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VIDEO - DUwHF #933 - James Ingebrand
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AUDIO - DUwHF #933 - James Ingebrand
James D. Ingebrand (Jim) is the President and General Manager of 3M Oral Care Solutions Division. 3M Oral Care provides a broad range or award winning innovative dental and orthodontic products to clinicians around the world.
Ingebrand brings more than 33 years of experience within 3M to his position. He started his career with the company in 1984, working as a marketing analyst in the Corporate Marketing Research Department. Ingebrand has since developed his experience through a series of US and global assignments in 3M’s medical, pharmaceutical and dental businesses. He was named Vice President and General Manager of 3M ESPE in 2014 and assumed leadership of the combined 3M ESPE and 3M Unitek business in 2015.
Ingebrand holds a Bachelor of Science degree in Biochemistry, as well as a Masters of Business Administration degree, both from the University of Minnesota.
Howard: It is just a huge honor for me today to be sitting in my own home with the CEO of 3M’s dental division, Jim Ingebrand. Thank you so much for coming by the house today.
Jim: It’s great to be here.
Howard: You've been with 3M-- well, let me read your bio.
Howard: Jim Ingebrand is the president and general manager of 3M Oral Care Solutions division. 3M Oral Care provides a broad range of award-winning innovative dental and orthodontic products to clinicians around the world. Ingebrand brings more than thirty-three years of experience within 3M to his position. He started his career with the company in 1984. That was the year I started dental school.
Jim: There you go.
Howard: So we went into dentistry the same time. Working as a marketing analyst in the corporate marketing research department, he has since developed his experience to a series of US and global assignments in 3M’s medical, pharmaceutical, and dental business. He was named vice president general manager of 3MSP in 2014 and assumed leadership of the combined 3MSP and 3M Unitech business in 2015. He holds a bachelor science degree in Biochemistry, as well as a master’s in business administration degree from the University of Minnesota. Man, we’re two twins! We started dentistry the same time, we both got our MBA. My gosh, I'm so…. how many world assignments…where have you lived around the world with 3M?
Jim: So I travel a lot but my time overseas was in the UK. It’s where I learned to speak this perfect English you’re hearing. So about four years in the United Kingdom, but most of my assignments have been global. So been traveling quite a bit. I think over, last count about forty-five countries around the world that I've touched down in at one time or another.
Howard: 45 countries around the world?
Howard: You sound like me and Ryan. We're twins in every category. But before I start this, I just want to be perfectly clear. This isn’t advertisement. No one pays me to go on the show, I founded it, I invited him, he did not ask to come on my show. I want to start with the international, because dentistry is so different around the world.
Howard: I’ve lectured in that many countries. I notice when you go to Europe, every other year they have the big IDF meeting in Cologne, Germany. One of the coolest cities in the world. It was the farthest northern outreach of the Roman Empire. And in those conventions, all the dentists want to go talk to the owner of the company and they're like: “Well, if you make this, I want to talk to you”. But in the United States, we’re like “Well, I don’t want to listen to that guy because he's selling. I want to go listen to an intermedier like Gordon Christian to tell me about your products”. Whereas, I have a very devout relationship with 3M because my sister is a Cloister Carmelite monk in Lake Elmo.
Jim: Oh! okay
Howard: So, every time I fly to Minneapolis, I got to go sit four hours in one minute with Pete Frachette Patterson or I would go sit with Sumitra. Those PhDs, they’re passionate. I want to remember some of their names, cause they give me so much of their time. There was Sumitra Mitra, Stephen Olsen, Joe Oxman, Brian Holmes. I would tell them what I was hearing on the lecture circuit. You could just tell they were beside themselves because they said “These guys are dentists and they don't understand biochemistry”. So when you're talking to some (inaudible 03:24) He said: “Well, I'd rather have an acetone base or an alcohol base”. You can just raise hands and say “Go to the board and draw out the molecular chemistry”, because Sumatra- did I say that right? Sumatra?
Jim: Yeah, Sumitra. I think that’s how she goes.
Howard: Sumitra. She would take me to a (inaudible 03:37) for hours and just mesmerize me with organic chemistry.
Howard: And you instantly realize that in Cologne, for some reason the dentists are smart enough to go to the company and listen to them because that's all they do. When the dentists here say “Well I don't trust listening to you because you sell this product, I’m gonna go listen to an intermediator”. Well, dude, when a patient comes to you and you say “you have four cavities”. They got to trust you. I grew up with five sisters and whenever my engine light comes on, I called the “idiot light” cause I dressed Barbie dolls for twelve years. The guy comes out here and he's talking about my transmission. It's all trust.
Howard: I like the European model of trusting manufacturers...
Howard: ...better than the dentists over here being so cynical.
Jim: Look, I think there's room for both and I don't mean to just sound diplomatic, but I think you're right. In the US, people want to hear about clinical experience, they want to hear from their peers, they want to hear “I use this product in my practice, it worked well or was a bust or whatever”. We embrace that, we think that's critical, but we have a lot of passion and guys like you mentioned Sumitra, Joe Oxman and the like. We're a material science company at the end of the day. I'm not a material scientist, but we have a lot of them.
Howard: But you’re a biochemist.
Jim: I do remember a few things about proteins and enzymes but that was about thirty years ago but we love that stuff. Our stuff is good and these guys love talking about it. So that's a treat for us. When we get clinicians that's interested in the science behind the product, we just love it. We think really smart customers, smart clinicians will want to use our stuff because they understand what goes into it.
Howard: So what years were you in the UK?
Jim: So it was in the mid-nineties from about ‘92 to ‘96 (inaudible 05:30) long time ago
Howard: (inaudible 05:33) I want to say macro for awhile because it's a treat. A lot of dentists haven't seen a dental office in fifty countries. They seem to be in a lot of turmoil going from the NHS government dentistry to private practice. When I got school thirty years ago I think they had twenty thousand dentists and they all were in the NHS. Now I think they're up to about twenty-eight thousand dentists and about five, six thousand are completely outside the NHS. What is it like?
Jim: I think it's a real mix in the UK. I was there just late last year. I visited some offices and what we're seeing there now on the site. We focus on both, but we spent probably a little bit more time in the private segment. A lot of group practices growing in the U. K. so a lot of the big GS cells in the groups are growing there but it’s a good market. I think it's like a lot of both developing and developed markets. People are recognizing the importance of it for overall health for sure. Recognizing the aesthetic part if they want to be able to take advantage of that. So it's pretty good but we are seeing a lot of changes in market to everywhere. But one of the things I think that makes them great and what I like about it is that even though it feels -especially in dental now- that is changing quickly it's still things kind of occur over a broad arc as you say and we don't have that you know total disruption that we see in some other industries.
