Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1059 Oral Care & Overall Health with Dr. Jonathan B. Levine of GLO Science : Dentistry Uncensored with Howard Farran

1059 Oral Care & Overall Health with Dr. Jonathan B. Levine of GLO Science : Dentistry Uncensored with Howard Farran

6/12/2018 8:12:04 AM   |   Comments: 0   |   Views: 242

1059 Oral Care & Overall Health with Dr. Jonathan B. Levine of GLO Science : Dentistry Uncensored with Howard Farran

Dr. Jonathan B. Levine is an esthetic prosthodontist practicing in New York City, Founder of two oral care companies GLO Science and Go Smile, and JBL New York City, Director of Advanced Aesthetics at NYU, international lecturer, author of the textbook, Smile Design, philanthropist, clinician entrepreneur, the Commencement Speaker at Boston University’s (BU) Goldman School in 2017, Chairman of the Board at (BU) Goldman School 2012-2015,  Advisory Board Member of BU Goldman School from 2016- Present, and recognized oral health expert currently holding 27 patents for innovations in oral care. His work focuses on oral health, the integration of esthetics and function, technological innovation and oral-systemic medicine. Dr. Levine is passionate about oral systemic medicine and the impact dental professionals have on patient health and well-being, and is committed to delivering that message to the public.

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1059 Oral Care & Overall Health with Dr. Jonathan B. Levine of GLO Science : Dentistry Uncensored with Howard Farran

Howard: It is just a huge honor for me today to be podcast-interviewing Jonathan B. Levine, he has Glo Science. Dr. Jonathan B. Levine is an esthetic prosthodontist practicing in New York City. He's the founder of two oral care companies Glo Science and Go Smile, and JBL New York City, Director of Advanced Aesthetics at NYU, international lecturer, author of the textbook "Smile Design," philanthropist, clinician entrepreneur, the Commencement Speaker at Boston University’s (BU) Goldman School in 2017, Chairman of the Board at Boston University Goldman School 2012-2015, Advisory Board Member from 2016 to present and recognized oral health expert currently holding twenty-seven patents for innovations in oral care. That is amazing. His work focuses on oral health, the integration of esthetics and function, technological innovation and oral-systemic medicine. Dr. Levine is passionate about oral systemic medicine and the impact dental professionals have on patient health and well-being, and is committed to delivering that message to the public. And  I've seen you on television myself so many times, so my gosh, you've been on The Today Show with Matt Lauer, who’s no longer there. The Better Show, Kate's Take, Wendy Williams — my mom loves that show — The Dr. Oz Show, The Dr. Oz Show again, The Dr. Oz Show again. I mean, my God, how many times have you been on The Dr. Oz Show?

Jonathan: Yeah, I know I did a quite a bit for about four straight years for about four or five times every year, talking about oral health issues, oral cancers, all the things that are relevant. So that was always an honor to spend time with that amazing show that they started and developed it. 

Howard: So what was the most fun, put them in order of most fun. Dr. Oz, Wendy or Matt Lauer on The Today Show? 

Jonathan: Being on The Today Show was kind of fun and those kinds of morning shows, I’ve done a number of them, but The Dr. Oz Show was the most gratifying because it was always a very intelligent conversation. Preparation was always key and it always tried to go after anything that was hot. So when let's say the plastic in Oral B had a toothpaste that was showing up in people's gums or the conversation about mercury or the lack of oral cancer detection by dentists and morbidity rates ever-changing in oral cancers, they were hot issues to talk about, and so that was the most fun because we went after it. We went after the hot issues. 

Howard: So what's the story on Dr. Oz? I know you can't climb up the pole all the way to the top without getting a dozen arrows in your back. Obviously, Dr. Oz has had his issues, but what is your take on Dr Oz? 

Jonathan: Mehmet is an amazing guy. First of all, he's an incredible cardiothoracic surgeon, headed up that department. At the same time that he did that, he started with a radio talk show, then he was discovered by Oprah, which then launched a show and the show ended up being a full-time job for him. He's an incredible physician, but he's also just an excellent researcher and has become America's doctor. Now, like you said, when you climb up the pole, you get into some hot water with the people trying to shoot arrows at your back, but he's a real physician, and I think his greatest stuff is still going to come. He's still a young guy, brilliant, and they've built one of the most incredible shows over time that has stood the test of time as far as resonating for the public and understanding what the public wants to hear. People take notes from that show, and it drives their thinking on their own personal health and how they take ownership for their personal health. So I think he's done an amazing job. 

Howard: Well, every time I lecture in New York City, every single time, at least one or two dentists has a personal story about Dr. Oz where they met him, they know him, sometimes they ran into them and they all say the same thing. They all say just an amazing man, a legend, but when I looked at every time he gets in trouble, the first thing I smell is, "Oh, he's bumping into Big Pharma, who wants you to go to the doctor and take a prescription pill with every issue." Whenever he's talking about some natural thing, some fruit, some extract, some seed or whatever, I can smell that his major problem is that Big Pharma doesn't approve of his message. Because everything I read is that Americans are 5% of the globe population and takes half the prescription pills. 

