Howard: It is just a huge honor to be in Sydney, Australia – sitting here talking to Emanuel Recupero.
Howard: Thank you so much for coming on this show today. I really like what you’re doing with Dental ED because education really hasn’t had a lot of innovation. I mean, you go back to the schools in America and that business model of a teacher standing up in front of a room with thirty students hasn’t really changed in three hundred years … and you started Dental ED. He’s a recognized leader, provider of advanced dental training and practice development, his integrated training services have been developed by the most respected names in dentistry, he has advanced the level of dental knowledge for thousands of dental professionals around the world for over sixteen years. Enhance your learning journey with the world’s best dental educators through either online courses, study clubs and workshops anywhere in the world. Emanuel Recupero started as a microbiologist and then worked in the pharmaceutical industry for seven years. In 1997 he started his marketing consulting company, providing strategic marketing solutions to the medical industry and then dental. He then started Dental ED in 2003 with the idea of making high-end education more accessible to dentists. So basically, this is a real innovation. So, basically, you started a long time ago – 2003 – probably before anyone, with online dental education?
Howard: Yeah. So tell us about your journey … how did that happen?
Emanuel: How did it happen?
Howard: Were you born in Italy?
Emanuel: No. I was born in Australia. My parents are Italian, so I am first generation Australian, and they immigrated out in the ‘60s and so I did a science degree and …
Howard: In microbiology?
Emanuel: In microbiology as a major, and worked in a hospital for about six months and felt that this is really not what I wanted to do. So I was going to go into research and then I decided to leave and work as a microbiologist and I found the whole culture a little bit too weird for me, so I had to get out and …
Howard: Who were weirder, the people or the bacteria?
Emanuel: Both. So a person came into the lab one and she worked for Parke-Davis, I think it was, and I thought, Wow, she’s got a car and she can talk to people and she can manage her own time and she drives around, and I thought, this is really what I want to do. So I applied for a job and I got a job with an American company called Syntex and they were based out of Minnesota, I think … I can’t remember exactly, but they made Naprosyn. So, have you ever heard of Naprosyn?
Howard: Yeah, an analgesic.
Emanuel: An analgesic, an anti-inflam … Ibuprofen, so they invented Ibuprofen, I think. And I worked for them for about three years and then from there I moved over to Roche and really was involved a lot in the marketing and sales part of the industry and got very well trained and then it was time for me to leave – and I felt that I probably could provide this knowledge and expertise from the pharmaceutical industry that they do so well in what they do in terms of marketing and strategizing and selling, that I thought I could apply that in the medical industry. And so I provided a consulting service and that went from 1997 to about 2003. It was doing well – it was called Medical Marketing Services, or MMS, and then I started to do some work for some dentists. It was a little bit too early then – well, every dentist was too busy for marketing … it was just not really needed.
Howard: In 2003?
Emanuel: About 2001, 2002 – still too early. Marketing people were starting to come in to it, but they were far and few between. There was Roger Levine at the time and the internet technology was sort of in its infancy, you had started coming up as well in that time, I remember very well.
Howard: But back then the average dentist in Australia was booked a month in advance.
Emanuel: Six weeks was the average, even more.
Howard: Six weeks was the average?
Emanuel: Even up to two to three months sometimes. So it was really …
Howard: Yeah, no-one wanted practice management.
Emanuel: They wanted practice management on how to streamline the practice but not how to build a practice – they didn’t want to build a practice anymore. It was just too much work – even to get a new recruit, a new student who’d just graduated, a new grad, was just so difficult. They would pay anybody to get into the practice, it was just that difficult. And so marketing was not really an in thing at the time. So I came across an orthodontist who … I did a marketing plan and strategy plan for him and he introduced me to the concept of study clubs, and I understood the model of the study club and I thought, Well, look, there’s gotta be a better way to get really cost-effective education, especially in Australia being so far and remote we had, the education that we had was quite incestuous - same people, same study club presenters with the same material pretty much - and I thought there are all these text book people that have all this wonderful wisdom to share but no-one’s ever heard them, they only know them by name. And I thought, well, how are we going to do this cost-effectively, to get such high calibre information out there. And that’s where we looked at towards the internet. And we were talking about dial-up in those days …
Emanuel: AOL, that’s right. AOL. And …
Howard: What year were you starting that?
Emanuel: Well, we started … the idea was around about early … mid … late 2002.
Howard: When I started Dentaltown, it was 1998. The AOL dial-up … you’d have to call three or four different numbers.
Howard: And I was just gonna put everything I had into Dentaltown. And I can remember my dad, my sister, my ex-wife standing in the kitchen crying for the whole day, telling me how insane this was, ‘cause the early internet … and that’s why Jeff Bezos, when he start the internet, he only sold books, because that was the only thing you could sell with it - text.
Howard: He wanted to [UNCLEAR 00:06:33] direct mail but most of the direct mail that he wanted to go into, which was cooking and fashion, all needed a picture and he said, We’re going to have to start with books because the internet pipes won’t be big enough to send down a picture. And then, so, you were even later with a video, I mean …
Emanuel: We were trying the impossible feat over dial-up which was trying to transmit high resolution photos or imagery – slide projection – as well as have a video and voice. And try and sort of emulate some level of live-ness about that presentation into a venue. So, dentists wanted to see their presenters live, watching it on the big screen, it’s gotta feel real. So we had a real big challenge and by some coincidence during that time – it was like in that week – I got an e-blast and it was about this new technology that came out which was called Centra and it pre-downloaded a lot of the content onto the hard drive and only streamed the audio, so that’s how it got around this. It was pretty revolutionary at the time, no other web-collaborating software, even WebEx couldn’t do it at the time. So this was kind of a real big milestone. So we trialed the idea of bringing in a number of venues and having a live speaker and testing that to see if it works. Well, we did that in June 2003 – it was a disaster! – but we did get a partial transmission out and it was the first time that web-conferencing was used in dental.
Emanuel: So we were almost going to pack up and say, No, this is not going to work. We didn’t get the support of the Dental Association, they didn’t think it was gonna work and there was a lot of people very negative about it, but there was also a lot of people saying, Look, this is the future. So we thought, well, let’s give it another try but let’s do it bigger this time, let’s get an American speaker and do it from overseas and transmit it into Australia – and so that’s what we did, we got twelve venues and we had a total of about seven hundred dentists all watching, and we had a …
Howard: Seven hundred from Australia?