Howard: What I thought is the most interesting is that in the twenty richest countries, you have five physicians, one dentist, and then the poorest of the poor country. It's reversed because if you're in a very very poor country you're not going get an MRI, and a CAT scan and be trained for colon cancer but when your teeth breaks and it hurts and you can’t eat, it's just not going away. I hear so many different numbers. I remember one time I was having breakfast with the president of the Chinese dental association. I said, “How many dentists do you have?” and he said the same answer as the president of the Indian dental association. He goes “what's a dentist?”, he goes “did you go to a five-year program? A four-year? A three-year?”. What if you're out in a village and there's two thousand people, no running water, electricity but your full-time job is sitting there making dentures, are you a dentist? He also said that the populations for China and India in reality were-- When they say they have a billion, three hundred million, it's plus or minus seven million. So how many dentists do you think are in the world? What do you think the global view dollar amount of is?
Jim: I don't know that number.
Howard: I love stats and statistics but I'm guessing two hundred, two million dentists around the world.
Jim: I think the big thing is what you said in India and China, some of these countries. They’re not credentialed the same way right? It's the family business you learn on the one hand, on the other hand, and you've been there. Beautiful dental schools, beautiful dental offices as good as you see anywhere in the world. I think that's what makes some of these countries so interesting to go and visit because the top tier dentistry kind of looks the same everywhere, right? There's a standard and it's great. I wouldn't feel bad about going there myself or any of these places but when you get down into the some of the remote areas or the mid or lower tier, what we would call dentistry it gets kind of interesting, a little more exotic.
Howard: The most exotic doctor I ever saw was in Brazil. I told these dentists, I love it because when I go lecture I'm picked up by dentists and I tell them “I don’t want to stay in a hotel, I stay in a hotel in the United States, I want to stay in your house". I find it very interesting. A couple of interesting things around it is... I'll be lecturing on Saturday at A.T. Still, every dental school I lecture in "I say raise your hand if you have a family member, a mom, dad, uncle in the in dentistry" and third of the hands go up. It's the same in every occupation, goat herding, wheat farming, all my friends when I grew up in Wichita that went into wheat farming, they went to their grandma who passed away (inaudible 09:35)so it's a very family-- I've spent the night in a house in San Powell that had 35 dentists in their family tree and almost all of them lived in the same house.
Howard: Same thing in New Delhi, I think that one was like twenty-seven or twenty-eight and all that like three lived in one house. I just love it, it's so cool but-- so let's bring it back down to Clinical dentistry. What are you most passionate about? What is 3M dental doing that's got you waking up with a kick in your step (10:03).
Jim: Sure, we have kind of a mission, vision, whatever you want to call that called "lifelong oral health for everyone" and that's really what we see. That's in six words, I think that encapsulates our passion as good as anything and we like to think it's very aspirational on the one hand. We're not there yet but when I think about it we are really trying to work across all those. So when you start thinking about lifelong we recognize that it's not just for kids, right? There's an incentive pediatric dentistry for us but we have products that are for that segment for young adults, for adults, and even old timers, so we think about what are the needs of each of those? and if we get it time, talk a little bit about some of the fun things going on in each of those, so that's a lifelong piece. But oral health piece is really great to see that starting to get recognized certainly in the U. S. and elsewhere. I'm not the first to say this, I know by a long shot but this link between good oral health and overall health. We're just chuffed to see that get recognized. 3M, we're also a healthcare company, we're a $ 6,000,000,000 healthcare company with a big dental business.
Howard: How big is the dental business of that six billion?
Jim: It's over a billion about 1.3 billion so we see that great link between oral health and overall health. Then for everyone we recognize you know where global and we're doing what we can to make dental easier and more accessible because this access to care everywhere is an issue certainly in the U. S. but around the world. So we're also living that with some of the philanthropic things we do with some the great organizations out there so lifelong oral health for everyone is really a theme that I think channels and speaks to the passion and the energy of the dental business.
Howard: It's kind of interesting how one of my favorite Pulitzer Prize winning books of all time was 'The Rise and Fall of the American Healthcare System' by Paul Starr and it was so interesting how in 1858 the dentists branched off because they wanted a chair and the physicians wanted a bag and there goes the schism. I've been told so many times when you're not a real doctor and I'm like "well either's Dr. Dre, Dr. Pepper...Dr. Seuss" but it's funny if I would have become a dermatologist and popped a pimple...
Howard: Or an eye doctor and found your glasses, I'm a real doctor but now you see them merging back. When I go into these dental schools... You have the dental school, the med school, same teachers, same faculty but it's really coming back together and I find it shocking that we're just waking up to the fact that gum disease, which should be the surface area of your hand.
Howard: If your hand was just oozing blood you chose someone.
Howard: but I think it's really coming back together this world's health system oral-systemic link isn't it?
Jim: Yeah, I think it's the right focus person, that makes a ton of sense and I think just recognizing that the job of dentistry broadly is not just to fix things when they go wrong, which you obviously do but keep people healthy.
Howard: So you guys have done some huge merger and acquisitions when you bought SP at Germany.
Jim: Right, yeah.
Howard : You still research in Germany, research in Minnesota, and which ones are smarter?
Jim : Yeah, how am I going to answer that question? But to the first question? Absolutely. I mean SP, that was a great acquisition one of the best ever really in the history of 3M certainly in my opinion and great for a dental business. We took two great organizations with passion for science and we're able to combine those two and we still have a big headquarters in little town at Seefeld, Germany, in Bavaria, so we do manufacturing there we do have a big laboratory there as well, we do some of our global both in Germany and some of the global business teams are located there and then we have the same in Saint Paul Minnesota.
Howard : Well I'm going to weigh in on which ones are smarter.
Jim Ingebrand: Sure.
Howard : Because, seriously, my dad when we went on vacations he liked to go to all the amusement parks, like Six flag (inaudible 14:31) hands but when we go to like a Six Flags in some city, he would call and find places that we could tour so we went to a Coors beer. When we bought our family station wagon, we drove to Detroit and watched it go through the line where they pulled us on a golf cart deal, he just loved to watch stuff even before I was in dentistry. I knew that Coors made their own glass bottles and actually were in the dental porcelain business back when Adolf Coors was still alive because he didn't like to outsource anything.
Jim : Right.
Howard: But when you go to German, Scandinavian, Liechtenstein, dental manufacturing companies... Wow they are just intense there. It's just totally intense and they don't have a marketing department and then you go to like an American manufacturing company and they don't even have a PhD but they got a sixty-person call center with the thermostat dialing for dollars so I always say "Germans make it so good, it sells themselves" and the Americans can sell so good they can sell you junk all day long that you don't even need and then China makes it so low cost.
