, physically. Physically, you can't look at someone and go, "I think they may have sleep apnea."

This is another are our institute is getting into but we've had to hold off a little bit just because of the regulations and things to do with sleep apnea because we've brought out a device that actually diagnoses sleep apnea. You'd give it to the patient, this little box, they'd wear it on their chest and then, they'd take that home with them and it's got a sensor that you'd put on the ring finger and it's got a cannula that sits under your nose that measures your snoring. They wear that overnight, they bring it in the next day to the practice and you can actually run a sleep study. It will tell you how many apneas you've had, your oxygenation, your pulse, snores and your body position. Now dental clinics can set themselves up to deal with sleep apnea. I think it's been heavily undiagnosed in this country. A lot of people have it and are unaware that they've got it. I think this is going to be a huge thing over the next couple of years and we're at the forefront of that with this diagnostic software.

Howard Farran: You worked for ... I don't know who's bigger, Dentsply, now that it merged with Sirona, or Danaher? One of them is number one, one of them is number two. You worked for Ivoclar and that would be about the same size as the dental division of 3M ESPE. What was it like working for the two biggest companies in dentistry. Was that a lot of learning, a lot of information? What was that like?

Nick Peters: It's like a baptism of fire, with me because I was a dental technician, Dentsply were the first people that actually gave me a chance to get into this side of things so I'm forever grateful to Dentsply for doing that because they always go, "We want a guy with such-and-such experience, years of experience and sales experience," and this is all stuff I didn't have but they knew that I had they skills to know the products and they chucked me on a lot of courses while I was there so it was really good in terms of helping me transition from working at a bench to actually talking about stuff, rather than actually doing it, which is a completely different skill, having to communicate stuff. I was very good at making stuff but I was also quite good at showing other people and training people so it was good.

Also, Danaher were very good as well but there's a lot of cogs in there. To get things done, they've got a five year objective so if the industry changes, like it always does, they've already set their target and they're aiming for that target. The size of company I'm in at the moment is quite good because we can adapt with the trends and I can do things, I haven't got a huge amount of people I can go through. There's no middle-management, as such, well not many so if I needed to speak to the owner of the company, Eduardo, I could email him so that's the good thing about working for these smaller companies than these bigger companies, that's for sure.

Howard Farran: Yeah. So, what's your goal with dentaltalkshow.con?

Nick Peters: My goal is, really, if there's anyone out there who has got anything interesting, cutting edge or anything useful or they think that my audience and your audience might find interesting, please get in contact with me at my email address, The objective really is to show what's out there, what all the latest things are, like 3D printing, intra oral scanning, the materials that we're using and, like I say, sleep apnea, that's a big one. You can come, check out my YouTube channel, hit subscribe, you can visit the website if you've got any questions or any comments about how bad that episode is, or how good it is you can like it or dislike it. So, that'd be great.

Howard Farran: So you're looking for trolls?

Nick Peters: Yes! I want my own stalker.

Howard Farran: I can't be a troll because trolls have that long hair. I don't think there's any bald trolls.

Do you think 3D printing, building up an object, will replace CAD/Cam milling down an object?

Nick Peters: That's a good question. I've done an episode with a laboratory in London called NimroDENTAL and they've got some of the most cutting edge 3D printers there. They've got one that will print models, 100 models in a couple of hours and they've got ones that do more intricate things. They were led to believe, when they first bought these things that it's all plug and play, you just scan an object and it will 3D print it over here. That's not the case, they've had huge learning curve to get this perfected.

But the thing they were telling me that was quite interesting is the materials, now. It's good in dentistry but if they can change the materials where it's bio-compatible they can start building these things up in cells instead of plastics. They've recently built up a 3D print of a heart because they're very close to Harley Street where is all the main dental practices are and also all the main surgeries and plastic surgeries, anything in medicine, Harley Street in London is the best known place for all these kind of things. They're actually doing a ... there was a doctor there doing a heart operation on a child and so they did a 3D scan of the child's heart and they 3d-printed the heart so the surgeon could practice the surgery before he actually opened up the child to do the surgery. If they can change the materials so it's actually building up the heart in bio-compatible stem cells then it's gonna be amazing. And we're not far off, I don't think.