Emanuel: Yeah, because you’ve got twelve venues and in each venue there was fifty or sixty dentists, so you add them up and that’s how you got the numbers.
Howard: And who was your speaker?
Emanuel: We had Rick Roble from the US.
Howard: Rick Wobbly?
Emanuel: Rick Roble. He …
Howard: Rick Robbly?
Howard: How do you spell that?
Emanuel: R-O-B-L-E. So he’s both a prosthodontist and an orthodontist, and he did a presentation – it was live in those days, there was no recording, so he was up at three in the morning doing this presentation and it was successful. It went through and it worked and that was the birth of Dental ED. Since then we’ve had [00:09:38 John Coy) Gordon Christensen, Ron Goldstein, you name it. We’ve had plenty of people on the programme … we’ve done now nearly three hundred, four hundred, three hundred and fifty, four hundred lectures, live.
Howard: Wow! Now do you archive all of those lectures so someone can go back later and watch all of them?
Emanuel: We don’t release them. We’ve got them in our private collection as a memorial thing. Some of those things are a bit dated now, but some of them are still there.
Howard: So the element is still live? That’s …
Emanuel: Well, we’ve changed our model. We had a few experiences where the speaker went down and the whole network goes down and so we thought, after restless sleep I decided, Look, there’s gotta be a better way, yes, a safety recording net. So we did a backup recording and then we gradually developed our own software which we could launch that recording remotely on everyone’s computer at the same time and shut it down and then go into live Q and A. So we only had the speaker online for about, oh, fifteen to twenty minutes. It’s surprising, even today …
Howard: Do you remember Johnny Carson and the Tonight show?
Howard: Did they show that over here?
Howard: Oh, I didn’t know that was in Australia.
Emanuel: He’s dead now, isn’t he?
Howard: Yeah, he’s dead. Yeah, he died shortly after he retired.
Emanuel: Yeah, that’s right.
Howard: I think he died of emphysema, didn’t he?
Emanuel: Something like that, yeah.
Howard: But I went and watched - my mom and dad wanted to go and see that show live. So we went to Hollywood and saw his show at Arsenio Hall and Johnny walked out and he said, “These shows that are live”, he goes, “that’s a helluva lot of risk and I come in here and we just shoot this in the afternoon. There’s no pressure if someone forgets their line or screws up a joke and I look at these other venues like Saturday Night Live, where it’s all live, before a live audience but the people in LA aren’t watching it live, they’re thirty hours later and it’s a lot of stress going live and a lot of it’s unnecessary.” So that’s what he kind of figured out.
Emanuel: Well, yeah. That’s how I lost half my hair!
Howard: Well, I lost all of mine and I didn’t do any live!
Emanuel: Yeah, that’s what Dental ED really is. It’s sort of like an event management company. We provide a lot of courses and a lot of lectures, and a lot of study club lectures.
Howard: You have an office also in America?
Emanuel: We do. We run in partnership with a group called VisionTrust, Jeff Behan, and he’s based in Colorado, so yes.
Howard: And Jeff … what does he do for you in America?
Emanuel: Dental ED has a partnership agreement with many countries, some of them are sole partnerships. It’s a difficult model to explain, but some countries have sole partnerships with Dental ED and the others have other businesses that they run – and VisionTrust happens to be one of them, they have their own business and Dental ED is one of those services that they run. It’s a product.
Howard: Am I saying that right, VisionTrust?
Emanuel: Yeah, Jeff Behan is well-respected in the orthodontic as well as in GP land and he’s got a specialty in Facebook.
Howard: Oh, so he’s a dentist?
Emanuel: No, he’s not. He’s a consultant.
Howard: Oh, he’s a consultant.
Emanuel: Yeah, he does a lot of speaking on Facebook - how to use Facebook.
Emanuel: So, for the dental industry.
Howard: Yeah. Now, you also are putting hands-on courses … ‘cause you have a hands-on with Maxim Belograd, who we podcasted when we were … Maxim and I were both lecturing at the South African Dental Association in Johannesburg, so I convinced him after his seminar and after he was tired and exhausted and wanted to go to bed, to come back to the hotel room and do a podcast and he did. So, you’re doing hands-on and …?
Emanuel: Yeah, we’re in about eleven countries. We run study clubs and we run hands-on courses in those countries.
Howard: For like inlays, onlays, crowns …
Emanuel: Anything, well, pretty much aesthetic. We’re more towards aesthetic dentistry. We have done implants. We work with the top end speakers, Pascale Manye …
Howard: Wow! He’s from Brazil?
Emanuel: No, he’s from America.
Howard: Oh, UCLA!
Emanuel: UCLA. No, Southern California. Who else? Galip Gurel. We worked with a few good names out there, Newton Fahl, he would have been …
Howard: He’s from Brazil.
Emanuel: Yeah, he’s from Brazil. So, you would …
Howard: I confused him with ….
Emanuel: Composite guy. So, and that’s how we started, actually. Newton Fahl was the one the first course was thrown into, which is a pretty intense course to start. So we started from study clubs, then we went to hands-on courses and now we’re sort of progressing into advanced marketing software as well now.
Howard: So what’s the difference between online and hands-on?
Emanuel: Hands-on is where we, at the moment it’s not online. It’s where they’re in a venue and they … have you ever been to a hands-on, you used to practice as a dentist, didn’t you?
Howard: No, I still practice, I’ve been practicing for thirty years. What I meant by that is I could watch Newton Fahl or Pascal do direct composite in an aesthetic case?
Howard: But do you think the dentist learns more with show, touch, feel, working with the materials, the hands-on? Is online more didactic and what do you think is the focus more of online versus hands-on?
Emanuel: I think it, the advantages of online is that it’s accessible, perhaps more cost-effectively for a lot more dentists.
Howard: So, lower cost? Online’s lower?
Emanuel: Lower cost, easy reach, as well as perhaps convenient. Convenience is an important thing for a lot of dentists. Hands-on is a different experience – there is a speaker there and you are with your peers, I mean, dentists are social creatures. They don’t like being in the practice alone all the time, they need to go out there and learn as a group. They feel they get quite a lot of value doing that, they’re sharing their own experiences amongst each other as well as being in the presence of the speaker and sometimes being around that speaker that they admire so much and getting that feely-touchy and closeness to that whole experience is very important. I think that’s part of what our hands-on experience is about. A lot of the techniques that they learn is repetitive in some ways and is just a reassurance that they’re learning the right things, that they’re doing the things correctly - sometimes it’s new – but being in the presence of their mentors is really what it’s all about.