Jonathan: Right. A lot of his focus is a lot about taking ownership of your health, understanding a naturopathic approach also, and it's a fine line for him because he's going to be talking about natural ingredients and how to cook and being preventative so you don't have to take medicine. And then it becomes a fine line with some of these type of antioxidants and ingredients of how far you can push it, which I think that was a question mark. But the people I think who were detractors, when you look at the profession, I think have a high level of envy and jealousy. He's risen to the top, he's a real physician, he's a real guy, an amazing family guy. He started a foundation that I got involved with also, HealthCorps. I helped build their oral health initiative. Mehmet's been a patient of mine for years. His family's amazing people. So I've gotten to see him up close and he's the real deal. It's the best way I can put it. 

Howard: So how do you pronounce his name? Mehmet Oz? 

Jonathan: Yeah, he's from Turkey, so it's an interesting first name: Mehmet.

Howard: Mehmet. So you graduated from dental school in prosthodontists in 1989. I graduated in 87. When we were in school, no one said anything about oral systemic health. When was this first a concept for you? When did we first hear about this? 

Jonathan: Yeah, so I was in Boston University, pre-doctoral and then NYU PG Pros. David Satcher was the attorney general, and about fifteen, sixteen years ago, he came out and he called periodontal disease the silent killer, and he shed a light on the fact that the pathogens in the mouth, an inflammation in the mouth, from some of the articles and the research that's been done, has an impact on systemic health and inflammatory diseases. Some of the early studies came out of Columbia University with the epidemiologist Moise Desvarieux with the INVEST studies and that was about fourteen years ago, fifteen years ago, and basically they correlated P. gingivalis specifically in the carotid artery of the IMT, when they looked at the carotid artery, which is always a very strong indicator of cardiovascular disease. Fast forward fourteen years and there has been an incredible amount of science that linked inflammation in the mouth with inflammatory diseases, cardiovascular disease, diabetes, Alzheimer's disease, cognitive function, on and on and on, because they’ve realized most cancers are inflammatory diseases. So it's an emerging science I think the dentists and the physicians need to collaborate better. There's groups that are forming that are helping this collaboration and helping shed a light on the science because the science is really becoming powerful on this oral systemic medicine link. There are societies also that have formed where dentists are joining in because for us, we're the first line of defense as dentists. We see our patient two, three times a year. We see inflammation in the mouth, we see what's happening systemically as far as diet and blood pressure, and there are things we can do to make a referral and vice versa. It's a big conversation and it's one that's really getting powerful. 

Howard: So you have your dental office, JBL, because your name is Jonathan B. Levine, and the B stands for Brian, who is my favorite movie star in all of the television history. Brian, the talking dog, who drinks martinis for from Family Guy. Is that your idol, mentor, hero? The talking dog?

Jonathan: It never was, but I think it might become.

Howard: One of the guys that works for me at his desk- He's name's Brian so he's got a big picture poster of Brian, the talking dog. So, JBL NYC is your practice in New York City. So what was going on in your journey to start GLO Science and Go Smile? 

Jonathan: I started in dentistry and I literally fell into it coming out of dental school, learning porcelain veneers from this amazing technician, Adrian Jurim, who figured out how to etch porcelain with a two brilliant people at Stony Brook and NYU, and this was in the early 80s. And there I am as a twenty-six year old, bonding porcelain to teeth, and ended up lecturing people twenty years older than me, and it helped accelerate my own career, and then I felt the need to go back and specialize. Literally five years after dental school, I went back and got my Prosthodontic degree at NYU from '87 to '89. So that kind of got me on a road to think innovatively and think creatively and as a clinician, and involved with the esthetic dentistry and understanding the compromises that existed in the marketplace with professional whitening. At the time it was tray and gel and the hot lights of Zoom and we realized that the lights, wasn't called zoom back then, but those lights got hot. They sat outside the mouth, but the heat would accelerate the breakdown of the peroxide. Tray and gels work, but the gel goes all over the mouth. That takes hours, you wear it at night, and my big idea was I came up with some innovation that addressed the compromises. So that launched GLO after I started working on delivery systems for hydrogen peroxide that launched a company called Go Smile, and we sold that. We started that in 2002. I sold in 2008 and that came from a TV show. I did The View in 2002 and I showed them new innovations and the ladies loved this little whitener. It was an ampoule and you put the gel and it did a great job stabilizing hydrogen peroxide. You didn't need the need to change formulation, so it was very purified and now we created a very nice company called Go Smile, my wife and I. My wife did the branding. So it was fun. I was balancing the practice with starting a company and starting a company from scratch is very challenging. It's like running a marathon, and I've gotten pretty good at it because I've made every mistake possible. We say you got to fail fast and you've got to test and you get an idea and you want to build a team that could really help you accelerate what your ideas are. So I started with Go Smile, I now have GLO Science and between the two companies, about twenty-nine patents on delivery systems, medical device. GLO Science is more medical devices, mouthpieces that amplify formulations, and we now live in a whitening world and we also live in a anti-gingivitis world with therapeutics and moving into the orthodontic world. So we have a really nice team at GLO and we're about six years into it. A lot of learnings along the journey; it's building a dental practice, starting these companies, also being involved in education. It's good. I'm about a hundred years old because it takes decades to develop the skill sets and make the mistake so you get those learnings and you kind of move forward from that. 