Howard: and that those three can't seem to merge. Other countries need to be more low cost like China, everyone needs to make it as good as Germans , and everyone needs to sell better like Americans. Those are the three...
Jim: They have the perfect organization if you combine all those.
Howard: You would. So when you're making a product, what makes a great product? How long does it take to come out with a new product?
Jim: Yeah, I like to say it's all organized and it starts with great market research and you bring the need back to the laboratory and you develop out a timeline and out it pops.
Howard: Like an assembly line?
Jim : But the truth is that almost never happens. Not that we don't try from time to time, it just doesn't happen. Especially in a company like 3M, which is really all about their technologies so think about concentric circles that the technology sits in the middle of the company. What we do with that technology it goes all over the place, which is why the 3M as a company broadly is in so many different businesses. Yes, the marketing group has needs and says "Hey, we think a customer like this or that" but what happens is, these guys a very clever folks in the lab like you mentioned people like Sumitra and Joe and many more whether in Seefeld or in Saint Paul. They come up with these great ideas because they not only know the technology, they understand the business. They understand the real needs because they don't stay in the laboratory, guys like Joe that they're out all over the world talking to dentists all day long so they come out and they say, "we should do this, we should do that" and eventually we get a coalition of the willing...
Howard: The coalition of the willing?
Jim: and will start working on it and it'll get a critical mass of us say "Okay, this makes sense. Let's go with this product". Then we do a lot of work with outside folks to try to get you know input early on. We have a technical advisory panels, we have dentists and an orthodontist on staff, we have hygienists on staff that can keep us from going too far off the rails. Then we do enter at that point a formal product development cycle because we are in a regulated business and we have to have follow our SOPs and all the rest. Make sure we go through the right clinical development the write their own SOP --
Howard: They don't know what an SOP is.
Jim: (inaudible 18:18) approval. Stands for standard operating practices. So we just follow the rules. Not that we need to follow throughout the development process. I think it's atypical if I can use that term in product development life cycle in a maybe a dental consumable product. It could be anywhere from maybe eighteen months on the absolute short end of things to five years or even longer for things that tend to be more pharmaceutical-like.
Howard: Have you been following people eating Tide Pods?
Jim: I've heard of it. I've not imitated them. You'll be happy to know.
Howard: It's a serious thing. Are you going to go back maybe to product development people say "We can't make this product look edible, we don't want this bottle of resin to look like something you would eat with a chocolate." Especially, because you factory is in Bavaria, Germany and they're more known for chocolate than they are for dental materials.
Jim : Yeah, that hasn't been an issue, I would say, but I'll keep that in mind.
Howard: That hasn't been an issue yet. Right on, dentists! My (inaudible 19:25) don't eat Tide pods. That makes me even more proud to be a dentist.
Jim: That's right, yeah.
Howard: Back to macro. Do you see dentists restoring dentistry in more one way (inaudible 19:38) in another country more resin. Is it pretty homogeneous at the top? or is there continent--(19:49).
Jim: I don't see a lot of big differences. Things like using a bulk fill more popular some places than another. That sort of stuff I mean that's kind of I guess esoteric, Manutius sort of stuff. Broadly, what makes this business so fun from my standpoint, it is broadly similar right especially at top-tier dentistry whether it's done in Japan, whether it's done in Australia, whether it's done in Brazil, you ask anywhere but Europe wherever you want to go. It is pretty similar I find at least at my level...
Howard: I actually have found top-tier best dentistry in fifty countries you can go to bingo off the beaten path so far because of the smartphone; because they put-- When you and I got out of school it was the IBM mainframe then there's a new company making microcomputers was Microsoft software and now they got that mainframe in your hand. I've gone into villages where dentists say "I watched YouTube videos for a thousand hours so the cost of the best perfect information is literally free.
Howard: We have a quarter million dentists on Dentaltown and we make all our four hundred online CE courses free for dental students around the world and a dentist...Dental information is faster, easier, higher quality, lower income cost, it's free. You just started the 3M healthcare academy.
Jim: That's right so similar just what you said there's so much information out there there's, so many ways to learn. We had a similar situation where we had lectures...are owned by other folks, other clinicians around the world, we put support together for our products, people give me thirty seconds on how to use this product reckless that sort of stuff and we just basically took all that, put that all in one place and that's our 3M healthcare academy. So clinicians can go in there, they can check it out, they can register, they can keep track of some of their courses that they want to take and of course it's still early days and will continue to-
Howard: So is this all online then?
Howard: it's all in and how long has it been out?
Jim: I think less than a year, actually. Not really all that long.
Howard: How's it going?
Jim: Good. I think like I said it's early days for us. Folks are using it and we use it ourselves, right. I'm bringing in new employees who maybe doesn't have a background in their own business helps them get up to speed more quickly. It's like anything it's just making sure people understand and know about it.
Howard: We got our schools all distributors and now in China they have the largest Amazon...Alabida?
Jim: Yeah, Alibaba.
Howard: Alibaba and in the United States, we have Amazon and all these Millennials are buying everything on Amazon in the United States and Canada and they're buying it on Alibaba. When will 3M sell direct on those two platforms?
Jim: I don't know, I'm not going to answer for Alibaba, just because I'm not sure, I don't want to misspeak. For Amazon, we do have a few products out there well first of all 3M has a lot of products out there on Amazon. So different divisions of the company use a lot or a little. From a dental standpoint we have only about seven products that we sell directly through Amazon, and these are take-home products, things like our Clinpro tooth crème...
Howard: So more B to C stuff.
Jim : Absolutely.
Howard: So this is a consumer, not business-to-dentist?
Jim: That's right.
Howard: So what are your consumer things on Amazon?
Jim: Things like, 3M consumer products things like post-it notes and Scotch Tape and sandpaper and just like the consumer products-
Howard: But in dental.
Jim: in dental, it's really Clinpro Tooth Crème and a couple other...I think, TheraMints which is a little xylitol mint. A few products like that, very small now and only products that a consumer wants to--
Howard: Any predictions? We've both been in this game thirty years right?
Jim: Thirty-four years coming up.
Howard: Thirty-four years. My god, are we getting old?
Jim: No, absolutely not. We're just (inaudible 24:07).
Howard: Do you have any grandchildren yet?
Jim: No, I've got two daughters. They're both married, we're just kind of in that waiting zone and trying not to be obnoxious about that. So okay let's go.
Howard: You're not setting up books on how to make grandchildren?
Jim: No, I hope they have that figured out.
Howard: But what's your prediction? Obviously if your granddaughter...