Emanuel: Would you agree on that?
Howard: Yeah, I do. It’s kind of like movies and books. I have so many family friends that will only read the book and if they ever do go to the movie, all you hear about is how …
Emanuel: The book was better!
Howard: The book was better! And I’m always trying to explain to my sisters, “Well, it took you six hours to read the book, but the movie was only two hours.”
Howard: So again, you can’t do a six hour movie! I remember Oliver Stone … there’s only like a handful of people alive today that have made over sixty films. And Oliver Stone has lectured extensively on the challenges, ‘cause a lot of people complain. I remember in his movie “Watergate”, all the critics were like, “You said this guy did this and this and that was actually two separate guys and that’s a fact! Your movie’s a fallacy, it’s a factual flaw.” And Oliver’s like, “Dude, I don’t have time to introduce another character. I knew that was two characters but for a shortcut I had one character do two different humans’ stuff because I’ve got this time span.” But, yeah, I think that some people … like I always learn the most dental information reading the textbook. But I know very few people want to sit in a chair the whole weekend and kill a three-, four-, five hundred page textbook.
Emanuel: It’s quite surprising that a lot of dentists do love good quality textbooks. They do learn a bit, but then it’s about applying it – and that’s where the hands-on comes into it. A lot of these people, a lot of dentists that go to the courses where we bring some of these speakers out do read their textbooks before they come, but it’s just bringing the knowledge and the information all together, sometimes in a practical sense, is really what it’s all about.
Howard: So, what will my homies find if they go to dentaledglobal.com?
Emanuel: Well, they’ll find basically our study clubs and our study club program and …
Howard: And you said you’re in eleven countries?
Emanuel: Yeah, I think there’s about eleven.
Howard: And what are your eleven countries?
Emanuel: India, China, US, Indonesia, Singapore, Taiwan, Hong Kong, New Zealand, Australia … you’re testing me now … I know I’m gonna be embarrassed ‘cause I’m gonna forget a few.
Howard: Well, you picked up [UNCLEAR (00:19:21)] … China’s the most, number one populous – a billion three – India’s number two – a billion two – America’s number three – three hundred and twenty five million – but most people don’t realise Indonesia is number four – they have two hundred and twenty five million people!
Emanuel: Yeah, yeah. It’s amazing!
Howard: I mean, it’s a huge country.
Emanuel: And it’s a very big country.
Howard: And it’s spread out over ten thousand islands, right?
Howard: And Philippines is spread out over seven thousand islands - what an infrastructure challenge for Indonesia. I mean, you can’t have roads and bridges connecting ten thousand islands!
Emanuel: It’s a lot of plane flights.
Howard: Oh, yeah! And you couldn’t even run internet cable to ten thousand islands.
Emanuel: It’s quite interesting flying over Indonesia. It’s just forest – forest – forest. It’s amazing how much forest there is in Indonesia. They’re slowly getting rid of it but it’s still a lot of forest.
Emanuel: But it’s an interesting country, it’s still in the development phase. The beauty of it is that we’re in there and helping dentists with their level of education, bringing them up. Not to say that they are disadvantaged – they have access to material – but we’re bringing the courses in there and changing their paradigms, the way they think.
Howard: So I just retweeted him, if you’re following me on Twitter @howardfarran, on Twitter he’s @dentaled_global. Yeah, so China … a lot of people think that’s a very closed market but you’re able to get into China?
Emanuel: It is a very closed market. The challenges of China … everything can come out of China quite easy, nothing goes in! That’s our experience.
Howard: And they’re not very free on the internet?
Emanuel: No, there’re firewalls – you cannot run a website out of China, or a server out of China, without taking a long time to get through. It goes through a screening process and it takes, on average, about one minute thirty seconds, one minute before a page opens, so you can’t stream anything into China. So, we’ve been able to get around that by working with a partner in China.
Howard: Who’s your partner?
Emanuel: His name’s Benjamin Yan. He’s in Shanghai.
Howard: Benjamin …?
Howard: Yeah, I guess you would have gotten with Godfrey of Modern Dental.
Howard: I would have guessed you would have gotten with Godfrey of Modern Dental, but you went with this other guy?
Emanuel: Yeah, well he’s a Dental ED partner - he’s a dentist as well, a very successful dentist, and we have …
Howard: In Shanghai?
Emanuel: In Shanghai. And we employ two people as well to run Dental ED in China and they’ve got a very successful study club network. Dental ED is the largest study club network there and pretty popular too. So …
Howard: Now, what’s your prediction? Do you think China will loosen the internet strings and do think they’ll open up to Google and Facebook soon, or do you think it will stay a closed society for a long time?
Emanuel: Well, if Trump has his way, I think we’re gonna have a problem.
Emanuel: That’s the easy answer to it. It’s hard to predict whether China will become open or closed, it depends also on the governments and how they all get along, I guess. I think things are slowly looking like they’re going a little backward rather than forward at the moment so, who knows?
Howard: Human history has always been two steps forward, one step back, two steps forward, one step back …
Howard: And I do think we’re in a time period of one step back. Do you?
Emanuel: I think so.
Howard: Yeah, we live in strange times, but I always compare this century to the last century, so this is 2017. By the first seventeen years of the last century we already had a World War and the Spanish Influenza had already killed one out of every twenty people on earth, and it’s funny how people don’t learn lessons because they’re flirting with war and so many people are anti-vaccination. And they don’t realise that a hundred years ago when the ‘flu season came, one out of every twenty people from Indonesia to Guam to Hawaii to America had dropped dead and they were mostly the children under five who had never had any partial immunity to influenza, and elderly people who were immune-compromised. Philadelphia bought its first steam engine during the Spanish Influenza because they couldn’t dig graves fast enough, so they bought a steam engine and you would bring out your dead children and grandparents and you’d lay them on the street and then the firemen would come down, which was a horse and buggy, and they would load the dead people on and they actually thought there was, it was coming from rotting, stale water on the other side of town. I mean they didn’t even know. And then when they came out with the polio vaccine, there were parades and people were lined up for blocks and all those lessons have been forgotten and now you just have people who say, “Oh, I don’t believe in vaccines”.