Howard Farran: It's so interesting that you have 60 shows in your YouTube channel?

Nick Peters: Yep.

Howard Farran: And the most viewed show is dental reception training and that does not surprise me because dentists are finally finding out that the biggest constraint they have is three potential customers call an office before your receptionist can convert one of them to come in. So they're losing two out of three. Then when they do come in, you have to get three people that each have a cavity for one of them to accept and pay for treatment, so every time you do a filling, that was from three to get that one and from that three, it took nine calls to get in those three. So the funnel is nine to three to one.

Dentists are starting to realize, just like they blamed everything on their lab, they do these marketing campaigns, they blame everything on the marketing person, "Well that ad didn't work. You did a direct mail, Facebook ad, Google ad, that was horrible." No, it wasn't horrible, they just had to generate nine people for you to do one filling. And if you would train your receptionists to answer the phone and if you would quit naming her 'Receptionist' and start calling her 'Sales' incoming calls, telemarketing, whatever it takes. Start teaching them closing skills so when someone calls they convert them to come in and then when they come in, if the dentist would work on selling what they were doing ... you could get them from three, getting one in to just two to one in.

Nick Peters: Yeah.

Howard Farran: Then if there's two people, each had a cavity to get one of them to do it, you would double your business.

Tell us about that video and why you think it's your most viewed video on your YouTube channel, Dental Talk Show.

Nick Peters: Dentists love their gadgets. I go into so many dental practices and they've got everything but I always say to them, the most important tool they've got in their practice is that telephone because if you've spent millions on your marketing and your website and your videos and your YouTube channel, it can all go to waste when they finally pick up that phone, ring your office and your receptionist doesn't have a clue how to answer it or take down the information. This video is only six or seven minutes long but in that six or seven minutes you get a very basic nuts and bolts about how to ... People don't like to be selling because the first question they'll get thrown is 'how much is it?' It's a way of explaining that and getting away from that question of someone just ringing in to find out how much you are compared to Joe Bloggs down the road.

The three questions the receptionist needs to ask is, "What is is you want to achieve? When did you become aware of this problem," And "Is there a reason why you want to have this treatment now?" That's the three questions that are vital to get all your history. If you ask those three questions, you'll get a complete historical thing about what the patient wants, what they want to achieve and why they want to do it now.

Also collecting the data, collecting their name, smiling when you pick up the phone. Also naming the practice when you answer the phone. You've spent this million pounds on marketing and you don't even say the name of the practice. A lot of these things are very simple, but people forget to even ask. If they put the phone down by the time they put the phone down, they've forgotten who's called, they've not taken their phone number down or details or got anything from them.

That's why it's popular, I think because it's very good information. It's by a lady called Tracy Stuart who I highly recommend, if there's any dental practices out there running into any issues. She comes into your practice and her company name is NBS training and it stand for No Bull**** swear word.

Howard Farran: You can't say bullshit on Dentistry Uncensored.

Nick Peters: Oh, good!

Howard Farran: This is almost like a church you're in right now.

Nick Peters: Oh great, No Bullshit Training.

Howard Farran: Tell Tracy Stuart I'd love her to come on the show.

Nick Peters: I'll pass the message on, she'd love to do it.

Howard Farran: Another thing I wish you would do is take some of these YouTube videos, like the Dental Reception one and maybe the Plasma one and email them to and CC my son, Ryan@dentaltown.comn we'll put a couple of these at the end so they can see your stuff.

Nick Peters: Thank you, that'd be great. I'd really appreciate it.

Howard Farran: I called you, you didn't call me. I'm a big fan of yours.

Nick Peters: Well I'm really chuffed that you've taken the time to call me all the way from the States. I'm actually going to America in July.

Howard Farran: Where are you going?

Nick Peters: I'm doing the whole California Highway. I start from San Francisco, working all the way to San Diego going through many different places.

Howard Farran: The best vacation I ever did with my four boys, I have a big RV, a recreational vehicle, and we drove from Phoenix to San Diego and then we drove up the 101 Highway all the way to Canada.

