Dentistry Uncensored with Howard Farran
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918 Dentistry in Bolivia with Dr. Liz Quiroz : Dentistry Uncensored with Howard Farran

918 Dentistry in Bolivia with Dr. Liz Quiroz : Dentistry Uncensored with Howard Farran

1/9/2018 10:52:39 AM   |   Comments: 0   |   Views: 298

918 Dentistry in Bolivia with Dr. Liz Quiroz : Dentistry Uncensored with Howard Farran

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918 Dentistry in Bolivia with Dr. Liz Quiroz : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #918 - Liz Quiroz



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AUDIO - DUwHF #918 - Liz Quiroz



Born in La Paz- Bolivia, where she graduated as a General Dentist in 2010. Won a scholarship to study in the US, where she lived for more than 2 years, studying in Columbia University and New York University, taking as many courses as she could afford. Previous to her trip, had 3 jobs (as a Dentist and English Teacher) in order to afford her trip. Returned to Bolivia and got an Internship to study Oral Maxillo Facial surgery at the Hospital de Clinicas de La Paz. After that, she took an international Cleft Lip and Palate Course with Dr. Brian Sommerlad. Currently, she is taking an International Master’s Degree in Pediatric Dentistry and she is Working as a General Dentist in a Non-Governmental Organization. She is also a proud soccer Mom of a three year old boy.




Howard: It is just a huge honor for me to be podcast interviewing Liz Quiroz, all the way from Bolivia. My gosh, the internet is so cool that I can be talking to a dentist in La Paz, Bolivia. Thank you so much for coming on the show. 


You were born in La Paz, Bolivia, where she graduated as a general dentist in 2010. She won a scholarship to study in the United States, where she lived for more than two years, studying in Columbia University and New York University, taking as many courses as she could afford. 


Previous to her trip she had three jobs as a dentist and an English teacher in order to afford her trip. Returned to Bolivia and got an internship to study oral maxillofacial surgery at the Hospital de Clinicas de La Paz. After that she took an international cleft lip and palate course with Dr. Brian Summerland. 


Currently, she is taking an International Master's Degree in Pediatric Dentistry and she's working as a general dentist at a non-governmental organization. She is also a proud soccer mom of a three-year-old boy. What's your little boy's name? 


Liz: His name's Julian. 


Howard: Julian. 


Liz: Yes. 


Howard: Wasn't that the name of John Lennon's son? 


Liz: Yes, yes, actually yes, but I named him Julian after Julian Casablancas from The Strokes, which is my favorite band. 


Howard: This show is downloaded in all two-hundred countries and territories and islands. So many people are probably wondering what is Bolivia like, what is La Paz, Bolivia like? What is it like being a dentist in Bolivia? What other cities have you lived in around the world? 


Liz: Bolivia is a beautiful country. It’s a multi-ethnical country. We have different types of weather. In La Paz, specifically we can have the four seasons in one day. It's crazy. Trust me. Like when you go out, you never know what to wear because maybe you go out and it's sunny and beautiful, but then all of a sudden it starts raining and in the afternoon it's snowing and at night it's warm. It is very crazy weather. Right now, today, we're in the spring season, but it's actually kind of cold and so it's going to be like this until the end of the year. 


Howard: It’s amazing because you're in the middle of so many - five countries touch Bolivia: Brazil, Paraguay, Argentina, Chile, Peru. My god, you have neighbors - Brazil. Is there a lot of Portuguese speaking Bolivians on the eastern side and more Spanish speaking on the western side where La Paz is? 


Liz: In La Paz we only speak Spanish. Normally, no other kind of languages. We have two, they're very (03:04 inaudible). We have the Aymara, which is more spoken in La Paz, Oruro and Potosi, which are kind of close. Then we have the Quechua language that may be you saw in Star Wars. They use their language when they were recording some voices. Then, of course, you know the countries are close to Brazil, which is Santa Cruz. They kind of speak Portuguese, some people. 


Howard: Spanish and Portuguese are one of the five Romance languages that came from Rome. There's Romania, Italian, Portuguese, Spanish, French. If you know Spanish, if that's your native tongue, can you kind of get by in Portuguese because they're of the same Romance languages? 


Liz: Well, I understand Portuguese. I can read. I can write. I don't speak well, but I understand because it's similar. 


Howard: Yeah, very similar. What is dentistry like in Bolivia? Do they eat a lot of sugar and drink a lot of soda? Do they have water fluoridation? What's the oral health like in Bolivia? 


Liz: It's a huge problem for Bolivians. We have a lot of kids that have cavities. They are like a six-year-old. Their first molars are appearing and they already have cavities. Their consume of sugars is super high. We don't have fluoride water. As far as we know, we don't have it. We don't have a status about that topic. 