Emanuel: We tend to have only one generation of memory about our experiences unfortunately. The Second World War wasn’t really that long ago and there is very high tension again in the world. It’s all about competition and resources…
Howard: … and these wars just snap out of nothing. I mean, a confrontation in North Korea could also have China and Russia and everybody in it in one second, you know what I mean?
Emanuel: The world leaders bully each other too much, I think.
Howard: Yeah, things can just get out of hand so fast. So you say that you like to do a lot of the aesthetics, a lot of the high end aesthetics – Pascale and all these famous people. It seems like also in the market’s very big is endo, because endo seems to be one of those procedures where it seems like half the dentists I talk to, from Kansas to Kathmandu, will just tell you, “I hate molar endo, it’s so hard, it’s so difficult”, but they have people standing there in pain and I have to sell you cosmetic dentistry.
Howard: I don’t have to sell you to get you out of pain.
Howard: So is the endo market especially hands-on?
Emanuel: Well, first of all I just wanna back-track a little bit with about endo or people in pain and pros – people in pain are different types of patients than those that are not in pain, so dentists should be aware than when patients are coming in they’re different patients altogether, they’ve different motivations. People who require aesthetic dentistry don’t need, in their mind they have choices and people who need endo wanna get out of pain, so they’re different types of patients. The question about whether there is a need for endo courses, yeah, there are a need for endo courses. I just think that endo is so well-covered in the training of dentists … when you do more advanced endo training it’s got to do with a lot with the instruments and a lot with new technology that comes out. I don’t know why I haven’t really been that excited to be in that field. I just don’t really have a good explanation for it, I just felt that it was always very well covered. I like to be a little bit on the edge, a little more creative, artistic, and that’s probably why I like pros.
Howard: That’s probably why you like …
Emanuel: Why I like pros. Aesth…
Howard: Oh, pros.
Emanuel: Yeah, pros.
Howard: Pros, yeah.
Emanuel: So aesthetic dentistry.
Howard: It’s so amazing how when I go to Kansas - I grew up in Kansas - when I go to Australia and the United Kingdom, how hard it is to listen. It’s funny how so many times during my lecture I say, “Okay, ask me that, but ask me that question a lot slower, ask me that real slow”. ‘Cause so many little words are …
Emanuel: If I spoke Australian, you wouldn’t understand me.
Howard: Oh, yeah. And there are worse, there are a lot of dentists down here in Melbourne and Sydney where they start talking real fast and get all excited and I have no idea.
Emanuel: The Queenslanders have a more ocker Australian, which is really hard to understand if you’re a foreigner.
Howard: So, you like the high end aesthetics. So, who’s the hottest speakers in high end aesthetics? I see you got Maxim Bel…
Emanuel: That’s gonna be a little tough to …
Howard: He’s from the Ukraine.
Emanuel: … to put people …
Howard: Oh, plus I’ll get you in trouble.
Emanuel: Yeah, you’ll get me in trouble.
Howard: I’ll get you in trouble.
Emanuel: I mean, I do respect a number of speakers out there, all of the people that I’ve worked with … why I want to work with them is because I respect them, what they do. So they are leaders in their area, they do change the course of, they set new benchmarks, and that’s what I like. They think outside the square, they’re not normal dentists, they are very different and that’s why a lot of dentists follow them, because they are different, the likes of Pascal Magne is a very lateral-thinking person but he’s also incredibly …
Howard: Pascal Magne …
Howard: What, is that Spanish?
Emanuel: He is from Switzerland.
Emanuel: He’s extremely popular. He’s got a very …
Howard: So Switzerland’s … half of Switzerland is German descent …
Emanuel: He’s French and he …
Howard: So he’s Magne … so he’s French … so that’s a French descent …
Emanuel: [UNCLEAR (00:29:18)] and he moved to University of California and he’s been there for a long time, and his brother, they’re a talented team, both him and his brother, who’s a very well-known ceramist, and they produced a beautiful book that is really like a gold standard in prosthodontics, which I don’t remember the exact title but it’s an amazing book and it was way ahead of its time and still stands as one of the best sellers. And he’s an incredible person, he and his brother are extremely talented people, they’re just very artistic and also very scientific, so it’s … they’re both left- and right-thinking people and that’s very hard to get that in dentistry.
Howard: Pascal Magne, here it is – Ryan, you’re so good – he’s feeding me with the book. Yeah, I like his glasses too.
Emanuel: Yeah, his image is like a nutty professor in some ways.
Howard: Yeah. So do these companies, do these really high-end people, do they like any certain company’s products more than the other, or do they all seem to be using one company versus more, or are they all over the board?
Emanuel: I don’t think there are too many dentists who have a strong allegiance to any particular company. Perhaps at some point in time, because they like using the product that’s been developed, but these people are evolving people and so they will evolve with different products and therefore evolve with different companies. So, I don’t know that many speakers that remain loyal to one particular company.
Howard: Do you get a lot of dental manufacturers’ support for these courses?
Emanuel: Yes we do, we get some. Not a lot – we are independent, we don’t …
Howard: Do you get more revenue from the dentists or the dental manufacturers?
Emanuel: No, totally from the dentists, not from the companies at all. We hardly get any revenue, sometimes we do get some support from some companies but we don’t normally do that.
Howard: Do these high-end, aesthetic people, do they like any technologies more? There’s a lot of the noise in dentistry trying to push chair-side milling, like with Cerec and all that. Do you see the high-end doctors doing that, or …
Emanuel: Digital dentistry, yes.
Howard: Do you say its digital? Digital – is that chair-side milling or is that oral scanning?
Emanuel: It’s all of it. It’s the oral scanning, it’s the digitizing things that they’ve analogue … that do analogue in a way. This is the movement that’s taking place now and it will become standard, already there’s quite a few practices who’ve already moved totally into digital, but the digital processing from say the clinic into a lab is still kind of analogue but that transition’s already starting to happen, so gone will be the days where you will be taking an impression and doing a wax-up and working on a model – that’s gonna go, that will be all gone.
Howard: And you’ve started seeing the labs now that are giving you a discount because if you send an impression, you have to have a human pour it up in stone, trim the guide, do all the stuff …
Howard: But if you send in a digital impression, the first several steps are, don’t need a human.
Emanuel: Well, we’re working …
Howard: And so they’re transferring the cost.