Howard and Jim: (inaudible 24:31 )
Jim: Amazon's obviously made some noise. They want to come into this market, we've talked to them. I'm sure every one of my other suppliers in there are having those conversations. I'm waiting for the market, I'm waiting for clinicians to say "3M, I want you to put your stuff on Amazon" I mean we haven't had that conversation and quite frankly from my perspective you know our channel partners that we work with today really do a good job right. They do more than just put products in people's hands. They support the offices, they troubleshoot, they sell equipment, they service equipment, they do a lot. Now that said, do I think Amazon's going to figure this out and come in and they get a share? I think so, right? I'm not going to bet against Amazon they've been pretty darn good at whatever they're doing but I think they really have to bring a real value proposition to the--
Howard: Well it's so funny because they say the more things change, the more they says same. So let's go back to 1998, when I'm sitting there watching them talk about ESPN football and I'm like my god I want to be talking about root canals and I hired Ken Scott the next day and he's still there. He and his team of five I've written half of my lines of code. But we started that all these people the deals when you start a new business. How do you get monetized?
Howard: Everybody says we'll sell supplies. So we started programming a deal to sell the supplies but as all the townies logged on, we had the same mission. I started Dentaltown so that no dentist will ever to practice solo again. So that was in the digital world, in the physical world there's not a dentist saying "Dude, I'm in Salina, Kansas and that wraps my only connection to the outside world" and it's amazing. They value her because you know gossip, people in there like "well you know you're talking about all these different endo files. What's my favorite endodontist over there (inaudible 26:26) what does he use? and that guy over there, he's a big cosmetic guy he's with the AA CD, what impressive material does he use?" and not so much of the reps going to come in and explain sixty thousand skews but she is their only connection to the outside world and you're saying that you're still sensing that in the market. They're not saying "no I don't just want to just get rid of my own wrap and go all digital".
Jim: Yeah, there's a couple different things. So we did a little bit of primary market research. Which is a fancy way of saying we talk to some dentists and (inaudible 26:56) "What are we going to do? Are we going to start buying from Amazon?" and a small group of that small proportion said "Sure, you know I'll buy gloves or I'll buy masks or I'll buy cleaning materials and things but I can't, I'm not discounting Amazon, I think they'll figure this out, I think they'll figure out a way to add value." and into your point I mean it's getting easier and easier for anybody whether you know you want to get that the gossip factor or just click right here information.
Howard: The human factor.
Jim: There's a lot of different ways to get at it. So I think that will come but it's not an instant on.
Howard: So it's not going to be like a dam breaks and all of a sudden it all moves online, it never works (inaudible 27:38).
Jim: I don't think so (27:36).
Howard Farran: I want to ask you the most controversial question in your business because this is dentistry uncensored. There is more definitions of great market dental supplies than there are continents on earth and the younger ones you know we got to remember on podcast. Old guys like me are on desktops. I always say send me the email, email@example.com. Tell me who you are, how old you are, where you live, what country? It's 25% of them are in dental school and all the rest under thirty. I get one email a week that says, "Dude, I'm as old as you." Then I'll email back "how did you get--". All my dentist friends in Ahwatukee, 100 % that are fifty have never listen to a podcast one time in their life. So it's a millennial thing, they don't know what gray market means and if they asked someone, they're going to get seventeen different definitions. So what is gray market and why does it concern people?
Jim: So, great question. Gray market is just product that's meant to be sold in one market end up in another, at a broad category. So a product that was regulated for, manufactured for, labeled for...make up, Vietnam or Thailand or-- I don't to pick on anybody in particular, China for that matter, India, ends up in another market probably it could be South Africa, could be Europe, could be the U.S.. Now, why should that concern anybody? It should concern you because: one, a product you end up with in the other market, it may not not be registered properly, it may not be approved from a regulatory standpoint. Secondly, the supply chain hasn't been controlled right, so you don't know if that product set out on a runway in Dubai for you know two weeks at 110°F, you know baking. You just don't know much about that product that hasn't been controlled so even though it might be cheap the quality that product could be suspect. Honestly, none of that concerns me as much as the final point I make which is you don't know if that product is counterfeit. So that's what keeps me up at night relative to the grey market it's not that, (inaudible 29:57) the product went from here to there and maybe it's okay but we do see a lot of counterfeit product and that's when things get dangerous because you don't really know--
Howard: Where it would look like it was made by 3M but it clearly wasn't.
Jim: Absolutely, you see that people are good at counterfeiting products. So, once in awhile, we'll get a product complaint "Hey 3M, you know this adhesive, this composite, the cement, whatever it is. It's not working properly. Did you guys change the formulation? Did you mess with this product?" and whenever we get a complaint by the way, we love it when people send the samples back is then we can do an investigation and every once in awhile, we'll go "Look at this" and sometimes it's really hard to tell. Sometimes it's very hard to tell unless you do the analytical testing on the product and say, "that's not our stuff, that's counterfeit products".
Howard: It's funny that you mention. I sat on an airport in Dubai for two weeks, because I live in Phoenix. So for thirty years, it gets to 118 . You know twice, I was going to a lecture and the sky harbor close down because once it gets 126 these Boeing's don't have enough lift.
Howard: So they either got to start shedding weight or just wait until it cools down. But in so many products in my thirty years, they say "well, you know what? When that ships in UPS and it's a 118 degrees outside it's 150 in the UPS they basically baked it before I got that. I'm not talking about just dental materials, I'm talking about everything. So I could see controlling the temperature and the humidity, it would be huge.
Jim: There are certainly some impossible to save some money if you're willing to buy gray market product but you are rolling the dice. It has to be said just from a quality standpoint. What you put in your patient's mouth, to me, that's a little unsettling.
Howard: Let's go to macro of the United States, when you and I got in this business in '84 and I started dental school. When I was a freshman and dental gardens, I call it dental kindergarten looking back at those years. You Remember when these first DSL started like orthodontic centers of America, made it on the New York Stock Exchange had a billion dollar evaluation then imploded. Now, they're back. There's some people in the SO market that's saying "What's going to happen dentistry is going to happen to what happened to Forbes". When you and I were little, every congresses(32:22) owned their own building, now they're all employees. How do you see it?
Jim: You know, If you had asked me a few years- I've changed my view a little bit on this.
Howard: That's a sign of a wise person. I hate it when they always know politicians."Wait a minute, you changed your mind". Do you want someone that's incapable of changing their mind running the country? So, views change, they evolve.