The last study that we got is from 1995, something like that, and it wasn't even about La Paz, so I don't have the information about fluorides. I hope soon they will have some extra studies or something. The good thing about my master's degree program is that we are going to work on trying to get more information about cavities, the PUFA index, the (05:16 inaudible). We're going to try to find out what is our situation because we don't have any studies related to that topic. 


Howard: Wow. Dentaltown just released a course today by a pediatric dentist, Jeanette MacLean, about Silver is the New Black: Improving Your Practice with Silver Diamine Fluoride. In this course, Dr. Jeanette MacLean discusses how to successfully incorporate silver diamine fluoride for caries management into your clinical practice today, including restorative options. She's been on the forefront, where a lot of people when a two-year-old comes in and they have multiple pulpotomies and cavities, they have to go take them to the hospital and use general sedation, which can be very dangerous. She's been treating her patients for years with silver diamine fluoride, which kills about 80% of the cavity. She was covered in the New York Times. 


Have you seen her course on silver diamine fluoride? Because I know you're studying pediatric dentistry now. You're going to be a pediatric dentist in one year? 


Liz: Yeah. Next December 


Howard: Are they talking about silver diamine fluoride? 


Liz: Yes. We have here in La Paz a huge contradiction about that topic because many people, many dentists were using that in the past and many parents don't like it, don't like that option of using the silver diamine fluoride. 


In talking about dentistry, we're still in diapers. We have to learn a lot. We have to study more in order to get more information. We don't have information from here. There are some things that we can hear from one dentist to another, but like something written, we don't have. 


Howard: What about the online courses on Dentaltown. We have four-hundred and fifty online courses. Have you taken any of those? 


Liz: I'm planning on take the Silver Amine Fluoride. Actually, I think yesterday I read about it. I'm planning to take it. But the one thing that we have a huge problem in Bolivia is that, of course the course is going to be in English, which not many people speak English. 


Howard: Not many of the dentists do? 


Liz: No. 


Howard: For dentists in Bolivia, is an $18 to take an online CE course, is that a lot of money, is that no big deal or is that a big deal?


Liz: Eighteen? 


Howard: Eighteen. One-eight. 


Liz: One-eight. No, it's actually good. It's like a hundred and forty Bolivianos, which is okay for a course. Yeah, we can take it. 


Howard: I think one thing we might consider, I might give you a free pass so you can take all four-hundred and fifty courses free and then you might want to translate some of them in Spanish for your local colleagues. 


Liz: I would love that. I would be really thankful if you do that for me. 


Howard: Send her an e-mail at HoGo and tell Howard Goldstein to give her a free pass for those courses and then tell her that maybe for her colleagues maybe she can translate them. That would be amazing because that's what the internet is so good at is spreading information within a country from the older guys like me to the younger kids who are in school, but it's also a great transfer from one country to another since all these two-hundred different countries and territories, they all do things slightly differently and we could all learn so much from each other. 


Liz: Yes, you're absolutely right about it. 


Howard: Yeah. How old are you? 


Liz: I'm thirty-two. 


Howard: Thirty-two. How old is the oldest dentist you know in Bolivia that's still practicing? 


Liz: Eighty. 


Howard: Does he think there's more cavities among children today that he's seeing now when he's eighty, than there was when he was your age at thirty-two, which was half a century ago, fifty years ago. 


Liz: Yeah. I was talking to that dentist, she's a pediatric dentist, by the way. We were talking about it, she said that it increased a lot because we are having a lot of fast food chains are coming to Bolivia. We have a lot of Coke, and sodas that are fatty. I'm living in a building, you cross the street and then you're going to see a lady selling candies. In front of the lady, there's going to be another lady selling candies. In the school, there may be like five or six ladies selling candies. Of course kids are eating a lot of candies. 


Howard: Man, I want to live in your house. When I walk out of my house, I don't see any of that. I have to get in my car and drive three miles to get candy. I think you have a better living situation than me. If I send you some money, could you move some of those candy ladies to come sell in front of my house? 


Liz: I think they will be glad to go. 


Howard: So she's an eighty-year-old pediatric dentist and she's telling you that fifty years ago when she was your age there was a lot less decay. 


Liz: Yes. Yes, absolutely. Some years ago before these chains were coming to Bolivia, talking about Burger King, Hard Rock Cafe just opened, we have also Starbucks and some maybe other chains arriving, Canada, coming from China. There are a lot of candies coming from China. Before that we didn't have cavities. The number was not as high as it is right now. What we had was periodontal diseases because of the things that we usually eat in Bolivia. We eat a lot of corn, potatoes, a lot of those related products. Usually potatoes we eat a lot. 


Howard: How many people live in Bolivia and how many dentists are in Bolivia? 


Liz: We're around eight million people. 


Howard: Eighty million. 


Liz: No, eight. 


Howard: Eight million. Okay. 


Liz: Yes. I don't know about how many dentists there are in Bolivia, but I can tell you in La Paz we are about two-thousand dentists that are legally allowed to work as a dentist. 


Howard: What would you guess for the whole country? 