Emanuel: We’re working with one presenter at the moment who’s introduced this concept called “raw”, and he’s a very talented dentist and …
Howard: Raw? R-A-W?
Emanuel: R-A-W, yeah. He’s introduced this concept and he’s from Romania, his name’s Florin Cofar, and he’s introduced basically a total one hundred percent digital workflow for where you scan teeth, create templates, superimpose the template into a patient’s mouth when they come in, use DSD – you know what DSD is, right? Yeah, Digital Smiles Design.
Howard: Is that Kevin Coachman?
Emanuel: That’s Christian Coachman.
Howard: Christian Coachman.
Emanuel: Yeah, I mean it’s been around for a while but he, Christian Coachman has the luxury of perfecting that model a little bit there and now a lot of people are also using it.
Howard: Another Brazilian.
Emanuel: Yeah, another Brazilian. I’ve seen DSD earlier than that. I actually saw an earlier, raw form of DSD with Ed Maclaren, an American, so …
Emanuel: Yeah, yeah. I saw it in Adobe Workshop. It was really designed as a lab communicator, it’s a software, it’s really manipulating the data or imagery to communicate with a lab – that was the original design of the DSD but a lot of dentists use it now as more of a marketing tool to get case acceptance, but really the original idea behind it was to get digital form, a digital picture of teeth, send it to the lab with the measurements and get it all made up. So it was to try and avoid the impression-taking. So this guy now, he scans teeth, superimposes the templates, prints them on a 3-D model, does a mock-up, sends it off to the lab and then milled. So what he’s been able to do is preserve the morphology that he scans and prints out exactly or mills exact morphology and fits in the mouth perfectly with all the occlusion taken care of and everything. So it’s already taking place and it’s just that’s the transition, so.
Howard: What … so is he in Romania?
Emanuel: He’s in Romania, yeah. He’s pushing the idea through.
Howard: Is he in the capital?
Emanuel: I don’t even know what the capital of Romania is! Bucharest, yes, he is in Bucharest. Yes, I think he is, yeah. So, that’s where we’re going. There’s a potential that the lab technician’s role is going to change very soon and I think a lot of them know that with the advances of digital technology.
Howard: Yeah, what I love most about the digital is when you scan your prep and you see it on the screen, you’ll never scan your prep without looking at it and going, Oh, my god, I need to go back and smooth this or do that, or wherever you get magnification, whether you’re wearing loops or whether you’re scanning your impressions, you see it bigger … endodontists using microscopes, I see it now in surgeons in hospitals but just whenever you can see anything a lot bigger, the quality goes up a lot.
Emanuel: True. I mean what’s interesting from learning a lot on aesthetic dentistry is the morphology costs a lot to reproduce, the better the morphology, the more expensive it is and this is where people are pushing the technology to get around that, how to bring that cost down and I think that’s quite pertinent now – cost – because of the way dentistry is going. The whole economy is changing and the whole dentistry is changing and so it’s gotta become more cost effective to do things and a little bit faster and more efficient. So, I think people are gonna welcome the advances of digital technology.
Howard: Yeah, and like we started the beginning of this program … in the ‘90s these dentists were booked two or three months in advance.
Howard: You said six weeks was average in the ‘90s.
Emanuel: I would say that was a minimum.
Howard: A minimum?
Howard: And what is it now in 2017?
Emanuel: I think, I would hate to say that but there are some practices that are out of business now and there are many with holes in their books, with lots of gaps. It’s changed – there are dentists hurting.
Howard: Yeah, oh, absolutely!
Emanuel: Yeah, and it happened faster than what anyone would have expected.
Howard: So, but this is a lesson for dentists to learn around the world, because I have heard this lesson in many countries: a president, one was a governor in the state of Nevada, and he told his secretary to get him a dental appointment ‘cause he wanted to get his teeth cleaned, and she came back to him and she’s like, “I can’t get you in anywhere for like three weeks.” He’s like, “What? Call, tell him it’s the governor!” She could not get the governor in so what’s the next thing they did? They built dental schools, they passed licensure by credential - he looked into that and said, “Okay, you can’t practice in Nevada unless you take a special licence in Nevada, axe that, build more dental schools”, and that backfired on the dentists in Australia when politicians couldn’t get in for six or eight weeks. Then they let about a thousand foreign-trained Asian dentists come in, they doubled the number of dental schools and then you had free enterprise market forces like corporate dentistry coming in…
Howard: … and so America, before they started adding all these dental schools, there was about a ten day wait on average to get into a dental office and then it started coming down, but it only bottomed at five and the last three years it’s back up to like six, and I keep telling dentists that you’re score card with the government - I can get a pizza delivered in thirty minutes - the government, when you tell them there’s too many dentists and the politicians can’t get into the dentist for ten days, they’re not gonna believe you.
Emanuel: I think that was perhaps an explanation to a certain degree as to why things dropped, because we were having that issue here in Australia as well, where they were bringing in quite a few overseas dentists and when you have too many dentists in an area there’s only so many patients that they’re all fighting for and everyone was pretty comfortable. The status quo had just reached its level and everyone was okay, well everyone was feeling okay. Then throw in the GFC …
Howard: What’s GFC?
Emanuel: The global financial crisis …
Howard: Oh, right, that’s what you guys called it.
Emanuel: Correct. You throw that into the mix and people lose their jobs and then they’re really holding on to their money and they’re not spending on aesthetic dentistry as much as they used to, which is the bread and butter for a lot of practices too. Then that pie that was accessible once starts to shrink and when you shrink that very quickly like that in the last three or four years that it did and you have the number of dentists in that pool, then that pie is too small and someone’s gonna lose patients and then when you throw the corporates in there as well, with their marketing power and their business know-how and able to shift patients across to the businesses, then you’re drawing that pie away from other practices that probably are not so business savvy. So this is what’s happening, those that are not competitive enough and know the know-how of business and marketing, are looking down the barrel.
Howard: Well, you just alluded earlier that was a new area you’re going into, is marketing.
Emanuel: Well, Dental ED has always had its foot and roots in marketing. It’s something that we haven’t provided as our core business but in some ways we always have in a different form, we know about it and so we are producing some tools that could help. I always say that marketing is common sense but what’s common sense to me is not common sense to everyone, isn’t it?
Howard: Common sense is very uncommon!
Emanuel: It is.