Jim: They have their place for sure, I've come down a little bit from how much pettiness, speaking this for the US for the moment and all of that commentary internationally. But, I think a few years ago the predictions where I'll be 90%. It's just it's going to buy that by 2020 it's going to be 90% or I'll be working for somebody else. That sort of thing. Seeing that I think slow down, from a business standpoint, from 3M standpoint, still growing, still big segment, and whether talk about the big guys or the mid-markets. They tend to be growing faster but I think the rate of that growth seems to be a little bit more moderate. From what I've seen, some of the second-hand but some of the survey results as people are still going into dentistry because they want an ultimate even if they started a DSL or a group they want their own practice. They want that control, it's one of the reasons why they go into this space so I think as long as that's the driver you know that's always going to be a bit of a moderating effect so whether where you can argue, whether it 20 percent, 30 percent, whatever it is today. I think it'll (inaudible 33:57).
Howard: What do you think it is alike? It depends on the definition.
Howard and Jim: (inaudible 34:00) yeah group.
Jim: That's why I'd say 20 to 30%.
Howard: Probably 20% big box in more than one state and then another 10% regional in one state. But here's my deal. So, obviously you're publicly traded. So you got to be aware of Wall Street?
Howard: and you talk to these analysts. Don't you think it's a red flag that not one of these DSOs has gone public or even could go public. None of them could. Look at crazy companies like Snapchat. The most insignificant companies can go public. Russell has two thousand. Why do you think none of these guys can go public?
Jim: You know you'd have to ask him I don't know for sure.
Howard: well you know more than I do I've not publicly traded.
Jim: But I look at it, must be one of two things right? so if you're putting groups together, you want to get efficiency of some sort right? Otherwise there's no point, one plus one equals two doesn't make any sense, one plus one equals three now, you're talking about something. I think there's got to be one or two things happening. One, is the whole cost basis has to be lower because you're more efficient and how you operate, how you do purchasing, how you do training, all the costs of a dental office have to come down and/or you need to generate more patients right? That's the top line is there's got to be something about walking into a dental office that's part of a big DSO that says hey I'm going to attract more patients for one reason or another might be they've better advertising, it might be they have the latest equipment whatever it is. So you know if those things are both being moderated for whatever reason, the dental market in the U.S. despite the improving economy is still a little bit dampened. I don't understand why, I wish everybody would just go to the dentist but I think maybe just put in a little bit damper on it or some of the efficiencies that are not manifesting themselves quite as fast as maybe the business plans originally anticipated. I think certainly the efficiency piece seems to me to make some sense that would come over time, that there would be some cost deficiencies from aiming a group versus an individual practice but I guess we'll see.
Howard: They're not impressing me to make me think that they have their skills in economy. There's only so much of dentistry in finding a great location and a great website and great marketing and great advertising or finding a cheaper lab or a cheaper supply but the product is the dentist.
Howard: and the dentist-human relationship. I see two things that frighten me: number one, there's no dentist getting an A because they still need new patients forty years later. They'll be in a town of five thousand and they've got twenty new patients a month for forty years and I say "what do you need? I need new patients". You've gone through everyone in the county twice so in-dentists are still... They want to have advertise to get a new patient. I say "Take all your money and invest it in the new patient experience and an existing patient experience". If you took all that money and tried to keep a customer for life it's far more valuable than keeping any patients. How many dentists have you met says "Ma'am, we stopped taking new patients ten years ago". How many dentists have you met that said that?
Howard: It'd be a unicorn buying a toothbrush and then we go to the associative jobs and it's not just dentistry but the big stock market bubble today is saying Facebook, Apple, Amazon, Netflix, Google, Microsoft, their Millennials only stay with them one to two years and they quit. Then you go to any associate jobs it doesn't matter if it's at the big ones like Heartland in Pacific dental or just a regular dentist who as an associate, these associates don't keep their jobs two years so they're already saying "Man, after years of college I don't know work for you because you can't get two dentists on earth to agree about today is Thursday. They don't agree and we might get along real good and I might agree with your materials that you use from 3M" but then he wants to buy a CAD cam and I want to buy a laser and I want my lab man up the street he's made ten thousand crowns for thirty years makes it round he says, "no I want my dental assistant, who's never made a crown in her life to buy a CAD camera. Gosh, half the marriages fail...
Howard: …that's with love and children and holidays, you really think marrying a dentist is a good idea? I don't see any data groups. The patients aren't staying with their dentist for life, the associate dentist, are flipping in one in two years and it's the same human. You all hear the stories about how Google tries to man face which is to make the coolest work environment with foosball and beanbag chairs and all this stuff and they're the number one.
Howard: Their millennials stay with them just two years .
Howard: and Apple, Amazon is the worst they're just at one year for Millennials.
Howard: So to me I send back and say let's just talk about this anthropologically. Why do kids leave their home? They don't want to listen to mom and dad and when they go get a job, they don't want to listen to a boss. They want their own house their own dental office, they're humans and how many humans like checks and balances?
Jim: Yeah, No. We like freedom.
Jim: Yeah. We want to do what we want.
Howard: So I want to ask another macro question. How it affects dental supplies and how it affects us? When I got out of school and I would send Indemnity Insurance Delta a bill, I would just say I did a crown, thousand bucks, root canal a thousand bucks.
Thirty years later they don't care what my price is, they're sending me the price and it's called a DS, PPO. It's funny how dentists say they don't take PPOs. I'll say, "Really? You don't take Delta?" "Oh, I take Delta.” Well dude, Delta's a PPO and Delta's, on their website says 97% of all the dentists in America take Delta. So now they're-- my fees now are 40% less than thirty years ago, so when you're making a product, if your product takes two minutes to set up...
Howard: ...your product is twice as expensive as the products (inaudible 40:40) because the bottom line is this: If your prices are 40% lower, the only way that you make it is you go for 40% faster. Back in the day everybody used to schedule an hour and a half for a crown. Hell, you got a thousand dollars, you weren't even thinking of the clock.
Howard: But now that you're getting 600 you're like "Well, gosh, if I schedule an hour and a half…
Howard: You know how much more profit there'd be if I could do that in an hour?
Jim: For sure. Yeah.
Howard: Or forty-five minutes? So bulk fills another one.
Howard: When composite started you were curing a little layer, another layer, another layer. It was like playing, it was like making a cake.
Howard: Now you're sitting there thinking "I'm only getting a hundred dollars for this filling, I just want one squirt, cure, go.
Jim: Get it done.
Howard: ls the changing fee structure, changing product (inaudible 42:30).
Jim Ingebrand: We were talking about, thinking on new products earlier and one of the things we really think about very explicitly, not just as an afterthought. We think about clinical success, professional success, and personal success from the dentist's standpoint. Right?