Liz: Here in La Paz we have a lot of dentists, so I will say it will be like maybe ten-thousand around Bolivia. 


Howard: How many of those ten-thousand Bolivian dentists can read English? What percent can read English? 


Liz: I don't know about the rest because Santa Cruz is another situation. It’s more related to La Paz. But in La Paz, I can tell you. And I'm going to tell you this, in my master's degree program we are thirty students. From those thirty students, only my friend and I can speak, read, and write in English. 


Howard: Wow. It's that way in China too. I got to tell you, you're talking about the Chinese sending you candy. They call it the law of unintended consequences, but China instituted that one child per family rule and you think "Well, what does that have to do with dentistry?" Well, when you only have one child, you have two parents and your parents each have two grandparents. You have six people who have a job for every baby. The grandma and grandpa on the mom and the dad's side, that's four, and the mom and dad all have a job. What do they want to do to the baby? They want to bring him treats, so they buy them Hershey's chocolate bar, Coca-Cola. 


But the grandparents eat the traditional Chinese diet, the parents eat the traditional Chinese diet, so dentistry has never really been an issue. Then all these American companies, Coca-Cola, and Burger King, and Pizza Hut, and Coca-Cola, and all this stuff and now pediatric decay in China has exploded and so has diabetes. I want to point that out because we think of diabetes as an autoimmune disease in a cluster that shows up in families where you have diabetes, you have thyroid issues, you have celiac sprue issues, you have multiple sclerosis issues. You think it's just some purely autoimmune disease, but obviously the diet has something to do with it because these older Chinese doctors didn't even know what the hell diabetes was. The children have had an explosion in diabetes, dental decay. 


In fact I met the first pediatric dentist in Hong Kong and New Delhi, India and Kathmandu, Nepal. I've had three dinners with the first pediatric dentists over the last thirty years in those three great civilizations because it's an all new thing because of the change in diet. 


The reason I also want to point that out is that a lot of people focus on water fluoridation, which is a great thing, but water fluoridation can do nothing to a change in diet like that because you see great civilizations like Singapore with water fluoridation, Tokyo, Japan without water fluoridation and their DMFT rates have gone down pretty much exactly the same. They attribute it to educating the parents on brushing and flossing the children's teeth and giving them bottled water instead of Coca-Cola. 


Then in Africa you go completely off the charts because if you drink dirty water, you get cholera, diarrhea, could die, so you have the doctors telling their moms don't give them water out of the creek or the lake or dirty water, give them Coke so they don't get cholera. That's more important. I mean I'd rather have a cavity than die of cholera. Diet is so, so huge. 


Liz: Yes, I think that you're totally right. I think mainly the problem is education. If we teach our kids that it is very important for them to wash their teeth after eating a candy, that's going to make a huge difference. But before teaching out kids, we have to teach our parents to take care of their kids' teeth. 


I have this issue every single day in my practice. Usually parents arrive and they say, "Oh, this kid didn't let me sleep all night long. He was crying because he said that he had pain. I think it's a problem with his molar or something. Why don't you just do an extraction of the tooth? It is messing with my sleep. It is messing with my kid." I get upset sometimes because it goes to a point in which they're blaming the kids for the problem, but they don't see that they also have the responsibility of taking care of their kids and brushing their teeth and teaching them how to do it properly and stuff. 


I'm like sometimes talking to them I say, "Okay, this kid's crying in pain because he feels pain. I felt the pain myself. I know that is the worst pain in the world. For me that's the worst pain in the world to have a huge cavity and stuff. And you're blaming your kid because you couldn't sleep." They want me to do extraction and stuff of the tooth, but I have to explain then that maybe that's going to solve the problem now, but in the future your kids is going to need braces or something more expensive. You should teach your kid how to brush properly, to try to avoid sugary products. 


That's a huge issue that I have every day. I fight with it every single day. I am not even lying to you. Every day there's a parent that is going to be upset because his kid's crying. 


Howard: I know the patients are the best thing about being a dentist and they're the worst thing. It's just like life. 


Liz: Yeah. 


Howard: If you are born on Earth and you're the only human, life would be very boring. Now we have seven point four four billion and they’re the best thing about life and the worst thing about life. In Bolivia, what percent of the dentists work in private practice versus government public hospital practice? Is it half and half? Is it eighty/twenty? What's the ratio of public to private practice? 


Liz: We have more private practice. Talking about governmental institutions, we have very few. You should be very lucky if you get a job working for the government because everybody wants a job in that field, but it's very hard to get. Usually most of the dentists have private practice. I wish someday I'm going to have my own private practice. 


Howard: What's holding you back? 


Liz: My master's degree program is very expensive. I'm a mom so kids are expensive. I know that for a fact. 


Howard: They are. 


Liz: They're super expensive. Actually, my son's daycare tuition is more expensive than my master's degree program. 