Howard: It is.
Emanuel: Dentists have …
Howard: I mean look at these high profile business people, I mean you have the head guy of Go Daddy goes and shoots a big elephant, and it doesn’t take much common sense to know that you shouldn’t be on the front page …
Emanuel: Correct, correct.
Howard: … shooting some bull elephant. And the head guy of Uber is bringing hookers to board meetings. You don’t have to be very smart to figure out that some of these things … remember the most famous dentist on earth, was that Walter Palmer, who went and shot Cecil the Lion?
Howard: I think he had like two million hits on his website! And none of them were positive.
Emanuel: They were not patients.
Howard: Yeah, I mean, there are just some things that you just shouldn’t do.
Emanuel: Correct. Well, one thing that dentists should know now, I think, is that if they’re gonna go out in private practice they need to understand what business is and where business comes from and how you get it. You won’t be able to survive now.
Howard: So are you gonna start doing more business courses with Dental ED?
Emanuel: Maybe. We haven’t thought of it. We have to evolve as well. We have to go where the dentists want us to go as well. We have our core business but we need to evolve and we believe that we’ve always been in the forefront of helping dentists through education and we believe that the next phase is to help them survive as well. So, it’s not enough just to do and learn aesthetic dentistry but you really need to know how to get it out there and get the patients.
Howard: So, if you’re on Dentaltown - if you’re a baby boomer you’re on the desktop; if you’re a Millennial, born after 1980, they downloaded the app - and when you look at the podcast date and in fact, thanks, I really like it when you send me an email, firstname.lastname@example.org, just tell me who you are, what your age are, but I’m very, very surprised by so many who tell me they’re D2s and D3s and D4s, which is really cool because I know when I was in dental school, in … D2s, nobody was thinking about post-dental school. But I cannot believe … I got a couple of emails today from D1s! Like, you’re a freshman in dental school and you’re already listening to these podcasts and all this. So they’re all thirty and under. But what advice would you give a Millennial, let’s say she’s twenty five years old and she just graduated from dental school, let’s say she was your daughter, twenty five year old, your daughter, what would you tell her? I’ll set you up with some more baggage!
Emanuel: Yeah, yeah! Give me some …
Howard: I’ll set you up with some more baggage! She graduated with $200,000 of student loans and she says, “Dad, I want to practice so I can see the Sydney Opera House right out the treatment room window!”
Emanuel: Go and do a business degree.
Howard: Go, get a business degree?
Emanuel: Yeah. Do a marketing business degree if that’s what you wanna see.
Howard: What do you mean by that?
Emanuel: Well …
Howard: That it’s gonna be very, very competitive?
Emanuel: Of course.
Howard: You gonna have to know exactly what you’re doing.
Emanuel: I don’t think it’s enough to be a good dentist these days. In the olden days you could be a great dentist – I’ve seen great dentists, okay, but they’re not necessarily good business people. I’ve seen great business people who haven’t been really good dentists, they’re not …
Howard: And who made more money?
Emanuel: … that talented …
Howard: Who made more money?
Emanuel: … and made a load of more money.
Howard: Who made more money? The lousy dentists and good businessmen?
Emanuel: Well, a combination of both is really exceptional, and there are far and few between like that, but those people who understand their patients and the business of what they’re in and know how to communicate efficiently and produce good quality work and results, usually are quite successful. And the kind of ingredient you need, you need to know your business well, you need to know your market, you need to know your clients, you need to know how to communicate efficiently, you need to know how to sell – which is a dirty word for most dentists. It’s a cultural thing instilled at university. That’s not a true reflection of what’s out there, and when you’re out there and you run a practice, that’s a business. When you have patients, they’re clients. And when you try and provide them the service that they can choose, that’s selling.
Howard: And it’s sad because the people that are accepted at dental school, they weren’t accepted on any of the skill sets for success, they were accepted because they could get As in Calculus and Physics and Chemistry, and when you get out you’re not gonna use Calculus and Chemistry and Physics and the skill set that will be most successful is if you have a great chairside manner, can communicate with your patients, your staff, but usually the guy sitting in the library, the little Albert Einstein or Isaac Newton, getting an A in Physics, usually isn’t that person.
Emanuel: There is an image that’s put on there about marketing and selling and in the imagery of dentistry, and it’s taught in a way that cheapens their image and so that’s why a lot of people kind of shy away from it: we are dentists, we shouldn’t be doing marketing ‘cause it cheapens our image and it cheapens our profession - and that’s okay if you’re working within a hospital environment and very clinical and Red Cross and stuff like that – but when you’re out there in the true sense of a practice or a business, then you’re creating restorations and you’re dealing with people – that is a business, that’s the reality. It’s not a private hospital here, people come in on a choice – they have choices. You have to stand out. You have to be able to communicate – you’re dealing with people, you’re dealing with … as I was coming back to before that you have two sorts of patients, remember where I said they’re in pain and not in pain? The ones that are not in pain can make choices and you’re not necessarily treating teeth there - if they’re coming in and there’s no functional problem and they’re just not happy about their smile – you’re not treating teeth, you’re treating psychology and so you’ve gotta understand that very well and you’ve gotta be able to communicate that efficiently to get people to convert over and trust you.
Howard: And there’s two hundred and twenty countries … I think there’s only a hundred and seventy at the United Nations, but there’s over two hundred and twenty countries and some of this advertising and marketing still isn’t legal in many, many countries and I’ve always been surprised … like I think Romania has a lot of restrictions, so you’re talking about Romania; Hong Kong is very restricted, it’s still a very taboo subject and flat out illegal in some countries.
Emanuel: Yeah. I’m not of the belief that marketing should mean like car salesmen and advertising on TV and, “…you get this thrown in …”. That’s not what I believe in. I believe in that dentists need to know what business they’re in and how to communicate their skill set to the patients and understand on how to get that trust and give them good quality stuff. That’s my belief, and yes there are some countries that don’t allow you to promote it and it doesn’t make sense in the Western society to do that, especially with how things are going - there should be guidelines as to what people can do, but I think in most Western countries there are laws that allow them to promote enough to get the message across. It’s also what you do in the practice which is very important, that’s really where the business takes place.
Howard: I also think it’s hard for you to teach cosmetic dentistry around the world when there’s so many different norms. Like I notice the Americans and the Middle East, they have neon white teeth.
Emanuel: You’re talking about the Alabama area?