Anything we have to come up with and not just from a product standpoint but interacting with clinicians as an organization. We know our stuff has to work clinically, so we talked about that. We have to test the bejeebers out of it, we do tox testing, clinical testing, we follow the right regulatory paths, we do all that stuff. I hope if somebody picks up a product that says 3M, they know this product is going to work clinically. But then we talk about professional success and that gets out what you're saying. It's like we're going to be a good partner for a clinician, for a dentist, orthodontist, hygienist, whatever it is.
If we help you run a successful business, that's what we really mean by professional success. That means a couple things: it means how do we do things faster, more efficiently, more pleasant for the patient, making sure a second go-around isn't needed, fewer steps in a process, a more robust process, easier to do properly, harder to screw up, whatever it is. Bulk fills, sort of an obvious example, where okay, you get the same results and it's easier but that product also has to be kind of foolproof if you will, right? It has to work well, It has to work well every time, and so whenever we look at a procedure and we try to think about procedure approaches as opposed to- We're just talking about this cement or we're talking about whatever this product is. What's the procedure that's being used? What are all the steps in that procedure, and what can we do to bring value across all of those things I mentioned? Either eliminating steps or making something faster or making it more robust or whatever it is, because we recognize that there's a lot of pressure. When we really hit both of those parameters of a really good product that works great clinically, but also adds value professionally in the sense you'll see a economic benefit from using this product, we're ahead of the game. The last one is kind of the soft one, and it’s personal success, right?. What's a product that you feel good about using in your practice? Maybe because it's easier on the patient, maybe it's just a pleasure to use, maybe it's the ergonomics, or maybe it just helps you feel good about what you're doing because there's such great outcomes for the patient. We think about that, if we can nail all three of those clinical, professional and personal success, then we then we have a winner.
Howard: I'm going to play devil's advocate. I’m gonna say thirty years ago, demo materials were better than today. Which is like, well you can't say that, I'll say it because thirty years ago, all my restorations are gold and back then all the fillings were silver. They were half mercury, which you'll never find in a multivitamin, and the other half was silver, zinc, copper and tin. Like Silver Difluoride - antibacterial. Stannum fluoride is tin. Everything in amalgam was antibacterial and you know, 80% of our patients, Bubba, ain't ever going to brush or floss his teeth. We did this oral cosmetic revolution and we went from silver to beautiful white, but now I think it's missing an active ingredient because with the amalgam, I had mercury, silver, zinc, copper, tin - killing microorganisms and fungus. Do you think that one day we'll have a bulk fill ? I'll say it in another way, it seems dentistry is into making these beautiful barns and we talk about how great the barn is. But at the end of the day it's going to be eaten by termites within ten years and then you come back and say "We used to make these silver Mercury barns and the termites couldn't eat them. Do you think is it even on the wish list, dream list of 3M to have something that has the antibacterial properties that amalgam used to have into a tooth-colored composite?
Jim: I'll spin it a little differently because they're not going to use the anti-bacterial. I'll talk about a couple things, back to the preventions. How do we keep people healthy? Some of the work we're doing that I think is the most interesting is around controlling biofilms and managing biofilm. So rather than trying to go in and wipe out with antimicrobial, antibiotic type materials that you can't really do anyways. You can't sterilize the oral cavity. So, how do you how do you control that biofilm to keep that oral cavity, pH and other parameters that really help keep teeth healthy. We're doing some interesting work in that area so I'm excited about that I don't let the expert in it. The folks back in the laboratory are but I think to me that's a direction that we like as a way that's going.
Howard: I'm going to podcast the lead guy on that department.
Jim: You're going to?
Howard: I want to.
Jim: Okay, we'll talk to Joe Oxman about that. He's one of our experts (inaudible 47:00)
Howard: He will listen to me, he might listen. I'm pretty sure you're his boss.
Jim: That's an interesting research area for us and again at 3M broadly because we have a whole business called our infection prevention division in the hospital. Who worries about biofilms and cleaning biofilms and understanding biofilms
Howard: Do you know how many people die in a hospital each year from something not related to their illness?
Jim: Yeah, over a hundred thousand just in the U.S.
Howard: The Center for Disease Control says two hundred thousand.
Jim: Yeah, It's Crazy.
Howard: I had a little girl in my office the other day and she had nurse(47:32) all over her leg and her mom said "We went and visited grandma in the hospital and she was crawling around on the floor. Now, she has these patches the size of volleyballs" and then you look at CDC, which just drives me crazy. If I go because I have a patient that works at Intel that can take me into areas that you're not supposed to go to. You drive there, you go in a room, you take off all your clothes, you take a shower, you put on a spacesuit, and then you go work on chips.
Howard: and then you go across the street, the cardiovascular surgeon pulls up in his car, walks in his tennis shoes all the way, then washes his arms for an hour. Then does the surgery and in Intel, the room is filtering the air to less than one part per billion. Then you look at the CDC says "well what's the number one cause of hip failure? Well they get a hip transplant and then they get a staph infection". "A staph infection? He's wearing the tennis shoes he left home in and you have all these people coughing and sneezing and wheezing while grandpa's flayed open". How come this is higher quality than getting surgery at Chandler Regional Hospital?
Jim: There you go, great question.
Howard: We got a long way to go in health care. So you're saying 3M's-- this biofilm is not only going apply to fillings getting attacked biofilm but surfaces in hospitals.
Jim: We want to understand at a fundamental level how to keep teeth healthy, the oral cavity healthy. Part of that is understanding how to control and actually train biofilms that behave in certain ways so that's a whole area of research. The other thing and your listeners might roll their eyes the term bioactive and I don't know what it means nobody's really defined it. But we do have some really interesting work in that area, back to more directly to what you're saying. Fillings, materials that can dilute fluoride, and other things to keep a filling intact.
Howard: Here's my three wishes: when you go back to 3M, I want you walk back in there to your amazing R&D department and tell them again thank you so much, they've they've never turned me down, they never told me to leave and I sat there for four hours in one minute because that's what the IRS says makes it a business trip. I wish tooth-colored restoration could be antibacterial. You said you don't like that word, that's cool. The other one is and I got two more. The fastest growing population of the United States is women over a hundred, second fastest is women over ninety. Third fastest is women over eighty. The four thousand pound gorilla in the room is at -- 5% of Americans spend the rest of their life in a nursing home and when you check into a nursing home they get a baby bottle tooth, they get a route service care. One lesion per month, they come back to me sometimes. All this lifelong dentistry I did turned to mush in eighteen months. I have ten times gone to a nursing home and asked if I could just hang out, (50:48) "I'm a dentist because I want to do this." They have a wing and they have this little bitty five-foot-two, forty-year-old LPN and she's in charge of twenty people. Do you really think she's going to brush, floss all their teeth, give their meds, shower, bathe and then she fell down? They say they called the fire department at least one time per night because big ol' fat grandpa falls down in the shower and the little five-foot-two nurse can't pick up dead weight. A lot of times these firemen-- I've seen several calls where it takes four or five guys to pick up some wet guy in the shower and put him back in the road. Root surface decay, what could you make for that? It's obviously got to be a mouthwash, it's got to be a swish...