Howard: Wow. How do you educate parents towards dental issues? How do you teach them to have children with less decay? 


Liz: Well, what I was doing in my job, is we have a lot of people waiting. Usually they don't bring kids to the dentist area. When I see people waiting for pediatric stuff or the mom's waiting for the gynecologist, whatever, I go and I have some posters and I start talking to them like, "You know, I'm the dentist here in this health center. I'm here to help you. I can teach you how to brush teeth properly and stuff. I can show you some pictures. If you don't brush your teeth, these things are going to happen." Try to talk to them, try to convince the moms that they have a newborn babies, come to the office. I want to check if everything is okay with your baby. I'm going to teach you how to wash your teeth properly. You can teach your kids. Don't you want to sleep better at night without kids crying because they have pain or stuff? 


I try to talk to them a lot. I do that almost every day that I'm free. I go and talk to them because I have a portfolio, where I prepare some pictures and I start showing them. That has been helpful. I have a lot of people coming since I started doing that. 


Howard: In America the health insurance companies, especially United Concordia, have shown that the most expensive part of their health insurance premium is when a pregnant woman with gum disease has a premature baby and the expenditures to have to treat a preemie is a million dollars minimum. The hospitals are now really figuring out that gingivitis and gum disease causes inflammation and inflammation is a big trigger for mom to have a premature baby and get that baby out of there because of the conditions. What is your protocol? How do you educate pregnant women towards dental issues? 


Liz: Let me tell you this story. When I was pregnant, I was asking my friends because I have a cavity. I was throwing up all the time. I had a cavity and I was worried about it. I was asking my friends, my colleagues to help me and try to fix the cavity. Nobody wanted to touch me when I was pregnant. They don't even want to look at me because I was pregnant. That was a huge issue because I was like I don't want to have this cavity in my mouth. I'm a dentist. I don't want to, but no one wanted to help me. 


Usually we have traditions here in Bolivia, not many women are allowed and they don't want to go to the dentist because they are afraid that something is going to happen to the baby. That's a local tradition, local belief that they have. 


When I was doing my oral maxillofacial surgery stuff, I had an issue with a lady that was eight months pregnant. She was in pain and she needed to have some endodontic work and stuff but she didn't want. She refused it. We were talking to her and telling her, "You're feeling this pain. This can increase the risk of you having your baby before the time that you are supposed to." The mom didn't want to. She didn't accept to have the treatment. She said, "No, I'm going to hold it and hold it. I don't care. I'm going to be like this until my baby is born and then I'm going to go to the dentist." They're crazy. 


Howard: It's a battle. 


Liz: It's a battle. 


Howard: All animals are so protective against babies. They are just born that way. I'll never forget, I went salmon and halibut fishing in Alaska. When we flew into Anchorage, and my dad, and me, and my brother, Paul, were renting a car for ten days in Alaska. There was this car and we thought it was in a car wreck. It was totaled. I said to the man, I said, "That sucks. I said someone crashed one of your cars." He said, "No." He called then lower forty-eighters. Those are the people that aren't from Alaska, but are from the lower forty-eight states. He goes, "That idiot saw a big moose with a baby, so he got out of his car to take a picture of the moose and the moose charged the car." He jumped back in, but that moose just kept attacking the car. It damn near knocked it over. It looked like it was in a car wreck. It's like you just can't get stick your hand in between a momma and its baby. There are hardwiring instincts just do anything to protect it. 


Every country is different. Every country has different cultures. Lots of countries, their people have these old-fashioned remedies on how to fix dental decay. Like in America a lot of people believe if you swish with coconut oil, the coconut oil will absolve all the disease. Does Bolivia have its own cultures and remedies where the people are trying to be their own dentist? 


Liz: Yes sometimes, especially when I was working (24:59 inaudible) in a far, far away town from La Paz. It was like eight hours away. There was this issue that many people didn't want to go to the dentist. We have our remedies. I was like, "Cool, tell me." We have coca leaves. That's a huge problem. I'm talking about coca leaves that cocaine comes from, the coca leaves and stuff. But we have the traditional use of coca leaves because when you chew the coca leaves, they help you with the pain. It reduces the pain. 


Howard: Well, the first anesthesia was cocaine. The first dental anesthesia was cocaine. So you're saying if they chew the cocoa leaf, the cocaine in the leaf numbs the pain? 


Liz: Yeah, but it has a huge procedure to go from coca to cocaine. What we do, we have the leaves and we start chewing it and it reduces the pain. I can prove that because when I was around twelve, I had this pain. I had a cavity. Nobody knew that I had a cavity, but I had it. I went to the dentist. The dentist didn't believe me that I had a problem. He said, "You're fine. I can see just a small cavity. I'm not going to do anything (26:25 inaudible)." My dentist didn't believe me. 