Nick Peters: Oh, wow! Okay.

Howard Farran: We drove the whole west face and it was just so darned fun, just sitting in the RV. Some of those RV parks were on the ocean, some of those KOA campgrounds are just incredibly nice.

I want to ask one more dental question.

Nick Peters: Okay.

Howard Farran: Have you heard of a friend of mine, Dan Fischer, with UltraDent Dental?

Nick Peters: I can't say I have.

Howard Farran: Dan Fischer started a bleach way back in the day. It was called Opalescence bleaching. It was when tooth-whitening came out.

Nick Peters: Okay.

Howard Farran: This was way back in the 80s. My god, England was the hardest country to get bleaching legalized. I think he spent well over $1 million in legal fees and went before judges and this and that. It was like trying to get a chemotherapy drug approved.

Nick Peters: Wow.

Howard Farran: A lot of people have told me that the United Kingdom, that's a very conservative dental organization. It's hard, it's not laissez faire in the dental industry in the UK. Do you agree with that or disagree?

Nick Peters: Yeah, I do. Unfortunately there's a lot of reports in the papers from people doing them in dodgy places. It's been a grey area for some people because the peroxide in the bleach, well the peroxide allowed wasn't really great so people were using a lot stronger stuff than was legally allowed but it kind of turned a blind eye to that sort of thing. But bleaching's quite a big thing now in the UK.

Howard Farran: I want to ask you one other. You're never supposed to talk about politics, sex, religion, violence. I don't want to get into politics, but for the people listening around the world, you guys have a lot of newspapers and everyone in their own country know which newspapers are really good journalism and which ones are tabloid, sensational, crazy. Will you give us a rundown of which London newspapers would you say, if you're reading them online, you'd say, "Yeah, that's a really good, credible journalism," and which ones are just trying to say a bunch of crazy stuff to sell a bunch of ads. You know what I mean, tabloid versus professional journalism?

Nick Peters: Yeah. Everyone's quite blatant with their bias now. The papers are very ... at the moment they're making Jeremy Corbyn, who's the Labor Party guy, as a Socialist, Marxist, IRA-sympathizer. I think the British public are a bit more clever, I read a lot of papers that I completely disagree with, but I like to read them and get the opposing point of view. Just because I read that paper doesn't mean I believe their policies and what they believe.

Howard Farran: I'm not talking about agreeing with the paper's policies but agreeing that all the information is true, the journalism is professional, they're trying to tell you the facts or would you say they're all biased?

Nick Peters: Mostly all biased. This is why I've turned to online stuff for my news because things like Twitter are a lot quicker at telling the truth. Recently we had the attacks in Manchester and things like that. The first time I found out about it was Twitter because people were tweeting about it at the venue as it's happening. So I get a lot of my sources from people ... everyone with a phone is there own reporter.

Howard Farran: That's true.

Nick Peters: I watched the footage raw, from Twitter or Instagram or whatever, and sometimes you can watch the news after and see how they've put their spin on the video that you saw and maybe cut the bit at the end and have cut at the beginning to do it. But. We've got paper's owned by whatshisface ...

Howard Farran: Rupert Murdoch?

Nick Peters: Rupert Murdoch, yeah. So, I turned to online, really. I think, like most people, I fall in the middle. At the moment everything's either far-right or far-left, there's nothing really in the middle. But, there you go. It's a difficult ...

Howard Farran: It's true, I think journalism ... the politicians in the United States for almost 30 years have only had an 11% approval rating, which means 89% or Americans don't even approve of their own government and I think newspapers are right behind them.

Hey, Ryan, what we're gonna do ... that's been an hour but I want to segue off and show some of my homies some of his amazing YouTube videos. So I told him to pick a couple of his YouTube videos.

Nick, we're gonna end and go to your YouTube videos. I just want to tell you that it was a real honor that you came on the show today. I'm a big fan, I hope everybody goes to You got to subscribe to his YouTube channel. And again, if you've only got 60 videos, it'd only take you one hour, start a thread and post those on the dentaltown message board so everybody can see all the different titles, all your work and I bet your YouTube channel will explode.