Jim: Oral Rinse, Yeah.
Howard: What could she realistically do? because she's not going to get in there and brush and floss for two minutes, morning and night.
Jim: That is an area that back to this biofilm control type initiative technically that I'm talking about. That's something we recognize is a huge issue. It's tragic, really.
Howard: But we're lucky we're men.
Howard and Jim: (inaudible 51:59)
Howard: You will almost never see a man in a nursing home. You go to any nursing home in Phoenix there's a hundred women and one man named Lucky. Don't worry. We'll die of heart disease long before the nursing home.
Jim: That's probably true, sadly. I recognize that's a huge unmet need because-- even before you get to a nursing home, it gets hard for people. Their movement gets impaired. It's hard to brush, even brushing your teeth.
Howard: and Alzheimer’s, dementia...
Jim: all kinds of things. Something that makes that easy and back to the connection with a hospital. Similar kinds of things with intubated patients, patients on a respirator. We know that good oral hygiene is one of the preventive steps to keep people from getting ventilator-associated pneumonia. For example, in a hospital they know if they can keep that oral cavity clean. That's one of the markers that help reduce that effect. It's a big need in an area of our research.
Howard: Okay, my third and last wish. I'm writing all these down.
Jim: I'm just going to listen to the podcast and get it done later.
Howard: Gosh, it would be nice to have a reversible cement (53:10) matter. It'd be nice to cement a crown or an implant, or whatever then zap it with a laser or heat it up. Will cements ever reversible? Go from hardback to soft and then make it go hard again.
Jim: I don't know the answer to that one. You stumped me with that one. It would be good.
Howard: It'd be a dream! You got this crown on and you're doing an exam and you're not sure if there's decay underneath it. Let's say you do something to it. A radio wave, a laser, whatever then just take it off, look at it, recement it. An implant on a crown. Reversible cement would be-
Howard: If I could have that by Christmas in my stocking and don't make it look too pretty because I don't want to eat it and there'll be another tide pod casualty
Jim: I won't put it in a detergent pod.
Howard: Another change that we talked about. It's so fun to talk someone as old and senile as me thirty-four years into this. When we were little there were a hundred dental suppliers. Now, it was like two or three that probably do two-thirds of all the business. Did that change anything? Did that change your world?
Jim: Well, yes and no. For sure, the big guys are getting bigger. Dentsply Sirona merged and doubled the size of their company. Kavo Kerr and Danaher continue to do acquisitions and they picked up Nobel a few years ago, they're getting bigger. We mentioned SP a while back so we're getting bigger. What I've noticed in the dental business and dental supplies in particular every time there's consolidation at the top. This is such a creative group there's always a new widget, a new product coming up. It's amazing. You go to some of the big trade shows and especially IDS and Cologne every other year. It's kind of an inventor's paradise. You don't need to invest in a factory. You can come up with a new widget or a new technique or a new instrument or a new something. Without a ton of capital and there just tends to be a lot of innovation in this in this business.
Howard: Ryan, your mom used to get so mad at me because so many times when our anniversary, "Let's go someplace fun on anniversary." I say "Okay, let's go to Cologne, Germany" she's like "Really? You’re gonna take me a dental convention?" What's so cool about it is there's dentists there from every single country on earth. I've known a lot of dentists that made a lot of money there because there'll be some great product and the guy just sells it in Korea.
Howard: He gets the distribution rights work for America. For five days, it's open. If you just slowly walked by the booths for five days, you could not walk by all the booths.
Jim: No, that's the difference.
Howard: Holy-moly, it's crazy!
Jim: You go to a big dental show in the U.S., even when it's busy, there's not many people there. People don't go to dental shows so much in here. That's the amazing thing about the IDS show. It's crowded it's like the Minnesota State Fair on a busy day. It's hard to even walk down the aisles right?
Howard: It's over a hundred thousand dentists.
Jim: It's crazy, it's fantastic.
Howard: It's so cool because you're standing at a booth and you're hearing ten different languages around you. God, it's like going to dental heaven and it's only every other year.
Jim: Very cool.
Howard: You just said something about meetings. A lot of meeting planners: Hinman, Yankee, CBA, they say attendance has been drifting down over the years. Do you see that?
Jim: yeah, absolutely.
Howard: Do you have any hard numbers like over a decade ago?
Jim: I don't have them in front of me but we track that
Howard: But you say meetings are getting smaller.
Jim: Yeah, how many leads we get. I think it's back to what you commented on earlier. It used to be you went to the dental shows to do one a couple things. One is to learn about what's new from the manufacturers and then get deals, I suppose if you were going buy product at the trade show at least from my standpoint. Of course, you'd go to lectures and things and learn as well. But you don't need to do either of those things if you don't want to, right? There's so many other venues where you can learn whether online or other study groups and all those kinds of things so that happens. Then through our channel partners and other ways to terms that get deals and bargains on product you don't really need to go to the show to get those deals either.
Howard: This is very expensive for you guys. Dentaltown always has our little podunk home out of town booth and I just look at how much space you guys got, that's a fortune.
Jim: It's expensive to exhibit at a trade show.
Howard: You promised me an hour of your time, you're the top dog at 3M and dental. Can I keep you and go into some little overtime?
Howard: Let me tell you how old and senile I am. I've been using 3M impregum not since I graduated in '87. I use it in dental school and all these people always try to tell me "You should try (58:16) why don't you scan their price?" like "Dude, this works perfectly!" so why am I gonna fix broken? So number one, am i the oldest impregum user on earth? Who's used it non-stop for at least thirty-four years? What's the future of impergum and do you see a good a reason to switch from a polyether to a polyvinyl? You got so many different polyvinyl impressions or now you got digital scanners, you got the true def scanner. Everybody says you should scan your impression I'm like "Am I gonna use this stuff until I die?"
Jim: I hope so. We love impregum. I wished everybody would use it. In fact, everybody should use impregum. How's that?
Howard: Your lab man will agree just call your lab man and ask him.
Jim: It is a great product and believe it or not the geniuses and the smart folks over in Seefeld, Germany where we make it are still working on it. We're developing more versions, upgrades, different-- tweaking that technology. In 2018, look for more, look for more impregum. Now the other things you said, of course. When I think about the dental business and you commented that there's so much diversity in terms of opinions about what people like to use so of course, there's other impression materials and there's scanners and one's better than another but for sure impregum has got that history and it's just an inherently amazing material. It's inherently hydrophilic in terms of how it works as the like and get into all those nooks and crannies especially when things are a bit juicy if you're taking an impression. It works great.