At night I was sleeping and I felt the worst pain I ever felt in my life, ever, ever. I had my (26:37 inaudible) when I had my son, that was a joke. The pain that I felt, it was awful. The dental pain is the worst pain I ever felt in my life. It was like three AM in the morning. There were no dentists around. I had to go to my dentist, which was like two hours away, so my mom gave me coca leaves. I started chewing them and then I fell asleep. 


Howard: So it did work? 


Liz: It worked. It worked and it's still working. Many people are still using it because many people don't want to go to the dentist especially when they have kids because they say dentists are expensive. They're still using it. Usually in towns that are very far away from the city where you cannot find a dentist or you have to walk two days in order to get to a medical center, they are still using the coca leaves. 


Howard: Wow. Well, I know it's a big process to get cocaine out of the coca leaf, but is there actually anesthetic cocaine in a coca leaf? 


Liz: Well, yeah, there is anesthetics, yes, of course. But related to cocaine I don't know a lot about it. But yeah, the coca leaves have some effect that puts you to sleep, your teeth to sleep. Yes, it affects . (28:08 inaudible) some anaesthesia. Yes, it has. Many people, for example, people that work in mines, miners, usually in order to not feel hungry or not feel that they are tired they start chewing the coca leaves. 


Howard: Wow. 


Liz: (28:31 inaudible) the fact that they have to eat or they have to rest. They chew it. When somebody dies, also, you start chewing the coca leaves because that's a tradition. You have to chew it and you're praying, eating and chewing, local tradition. 


Howard: It says in 1961 the coca leaf was listed on Schedule One on the United Nations Single Convention on Narcotic Drugs, together with cocaine, heroin, with a strict control level on medical and scientific use. The inclusion of coca leaf on Schedule One was done with the dual purpose to phase out coca chewing and to prevent the manufacture of cocaine. The single convention mandated to destroy coca bush if illegally cultivated. 


The rationale for including the coca leaf in 1961 in the United Nations Convention is mainly rooted in a report by a commission after a brief visit to Bolivia and Peru in 1949. It concluded that the effects of chewing coca leaves were negative even though it does not at present appear that chewing of the coca leaf can be regarded as a drug addiction in the medical sense. The World Health Organization expert committee on drug dependence later withdrew this argument labeling coca as a form of cocainism. The report was sharply criticized for the makeup of its researchers, its arbitrariness, poor methodology. 


I've always thought the coca leaf should come back because it's also an appetite suppressant and with the explosion of obesity it would be an ideal snack if you chewed the coca leaf and it had a very, very mild stimulant and mild appetite suppressant. That could really go a long way when the fastest growing disease in America is dental decay, diabetes, and obesity. I really think  the coca leaf should come back. Do you think it's also an appetite suppressant? 


Liz: It is. As I tell you before, miners use it for that thing, to stop eating and stuff. 


Howard: In your thirty-two years of living in Bolivia, have you ever met people addicted to the coca leaf? 


Liz: Never. 


Howard: Yeah. It's one of those one-size-fits-all stupid laws that our governments are so great at making. I mean, I swear, the one thing that happens when you get older and older and older like me is you just start losing all faith in government. They're supposed to be leading the people and they're always the weakest link of every society. I've lectured in fifty dental countries around the world and I've had dentists tell me in fifty different countries that basically they'd all be doing so much better if it wasn't for their own government. It's like their government is the problem and the government thinks they're the solution and the leaders. 


Here's another example, the coca leaf. If your fastest growing diseases are dental decay, obesity, and diabetes and coca leaf is an appetite suppressant and you've never seen anyone addicted to a coca leaf, I mean why not? 


Liz: It's also healthy when you have tummy aches. When you have tummy problems, you drink the coca leaves tea and it helps you. It reduces the pain. It reduces the bloating and stuff. The bad thing about coca leaves is something that I don't like. (32:13 inaudible) when I was doing (32:15 inaudible) is that it turns your teeth green, a different color. 


Howard: Wow, really. 


Liz: Yes. 


Howard: Just because the green in the leaves it sticks to your teeth? 


Liz: Yes. 


Howard: You know what my first thought on that is? I've seen that rodeo before being fifty-five. I'm old enough to be your dad because I'm fifty-five and you're thirty-two. If I would have had you at twenty-three years old, I'd be your dad. When they came out with the first mouthwash for gum disease, it was called chlorhexidine gluconate. When they got it FDA approved, one of the side effects was it stained your teeth. It didn't stain your teeth. It stained the plaque. 


People would come in and they'd go, "This mouthwash is staining my teeth." I'd set them in the chair and I'd give them a mirror. I'd raise them, so I'd be standing eye level. I'd take a little toothpick and I'd just wipe off the stain. I'd say, "See the reason you have gum disease is because you're not thoroughly brushing for two minutes every morning two minutes, every night. 


In my lifetime, I've never gone in someone's bathroom and seen a functional toothbrush. The bristles are always frayed. It looks like an elephant sat on it. Straight, small, soft bristles. That's why I like electric toothbrushes because would you rather take a saw and saw through a table or would you take a power saw and power right through it. 