Nick Peters: Fantastic! I will do that this weekend. Thanks very much, I really appreciate this talk and I hope to see you soon. Next time you're in London ...

Howard Farran: But now my homies are gonna want to hear from your boss. My gosh ...

Nick Peters: Eduardo Anitua.

Howard Farran: They're going to want to hear from Eduardo. Tell Eduardo the same thing, he should come on the show. On the dentaltown app and online, we've put up 411 CE courses and they've been viewed almost a million times

Nick Peters: Okay.

Howard Farran: So, going around lecturing in the flesh is slow, he could take that time, record one, make it an online CE course. There's actually two million dentists online.

Nick Peters: Wow.

Howard Farran: Two million. There's 211,000 in the United States, 150,000 in Brazil, 150,000 in China. They're just all over and he could reach more of them quicker digitally, online, YouTube, dentaltown, than ever, riding around the countryside doing in the flesh programs.

Nick Peters: I will definitely do that. He's an amazing guy and he's even done TED talks.

Howard Farran: Oh my gosh.

Nick Peters: He's very good. He's friends with quite a lot of celebrities and the King of Spain. He's a big fish, really, but he's very humble. He's built a great business.

Howard Farran: It seems like all my dental friends in the UK they're number one resort that they want to go on vacation is Spain, on the Mediterranean.

Nick Peters: It's beautiful. If you love [inaudible 01:00:40] everyone there is so healthy. Everyone is beautifully healthy because they've got lots of ... they eat tapas, so they eat for a long time, for two hours but they're eating little bits and bobs. They drink wine, really nice wine and they love their steak, steak is amazing. If you're a meat-eater it's great!

Howard Farran: Do they serve whiskey for the Irish and vodka for the Russians?

Nick Peters: Yeah.

Howard Farran: Or just wine?

Nick Peters: Yeah, they do a very good gin, I find as well, called Nordes.

Howard Farran: Gin? Gin is a British thing. You know why the British like gin?

Nick Peters: No.

Howard Farran: There's an ingredient in there that's quinone, which they thought, when the sun used to never set on the British Empire, and they were in all these tropical parts with Malaria, and they really believed and thought that it helped them resist Malaria. It turned out later it actually had an anti-Malaria component, of course for more effective treatment. It would need to be in higher concentrations but gin, was the beverage of choice for anybody sailing around the world where there was Malaria.

Nick Peters: Oh right. It is now, anyway. It's really come back. Everyone with a garden shed, making implants, I was saying earlier, now everyone's making gin, in the UK.

Howard Farran: All right. Well, thanks again for coming on the show. Have a rocking-hot day.

Nick Peters: Hi, and welcome to a special episode of the Dental Talk Show. I'm your host, Nick Peters.

So here we are, in the heart of London at Lister House and I'm here today with Dr Carl Manhem and I'm here with a Channel five crew who are filming an episode of Botched Bodies. We basically have a patient who's come in today who's had some implants placed abroad, they've not been put in properly and they've started to fail because they're infected. Because of that infection there's a loss of bone around the implant. The best thing to do in this case is to pull that implant out, because it's never going to integrate however much we clean it. We're going to place a new dental implant into to socket and we're going to place PRGF, which is Plasma Rich in Growth Factors, around it to help grow and regenerate the tissue.

PRGF is a way of utilizing the patient's own blood to help heal themselves. Basically we take a small amount of blood, we spin it for eight minutes and it separates all of the red and white blood cells, that fall to the bottom, and it leaves us with the plasma at the top. The plasma, if you add calcium to it, turns it from a liquid into a jelly. That's the best way to describe it. Then this jelly is then utilized to place where we want to grow and accelerate the healing process.

Patients find that there's also less swelling because we're not using the white blood cells, which contain the leukocytes, which are responsible for inflammatory effect. Also, there's something within the plasma itself that we've actually found has an anti-inflammatory effect to it. The good news to the patient is that they have a lot less patient and also they have an accelerated healing process that takes place. It's a very un-traumatic technique for the patient because you don't have to do a bone graft, you don't have to do anything that's too nasty. All you need to do is take a little bit of blood and that's basically it.