Howard: I mean even California, Hollywood …
Emanuel: Oh, right …
Howard: Middle East, I mean …
Emanuel: Yeah, yeah, yeah.
Howard: Some of the whitest …
Emanuel: California’s got a lot of white teeth.
Howard: Some of the whitest dental work I’ve ever seen in my life is out of Dubai, Iran, the Middle East loves white teeth, so do the Americans, but a lot of people in Europe – they think that looks like a clown! They want it more natural.
Howard: You even see that in breast augmentation – in some countries they look like crazy, and then other ones are, they’re almost subtle.
Emanuel: I don’t know why there is that American look. There’s the European look …
Howard: Very clearly those two are looks.
Emanuel: They’re two different looks. Sometimes being subtle and natural-looking is also very good and I think that’s, there’s that mentality and then there’s the big and bold, which America is really well known for, so I think it’s a cultural thing more than anything and I don’t know exactly where it stems but when it comes to white teeth I think the rule is that your white teeth should not be whiter than your eyes.
Howard: Well, I remember when the bleaching came out, [UNCLEAR 00:51:22] had to scramble for lighter shades …
Howard: … because people were, had bleached their teeth so white they’d have a cavity and in 1987, 1988, 89 any filling you did on the anterior teeth after they’d bleached the bejeezuz out of it, looked like a dark, yellow, old filling and they had to come out with bleaching shades and I can remember going to dental conventions and all these dentists [UNCLEAR 00:51:48] Bob Gamely saying, “This isn’t white enough.” There was the CEO of Ivoclar and they’re like, “This isn’t white enough – we need a lot whiter stuff.”
Emanuel: I’m not of the belief of having really, really white teeth. I think it’s nice to have white teeth, but not whiter than the eye, your eyes – I think it’s just starting to look a bit too abnormal for me, but I’m more on the European style, I think.
Howard: Yeah, so you were born in Melbourne but your parents were born in Italy.
Howard: I have heard … it seems like Italy has more dental implants companies than … one guy told me that Italy had ninety different implant companies! Is that true or is that not true? Or is that an exaggeration?
Emanuel: It’s probably a little bit of an exaggeration. I think there’s a lot of implant companies and they’re not all from Italy, there’s quite a few from Korea, there’s quite a few from China as well …
Howard: But there’re a lot of small implant companies …
Emanuel: Yeah, it’s amazing how many implant companies there are and the question is why are there so many implant companies?
Howard: Is that one of the countries you’re in? Italy?
Emanuel: No, we’re not in Italy.
Howard: You’re not in Italy?
Emanuel: No, no, we’re not in Italy.
Howard: Oh my gosh. You’d think that ‘cause your mom and dad were …
Emanuel: Yeah, it’s not our market, Europe, at the moment.
Howard: Because they don’t prefer English in their education?
Emanuel: It’s not that. It’s just that we haven’t reached there yet, we are reaching in the Middle East in the moment and we are in the plans of going into Russia, so that would be interesting.
Howard: So are all your lectures in English?
Howard: And of the world’s dentists, what percent can listen to an English dental lecture?
Emanuel: A few, but we have them translated. In China …
Howard: Oh, you have them translated?
Emanuel: Oh, of course!
Howard: Oh, okay. So …
Emanuel: In China it’s …
Howard: I call the rule of fifty million. If you’re born and you have fifty million people to talk to, like in Italy or China or Brazil, well you don’t need a second language. But if you’re born in, like, say Denmark and there’s only five million people to talk to, you need to learn how to talk German, Italian, English, Spanish – so by the time the country is five million or less, they average like five languages …
Howard: … by the time it’s fifty million or more, they only know their mother tongue ‘cause there’s no necessity to …
Howard: So is that what you’re finding? Most countries over fifty million you need a translator?
Emanuel: Yeah, I mean, yes, we … there’re still some countries that are not very English receptive, but they are evolving. Obviously English is the world’s language, but there are some countries that are a bit behind on that. China is one of those countries and some of the South East Asia regions or Asia proper as well.
Howard: Japan is the least English-speaking nation?
Emanuel: Yeah, there’s a …
Howard: I found far more English … because if you think about it, Tokyo, it’s north of Korea, it’s halfway between Korea and Alaska, the city, Tokyo, is on the outside facing the vast Pacific Ocean, it’s an island, it’s one of the most isolated cultures known to man, and it’s just almost no English on that island. But you know the cutest thing I ever saw in China ever? I was an hour or two west of Shinjin, I was deep into China, I mean I was so far back there that whenever I’d walk around, everyone would just stop, I mean I felt like I was an alien or a unicorn or, I mean they would stop – and this little girl, it was at a school, and this little girl – she was so cute, I don’t know how old she was, maybe she was six years old – she walks up to me and she goes, “Oo sah?” And I said, “What?” She goes, “Oo sah?” And I didn’t know what she meant and then my friend starts talking to the little girl and she’d learnt how to read and she knew I was from USA…
Emanuel: Oh, right.
Howard: … so she phonetically said, “Oo sah”. And I said, “Yeah, Oo sah, it’s Oo sah, me Oo sah!” And she’s all excited and ran away. I thought that was so cute.
Emanuel: Yes, I wouldn’t have picked that up, yeah. That’s good.
Howard: So you’re translating. What countries are you translating mostly? China. What else?
Emanuel: China really is the only country we translate. We will in Russia as well, but in China … Indonesia we get away with English.
Emanuel: Yeah, yeah.
Howard: ‘Cause that’s a quarter … two hundred and twenty million people.
Emanuel: Yeah, they’ve got a good grasp of the English language in Indonesia. We don’t feel like we need translators for the courses we do.
Howard: But you feel like you need it in Russia?
Emanuel: In Russia we probably do, yeah. And in China definitely, yeah.
Howard: What about Brazil?
Emanuel: Brazil, we’re not there so I don’t know, but Brazilians are not very English-orientated.
Howard: Yeah, neither is Mexico … I mean Mexico is a hundred million people. So Central and South America has three hundred million speak Spanish, two hundred million speak Portuguese from Brazil – they have no need to learn another language. I swear you’ll find it following the rule of fifty million. You know that if in a country they’ve got more than fifty million people … and also in the rule of fifty million, say you go to a really rich country like Italy or Germany where they have over fifty million people but they’re all highly educated and know English, they’ll still tell you, Well, I would much rather prefer to hear it in my native tongue, and after an hour of translating what you’re saying in English to my native tongue in German or Italian, I’m exhausted, I’ve a headache. So if you lay down two books for them in Italy or Germany, all the Italians, one’s in Italian and one’s in English, they’d always pick up the Italian.