Then I would get them an electric toothbrush out, like a Sonicare and without any toothpaste, because you don't need any toothpaste, dry brushing removes just as much plaque. They would have all this stain on their teeth and within just two minutes of using a nice electric toothbrush all that brown Peridex stain was gone. I said, "See, that's what's causing the gum disease." 


When you say it turns their teeth green, I bet it's not turning their enamel green. I bet it's turning their plaque green. If you gave them an electric toothbrush or a brand new toothbrush where all the bristles were straight and had them dry brush for two minutes, all the green would be gone. 


Liz: Not really. I think it turns your enamel green because I've had cases in which patients who are really old and they were brushing, not every day but they were brushing. But their teeth turned eventually green and black. 


Howard: Wow. I wish you had posted those pictures on Dentaltown. 


Liz: I can do it. I can do it. I did a huge study about that and the issue about adults like grandpas that have a lot of problems. Usually periodontitis, gingivitis, that kind of problems, but they had their teeth complete, but the problem was the gums, gum disease and stuff. And also I know that the color of the teeth were green, some of them were black. 


It's a very interesting study that I did. You were talking about government. Government's not helping us either here in Bolivia. I graduated with the best grades. I had my scholarship. I travel. I took courses, international courses. I have so many things going on in my life as a dentist. But the government still doesn't consider me good enough to be able to practice in governmental field. 


I have a relative who just graduated from dentistry school and she is already working as a dentist in a governmental hospital and I'm still here waiting. You see usually the government just hires their people. He's not going to hire me because I don't belong to that field, to that party. 


Howard: Oh, the political party? 


Liz: The political party. I don't belong to any political party. I don't have let's say a stable job because of that fact. Many people that just graduate get jobs really easy because they belong to that political party, but I don't. Thirty-two, I should already be in a good position, but I'm not because I don't believe to any of those political parties. 


Howard: Yeah, I do not belong to a political party also for years. I initially became a Libertarian. The two big parties in America are Democrat and Republican. I lost faith in both of those parties before I got out of college. Yeah politics is just - my god. I don't know what is worse than politics. It's the worst part of society. 


You were saying that coca leaves turn their teeth green. When I'm in Asia, they chew the betel nut which stains their teeth red. You're saying coca leaf turns their teeth green, betel nut, which I think it's called Areca nut, but in the betel leaves and it looks like it's blood. They look like vampires. They're walking around with these bright red teeth. But speaking of color, coca leaves turns them green in South America, betel nut turns them bright red in Asia. The silver diamine treatments, they kind of turn the teeth black. Is that a big problem with mom? 


Liz: Yes. I had that thing. My parents did that to me. My teeth were black when I was a baby, so when I was young. There was a huge controversy about that stuff. Many people say, "No, it's good to have your children using that stuff, the silver diamine fluoride." Some people say, "No, it's not okay." There's a huge controversy, but they stopped. In the governmental field, they don't do it anymore. In my practice, in my health center, we don't do it anymore. We are not allowed because you know. We know that we have good results with that but the problem is parents don't like it, don't want to see their kids with their teeth colored black. 


Howard: Getting a government job, it helps you to be in a political party? 


Liz: No, actually being in a political party, helps you get a better job. 


Howard: Yeah. What percent of the dentists are boys and girls? When I got out of school, over 80% of all the dentists were men. Now, thirty years later, you go into the dental schools, they're half man half women. In Bolivia, you've got eight million people. You've got 2,000 dentists in La Paz-Bolivia, which is the capital where you live. You think there's about ten-thousand dentists in the country. What percent of those dentists would be boys and what percent would be girls? 


Liz: I think they would be almost 60% ladies. 


Howard: What percent of the female dentists in the United States would you consider ladies? That's a joke. That was a joke. I'm not always funny. I just try to be funny, but I'm not always funny. Wow, so you have more women dentists in Bolivia than males. Why do you think that is? Why do you think it was mostly males thirty years ago in the United States and Canada and why do you think in Bolivia it was majority women? 


Liz: I was reading about this topic. When the dentistry school was created in Bolivia, in La Paz, I'm going to talk about La Paz. 


Howard: What year was it created? 


Liz: I think it was 1949. 


Howard: 1949. 


Liz: Yes. 


Howard: Wow. Is your favorite NFL football team, the 49ers? What's your favorite football team? 


Liz: I don't know. I like the Red Sox. No, the Red Sox are baseball, right? 


Howard: You like the Red Sox? Well, if your first dental school was built in 1949, you have to be a 49ers fan, the San Francisco 49ers. But anyway, continue your story. 


Liz: I like New York. 


Howard: You like New York. So you went to Columbia in New York, right? 


Liz: Yes. 


Howard: Could you see yourself living the rest of your life in Manhattan or were you missing Bolivia when you were in Manhattan? 