To summarize how to get a failing implant out of a patient, this is one way of doing it, you can use a BTI explantation kit, which contains a torque wrench and various externa and interna implant extractors. Take, for example this case, you've got a patient with initial stage of bone-resorption. The first thing you do is cut open a flap. You then manually inset the extractor in the implant internal thread in order to ensure its fixation. You then connect the 200 N/cm counter-torque wrench and turn it in a counter-clockwise direction. Torque is applied gently in counter-clockwise direction until the implant is fully extracted. Once you've removed the implant, you can then remove a lot of the gunk that's in there. You do some alveolus scraping. You then wash the alveolus with metronidazole and lastly you fill Speaker four the de-fit with as much fibrin to help regenerate the bone there, and of course, run a suture through it.

There you have a simple way to extract an implant that's failing.

Thanks for watching this week's Dental Talk Show. Please remember to hit subscribe and please remember to comment down below. Also, share amongst your friends in the dental industry and spread the word and I'll catch you next time.

Jordan: Welcome to the Dental Talk Show. My name's Jordan.

Jae: And my name's Jae.

Jordan: The Dental Talk Show is the place to come to find out the latest news, views, politics, products and techniques used in the dental industry today.

Nick Peters: And on this week's Dental Talk Show is Tracy Stuart's Treatment Coordinator Training.

Tracy Stuart: This is Tracy Stuart from NBS Training. I'm a Practice Development Specialist and today I'm going to be talking to you about the Treatment Coordinator role.

To many dental practices, a Treatment Coordinator is a luxury, it's on your wish-list. Every practice needs a Treatment Coordinator.

A Treatment Coordinator is the bridge between the dentist and the patient. The Treatment Coordinator is the person that's actually going to manage the patient around the practice and the benefit to you as a clinician is this takes away all the non-clinical time that you would spend with the patient. If you were to add that up, over the course of the day, that would actually cost you quite a bit of money.

So, your Treatment Coordinator would actually meet with your patient and find out all the emotional reasons and factors around why your patient is looking to have some dentistry, be it some implants, to have a white smile, or a straight smile. The patients are happier to talk to a team-member about the reasons why they want to have a nicer smile, which means the Treatment Coordinator has converted that patient from a free consultation to a fee-paying patient when they see you. So, when they meet with you next time, they have already decided that they want to have the treatment. As long as you don't hurt them and you're nice and you smile, the treatment has already been sold.

The beauty is, there is no pushy, hard sales. It is a Treatment Coordinator that has been trained to find out what your patient wants and your treatment plan would actually meet the needs of your patient.

Here are my five steps to a perfect Treatment Coordinator interview:

First of all, you're going to meet and greet the client and make them welcome. Secondly, you're going to find out about them. So, if your receptionist has already got some information about the patient, make sure that you have this, because you don't want to be asking the same questions that your receptionist has already asked. It's not going to make you look very professional. Then you would ask a couple more of open-ended questions, which would typically be a 'what', 'when', 'why', 'how' question. You would then take some photos of your patient, just a front-view and maybe a couple of side-views and pop the actual tablet, or whatever it is that you're going to use, or put the photos up on a screen and here is where the magic happens.

Give the patient a pen to hold and invite them to show you what it is that they would like to change, not using any negative words, as in 'hate' or 'dislike'. The patient will then show you what it is that they want to change. You can then show the patient some examples of cases that you've completed and you can show them some testimonials and you can show them different ways of spreading the cost of the treatment. If you follow these steps, the patient will pay, in full, for the next appointment, which is typically your comprehensive assessment and they are already converted and accepting to paying for the implants or cosmetic smile because you have already built the relationship with the patient and they are buying what they want, with no pressure and no hard-sale tactics.

Jae: Thanks for watching the Dental Talk Show, this week. Please hit subscribe, follow on Twitter and also download from iTunes.

Jordan: Don't forget to visit the website at and add your comments below.

Jae: Catch you later, next time.

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