Howard: That's the last area we didn't talk about. One of the biggest changes when you and I started in '84 there were fifteen thousand dental labs. Now, that's cut in half there's no more one in two men shops. Right now, it's down to seventy-five hundred but all the fast growth is in the top two hundred labs. Are they telling you [that] dentists are going towards digital? Do you have a digital scanner? When was that zero? When did it hit 1%? Where's it on?
Jim: I think it's at about 10 to 15% of penetration in terms of people doing scans and chairside mills and all the rest.
Howard: So any digital?
Jim: But I think that's the interesting part is going back away and again. You don't have to go back too far as well. Well, labs are going to go away. No, that's not happening. The interesting part the labs are embracing digital more than anybody else. Every lab that's still around has probably embraced digital. All their internal processes are digital workflows so if you send a traditional impression, chances are they're gonna take a scan of that impression and the rest of the workflow is going be digital on the lab. Labs, I find them proactive and very innovative in terms of how they're adopting digital workflow technologies. I think it's actually going kind of go to a lab and then maybe bounce back a little bit into more chairside. Same with 3D printing, that's a whole very exciting area. I'm doing all kinds of neat stuff. Chances are any dental or other orthodontic lab you're going to walk into is going to have rows and rows-
Howard: That's my retirement plan. I'm gonna get a 3D printer to print itself and just keep making itself and I'll just start selling them out the front door.
Jim: I don't think we're too far from that, honestly. It's another one of these areas where the technology, it's moving so fast it just makes you grin (inaudible 1:02:29)
Howard: Do you think Elon Musk is correct that if we allow artificial intelligence into drones and robots that they will take over and all humans would have been is the merge between biology and drones? They're seriously scared about this.
Jim: I don't view that quite as dark as he does. Even in the last couple of years, this stuff is really gone.
Howard: I hope those drones get sophisticated because if I ever get remarried it's going be to a drone. I'm not marrying a human, it has to be perfect or just smart drone.
Jim: That's funny.
Howard: Then I'll have a remote control just turn it off. It was a huge honor that you would take your time. You're the busiest man in dentistry and you took the time to come by my house.
Jim: It was my great pleasure.
Howard: I want to end on my final question. Sometimes, they're driving to work and they get blue and they say, "Man, I spent eight years. I graduated $250,000 of student loans. It's gone from indemnity insurance to PPOs and now there's corporate dentistry. Sometimes she emails me between twenty-five and thirty and says, "Howard, do you think I made a bad decision to become a dentist?" What would you tell her? What would you tell the graduating class of dental kindergarteners?
Jim: Now, this will be very sincere in my part. One of the things that I just love about this business and I think is underappreciated. And, this will sound like I'm pandering, I'm not- is the difference you make in people's lives. I just get goosebumps, I get a rush thinking about it. If you have a bad day or whatever, and I know not all dental procedures are pleasurable for the patient and all the rest, but it really changes people's lives. I'll give you two, if you got time, just two examples.
Jim: I was visiting a dentist that had an interesting procedure and he's talking about what he's doing and this was a Friday. A patient was so chuffed, so happy about the job and this totally changed his person's life, that they took off work, came in to the office just so I can stare at their teeth and see the work the dentist had done. I mean, this person was gushing. They went on and on how thrilled they were, how happy they were about this work. Now I'm just in awe, I could work all day long, I'm not going to have that profound effect on anybody's lives. I don't get that buzz of being able to just really make that kind of difference in somebody's life. I had a similar experience talking to an orthodontist who again, similar thing. Young kid, bad class two malocclusion type thing. That kid you know, just a kind of kid who would get picked on in school, just cause he looked kind of funny. The orthodontist telling me the story about how she treated this kid and she shows me a picture a few years later. This kid's a young, strapping, handsome teenager who had his life changed. By the work this person was able to do-- That's just something that you're so fortunate to be in a position to make that kind of impact. That's what makes me jealous of the profession.
Howard: And you know, one of the things - if you really want to get big clarity on things, is number one, get out of your own tribe, travel. Go spend the day in a dental office in Somali, Ethiopia. My favorite dental offices, I was staying in Cambodia. Ryan, what was that big religious place in Cambodia?
Ryan: Angkor Wat.
Howard: Angkor …, I didn't even know it existed and we drove all the way there. It was about a six-hour drive. Do you like driving from Phoenix to the Grand Canyon and stop at the dental offices? But when people say "Oh well, but my patients are here in America, they don't have the money for dentistry". Go walk up to any girl in any country of the world today and say "How much money would I have to give you to pull your front tooth, give it to me and go the rest your life without your front tooth?" a 100% would go "Oh my God". I say "Obviously you would do it for a million dollars" "No way!". You chose a profession where people won't give you their front tooth for a million dollars. Same thing with that girl dental student, I say "Well, if the $250,000 student loans bothers you so much, I’ll tell you what, I'll pay off your student loans if you extract your front tooth, give it to me, go he rest of life without it" and then they start laughing. Think of how many products in your house. If someone said "Hey I'll give you a million dollars if you give me your iPhone and never have an iPhone they're like "Dude it's all yours" but they won't give you their front tooth. That's where dentistry is different than medicine. Dentistry is half-beauty: ear, mani-pedi, hair extensions, beauty and half of its health. There lies the most romantic connection of dentistry. People don't care if you take out their gallbladder and throw it away. You go take out their front teeth and throw them away?
Howard: Like an appendix. “Well, I had to have my appendix taken out. No big deal”. I say "What about take all your teeth out?” oh my god. Here's another weird thing about dentistry and that romance. Go into any room full of women and say "Raise your hand if you've ever had a dream that all your teeth fell out". The girls raise their hand. There's even psychiatric papers on it written by PhDs and MDs and only about 10 or 15% of boys will say that. But all the girls would have a nightmare of losing their teeth...
Howard: ...by age forty. I read a PhD deal where I think was like 98% of girls by age forty have had that nightmare. None of them will give you their tooth. I've been in Somalia, Ethiopia, Tanzania. The poorest girl in the village wouldn't take ten thousand US cash to pull her front teeth. And she has no running water or electricity. You picked the best profession in the world and you'll never master it. All you can do is practice it and they say practice makes perfect, but it doesn't in dentistry. You'll never master dentistry, it's greater than all of us. And it was just a huge honor that you came by to talk about this.
Jim: Thank you very much. My pleasure as well.