Howard: Or the German.
Emanuel: Yeah, I do.
Howard: But again, when you get to those countries, ten million, fifteen million people, whatever, they’re fluent in English.
Emanuel: Except Farran, that’s German background, isn’t it?
Howard: Farran is a bizarre name. So Farran, almost all of Farrans are in Lebanon, and it’s Arabic for baker …
Howard: … and they can’t figure out if a Lebanese man went to Ireland or if a MacFarren changed their name to Farran, because when the Irish came to America the Irish diaspora, about 1850, every immigrant group is heavily hated and the Irish were among the most hated, and you know why they were the most hated?
Emanuel: In America? They were trouble-makers, weren’t they?
Howard: Well, what is was is all the groups that came to America were fleeing the Catholic church. So they were all protesting the Catholic church, there were Protestants, there were Lutherans from Germany, Mennonites, there were Quakers, there were Episcopalians, there were every group known to man came here - and then here comes the damn Roman Catholic Irish and when they started building their churches and cathedrals in Boston and New York, all hell broke loose, and my great-grandmother, they kept telling them, You gotta get out of Boston, you gotta get out of New York! So they went to Ohio and then mine went all the way to Parsons, Kansas and they all told everyone that they weren’t Irish – they told them that they were German. Until World War Two broke out and then they went back to being Irish! And my great-grandmother, who lived to be like ninety nine, she kept a sign that said, “Help Wanted. Need not apply if Irish”.
Emanuel: Right. Okay.
Howard: And the story continues, when my mom, who was Irish Catholic, married my dad, who was Protestant, both families didn’t approve the marriage and they got married – both parents were not for it and when they had my two older sisters, the grandparents didn’t even show up.
Howard: But I was the third – I was the first boy and that’s what piqued the interest of the grandfathers so they wanted to check me out because I was a boy. And so it was the third child before a Protestant and an Irish Catholic family could speak in in the same room in Parsons, Kansas.
Emanuel: It’s …
Howard: Times have really changed. I think that was 19…
Howard: I was born in ’62. Yeah, those were interesting times.
Emanuel: Mm, so, good on your parents for breaking the mold!
Emanuel: They were very forward-thinking people.
Emanuel: Love conquers everything.
Howard: So what is … so let me … my gosh, we already went over an hour … we went over our hour limit. So final close, why should they go to dentaledglobal.com?
Emanuel: Well, not only do we have good education there as well, there’s a list of study clubs there, but we’ve also developed a new product there called MyPractice, and MyPractice is a pretty smart, revolutionary system. Have you heard of Infusionsoft at all?
Emanuel: Okay. This is the Infusionsoft of dentistry. It’s actually very tailored for dentistry and a lot more powerful as well. So it can do, for example, a survey – which you might think is a basic thing in a practice, an electronic survey – but when you give this survey to the patient, it will do multiple things at once. It will first of all assess the patient – if they’re happy with your service and the practice and if it does, then it’ll open up to Google Reviews and it will also prompt them to Facebook Reviews. Then it’ll also ask for word-of-mouth referrals. It does it in a very systematic and clever way, it’s a very intelligent system. Then it reports back to you in the practice on all the people who’ve come in and will compare your stats against the national average of other dentists and will also make recommendations on what type of marketing you need for your practice to improve on and where you don’t need to improve. So that’s just one component of nine modules in this system and it’s a very intelligent system.
Howard: Infusionsoft is right up the street from me in Phoenix.
Emanuel: Right. Infusionsoft is essentially a click-funnel software and that’s what it does and there are click-funnels out there … it’s put it in such a way that you’re easily able to manipulate it, and that’s the beauty of Infusionsoft. This system is like that but it’s very tailored for dentistry so it has lots of applications for treatment planning, it does specific information videos, it can actually send a camera over the phone while I’m talking to you, for example. I’ll give you an example: I’m a receptionist and you call and you wanna enquire about veneers and I wanna know the condition of your mouth basically, or your teeth and I don’t know, and to start that process of communication I can send the camera to you via your phone and you take a snapshot and it’ll send it back to me and we can be talking about your teeth, but I’ve also captured your details in the same time, so I can follow through with information - that system starts to take care of that. That’s the power of MyPractice – it’s a very powerful system and the people who are using it are getting very good results. They’re the tools that …
Howard: And they can find all that on Dental ED Global?
Emanuel: Yeah, yeah, it’s there.
Howard: Dot com? Is it dot com or dot com dot au?
Emanuel: It’s dentaledglobal.com.
Howard: dentaledglobal.com. Nice. Well, again, it was an honor that you could come by and like come on the show and talk with my homies. I’m sure they enjoyed it and I’m a huge believer in continuing education. I tell people all the time that in the thirty years watching dentists crush it, watching them lose it – the number one variable that I track for dentists crushing it was the ones … the ones that failed took the minimum twenty hours of CE to get their license reinstated. Like Australia is twenty hours a year, sixty hours every three years, but the ones that did a hundred were doing great, the ones that did two hundred or three hundred were crushing it. And as far as going on the hands-on courses – what I liked the most about the hands-on courses is you’d be learning a lot about the course but then you’d be meeting buddies who are also going for it. And the one thing I noticed early on in Phoenix, is that every time you went to a dental continuing education, even though the town had thirty eight hundred dentists in the valley, it seemed to always the same hundred guys …
Howard: … going to every one of those courses. And those guys just hit it out of the ballpark.
Emanuel: You’re right. Most of the guys who do Dental ED hands-on courses are the same faces.
Howard: Oh, yeah.
Emanuel: And they don’t worry about CPD. In fact, that’s why we don’t focus on CPD. It’s because the people that we deal with, who we believe are the top ten cream of the crop, don’t think about CPD because they do their education, they do training, the love education.
Howard: What’s CPD?
Emanuel: Continuing professional development.
Howard: CPD. That’s the British?
Emanuel: The English, yeah. Australian perhaps moreso.
Howard: Now is that the United Kingdom, the England, the Great Britain? Alright, well thanks again.
Emanuel: Yeah, thank you.