Liz: I love Manhattan. I think that is the place that I want to be, but the huge problem is that I couldn't practice as a dentist. It was very expensive for me to be able to pay for school there. That was one of the main reasons that I decided to come back. I miss being a dentist there. I was working in similar fields, but I didn't like it. 


I was missing my family too because here in Bolivia we are, I don't know, we are like twenty, thirty and still living with our parents. Not my kids, but I'm just telling you. We are very close to our parents. I think in the US, you are eighteen and you are ready to move. No, here, eighteen, we are babies still. We depend on our parents still until we finish the university or college, whatever. I missed being with my parents, especially when I was pregnant, I wanted to be with my mom. I missed my mom a lot. One of the main reasons for me to come back. 


Howard: Do you live with your parents now? 


Liz: No. 


Howard: How old would you say the average boy is when he moves out of his home in Bolivia and how old would the average girl be when she moves out of her home with her parents? 


Liz: Well about the girl it's going to be when she gets married. We are very traditional about this stuff. 


Howard: So how old would she be on average when she gets married and moves out of her home? 


Liz: Maybe twenty-four or twenty-five. 


Howard: How old would the average boy be when he moves out of the house? 


Liz: Maybe twenty-one, twenty-two years old. (43:11 to 44:21 inaudible) Yeah, we have a few nursing homes but like, for example, my grandma lived with us until she died. 


Howard: Yeah and my grandma, Mary, lived with us till she died. I remember, in fact, I got one of the biggest spankings in my life is because my mom was out buying groceries and grandma sent me to the store to go buy her some beer. My mom would never let her have beer. I bought her a beer and my mom did not like that at all. I said to Mom, I said, "She's eighty years old if she wants to sit there and drink beer, it's her business." My mom said, "It's my house." But anyway yeah, I thought my childhood one of the most fun things was coming home and seeing grandma Mary. 


I tell my kids that this will always be their home. They've all moved out but then some have moved back in and out. I like the nuclear family. I don't like the American way of kicking your kids out at eighteen and then kicking your parents into a nursing home as soon as they can't tie their shoes. Yeah, I think it's family first and business is second. It's just the family. I love those cultures. I think South America has one of the richest family values I've ever seen. 


Liz: Yes, you're right. For example, as I see it because I was in the US many people were getting married because they needed a place to stay right, to be able to pay the bills, to share the bills. Here in Bolivia you have to be really sure when you're about to get married because you're also leaving your family and your parents are always there. 


My mom's always here helping me with my son and she's taking care of him. In the U.S. you have nannies, and babysitters, and stuff. Here in Bolivia, we don't have that. It's not often to see a babysitter or a nanny. It's more like grandma's are taking care of the babies. I don't trust anybody being with my son besides my mom. 


Howard: Yeah, you notice you didn't say your husband's mom. I notice that with girls. Girls always want their mom to babysit the children. They never want the dad's mom to babysit the children. Have you noticed that? 


Liz: Yeah, it's true. It's true. It's because I don't know the lady. I just know my mom. 


Howard: It's funny because I know a lady friend of mine was very upset because her two older sons when they had children, they almost never dropped them off at her house. They always dropped it off at their mom's house. She always complained about how that was so bad and everything. Then her daughter had a baby. And guess what? She does all the babysitting for that baby. I'm always saying, "Well, why don't you drop it off at her dad's mom?" "No, no. I want her." I thought well it was kind of funny how that was such a bad deal when your sons' wives always did that, but now you're doing that with your daughter. 


I lost my office manager, one of the best office manager I ever had, Sandy Wilkinson, love her to death. She had two kids and her daughter dropped a frog and said, "Mom, is there any way you would quit your job and babysit my baby?" Oh my God, she told me as soon as that baby comes out, I'm done. I haven't seen her since. She hasn't worked since. That baby must be four or five years old. I don't know, probably three or four years old. But, yeah, babies are everything. I mean they're just everything. I applaud your family values. 


Howard: It is true. My mom was really busy, had a busy life, but as soon as she found out I was pregnant and she was like, "I'm not going to do anything. I'm going to help you." She quit everything. She has some days when she says, "Okay, I'm going to leave your child here with you. I'm going to go with my friends." She goes out. 


Howard: She has like a grandma's group, where they start knitting for the grandkids. They start doing some more projects for the grandkids. They have fun there. It's a way for them to escape. She says sometimes, "You know, I raised you guys so you have to raise your own kid." I'm like, "Yeah, I know. Thank you." But she loves my son. 


Howard: You say in your bio that you're a proud soccer mom. Soccer is the most famous sport around the world. A lot of Americans think that it's football and baseball and basketball, but those are actually the three rarest sports in the world. Soccer is a hundred times bigger than American football and American baseball combined. I mean period. Like Africa has a billion people, but North and South America combined has less than a billion. From Canada to Argentina, Chile has less people than in Africa. In most of the world, it's soccer with a little bit of maybe cricket and some other stuff, but it's mostly just soccer. I mean soccer is probably 80% of the world's sports. 


But they're learning lessons from American football that these head injuries, these concussions and they're already extrapolating to soccer because soccer, they're not allowed to use their hands but they're allowed to use their head. What they've learned with soccer, which is even really bad, is that an American football game if you if you have a bunch of injury to your head, but then you don't play for forty-eight hours, the inflammation, swelling can go down, but kids that play soccer, they're bouncing it off the front of their head. Every day, year round they're kicking it with their feet and their head. 


Do you think soccer will ever say, no more use of the head and you can use your hand? I mean who cares if you hit your hand with a hammer, but you don't want to hit your head with a hammer. I mean would you rather lose your hand or your head? Do you think soccer will ever reform and stop the use of using the head or do you think it's such an ancient tradition that you're never going to change soccer? 


Liz: I think it's never going to change. I have to tell you that (50:51 inaudible) soccer matches I watch and the goals that were happening there, specifically, Carles Puyol from Barcelona team, I don't know, some years ago. It was the final in the World Cup. He scored a goal using his head. I think for me that was the best goal ever. 


Howard: I love that. I was so lucky because during the World Cup I was with my boys and we were we were lecturing in Africa when there were two African teams in the World Cup and we were lecturing in one of those two countries. I got to be in that country in a bar drinking beer with the most crazy African soccer fans you'd ever find. 


Then we were in Paris, France. And Again we were in Paris when they were playing a game and I'll tell you what, soccer fans - I mean if you go to a baseball game, those fans they look like they're all under general anesthesia. They're hardly moving, and you go to a football game, you think they're all excited and rowdy, but that's nothing compared to a soccer game. Oh my God, the soccer games. Those fans are ecstatic. Crazy. 


Liz: Yeah.


Howard: Oh my God. Those are some of the wildest fans. I love watching soccer. 


It's one of those things where you've got to be in another country cause United States isn't really a place to watch a soccer game. If you've seen a soccer game in Brazil, Africa, and France then you could never watch a soccer game in the United States. 


Liz: Or in Spain. You should go to Spain because you have the best soccer players in Spain: Barcelona, Real Madrid. They have the best people, right? Talking about Messi. Well, I love soccer. I am a huge fan of soccer, especially Barcelona team. I love that team. 


Howard: But I will make a prediction to you. I will make a prediction. I'm old enough to be your dad. When you're as old as me and your son is as old as you, every soccer fan around the world is going to start being concerned about using the head in soccer. At a minimum they could do, which the research to me seems pretty clear, that if say you played soccer seven days a week but you could only use your head like say Monday and Thursday or maybe just one day a week you could use your head. Maybe you could just use your head one day a week in practice and during the game one day a week. But this deal of using your head on a soccer ball seven days a week, especially when they're three years old, it's going to turn out to be a really, really bad idea. 


Liz: I think you're right. I think you're right. Totally right. Let me tell you this. Because I don't know if you've seen there's this soccer player, I forgot the name, but he’s using a head protector because he has a head injury, so he's not allowed to (54:07 inaudible). I don't remember the name (54:11 inaudible) famous goalkeeper. It's part of the game. It would be very hard to tell the kids, "Okay, don't use your head when you're playing." 


Howard: I never played soccer or football when I was a kid, so I know it wasn't that, so the only thing I can figure is my mom must've dropped me on my head. That's the only thing that would explain. Every time I see my mom, I always say, "Mom did you drop me on my head and didn't tell me?" She swears she didn't but I think she's just too embarrassed to admit that she dropped me when I was a kid because that's the only thing that would explain it. 


Liz: I think that happens to all moms. 


Howard: Well, hey, I want to tell you it was just an honor to have you as our first guest from Bolivia. I hope you post pictures of these green teeth on Dentaltown. 


Remember if you're in dental school and you register on Dentaltown and you say you're a dental student, you can listen to all the courses free. But I'm going to e-mail you and I'm going to let you have all those courses for free for coming on the show. And since there's only two people in your class that can speak and write English, maybe your hobby going forward will be - we have transcriptions of those courses, but maybe going forward what you can do is be the ambassador of translating those to Spanish for your colleagues in Central and South America so that they can learn how to do dentistry faster, easier, higher quality, lower in cost because at the end of the day, two million dentists around the world are trying to serve are seven point four four billion patients. I think if those two million dentists all shared all the knowledge they know with each other faster, easier, we would serve our seven point four four billion patients even better. 


So, I want to thank you so much for coming on the show. If you ever come to Phoenix, Arizona you can say at our house with me, and Ryan, and Greg, and Zach. Let me know if there's anything I could ever do for dentistry for you and in Bolivia. 


Liz: Thank you. Thank you so much for having me. Thank you for letting me share my experiences of my life here in Bolivia. I'm so proud to be on your show. Thank you so much. 



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