Howard: Well, I'll tell you. One thing that you could to look through smoke and mirrors and find the truth. If you look at any business on Shark Tank, the first question they ask is, anybody can do this, but what is your protective mode? Do you have any intellectual property? Do you have any patents? It is so hard to get a patent in the United States. It is ruthlessly hard to get a patent. They find a hundred reasons. The fact you've got twenty-seven patents, you're like a freak unicorn genius. How did you get twenty-seven patents? Does your brother run the US patent agency?

Jonathan: No, he doesn't. It's like anything else. You get one patent and to what you just said, you have to look at the white space and so you look at what is novel and what is existing in your specific field and you can have a very good idea, but there's boxes you have to check off to be able to get intellectual property past an application to the claims where you have protection. So you get good at it. I've done it since 2001, 2002. Fast forward now, and now you can really start generating it because I have a person who does the research. I have a great patent lawyer — we do the applications together — and it's really looking at the white space. It's really looking at what are the compromises that exist in the marketplace. Every dentist, every professional, could think of different ways of doing things to improve it, whether you're placing implants, placing veneers, you look at this latest thing in esthetic dentistry called First Fit, you look at digital smile design, you look at all of these things that are developing with software and there's so much newness and innovation that's coming out of dentistry speak today, and it's very exciting. The challenge is how do I take a great idea, get some protection, and then what do I do with that idea once I get the protection. Do I commercialize it? Do I bring it to a big company? And that's always a kind of a fun decision and it's a fun pathway in addition to our clinical practice. It's really a lot of fun to go after that. 

Howard: So you sold GLO science and you still have Go Smile?

Jonathan: I sold Go Smile. Sorry, I sold Go Smile, that one we build from 2001 to 2008. We sold that 2008.

Howard: Who'd you sell it to?

Jonathan: I sold it to the investor who helped fund the company. Watch out. As you build your company, it's all about the people you surround yourself with. I learned that painfully and so unfortunately I didn't have an investor that was aligned with our thinking to take a long view to build it, and so I ended up selling out early. We did fine but I felt it was an unfinished symphony, and so for me while I had my non-compete, I was thinking about what are the new innovations we can create and what came out of that, what emerged was this temperature-controlled mouthpiece that's a flexible circuit, universally sides, which literally launched a whole industry because there's plenty of people knocking us off when we ourselves are constantly innovating on newness and it's very unique. It's very unique. So sometimes things have a way of working out because we now have multiple iterations on this mouthpiece. We're about to launch a wireless version that will be speaking to your phone because like you said in the beginning, when you're talking about (unclear 00:16:00), you're not connected to your phone, you're not in business. You have to be connected to the phone, and so through mobile apps and through the phone, both our consumer division and also our professional division will have a mouthpiece that's going to be able to send reminders and do all kinds of things to help a person have a healthy smile, whether it's white teeth or healthy gums. So there's so much future here. It's very exciting, and the technologies is so changing around us. It's just staying current with the new company, it's building your team. So yeah, Go Smile, we sold in away and then we we're now building Glo. I have a fantastic team, great CEO, investor-partner who's helping us drive the company, great marketer, and we're in about three thousand dental practices today with our GLO science product. I do the innovation. I'm involved with the research and the team runs the company, does the marketing, and it's a great balance for me. I can focus on this stuff do best. 

Howard: So his website is, and I'm reading on it, GLO stands for "guided light optics". Glo innovation combines warming heat-plus-light in a closed system mouthpiece, activating the professional strength Whitening Gel and prevents oxygen from escaping the mouth for fast, efficient, long-lasting results. And you're in three thousand offices right now? 

Jonathan: That's right. We're at in now about three and a half years in the professional channel. We have a great partnership with the distribution company called Benco, which I'm sure you're very familiar with.

Howard: Benco, yeah. You know Benco stands for?

Jonathan: Yeah, that's Chuck and Rick's dad's name was Ben.

Howard: No, their grandfather's name. Benjamin Cohon. And then his son was Larry Cohen, Lawrence Cohen, who still runs the complaint phone when you call up and I love it. It's third-generation family and when you have a complaint and call the customer service number, it's him, it's second generation, eighty years old. He is the most amazing man and now his sons Rick and Chuck are third generation and that's what America was built on is these families. And then another competitor, Henry Schein's got a quarter of the market, [Paris? 00:18:31] has got a quarter of the market,  but then there's two private companies. There's Benco and then the other one is Burkhart and the lady running that is fourth generation. That company is a hundred and fifty years old and just amazing companies really. So why did you go to Benco and how have they helped you out?

Jonathan: I love that you know that, Howard, about Benco, because Chuck is on our board for Glo Science and they've been just unbelievable in helping a young company grow, and I think also in response, because we have something that looks cool and new, we were able also to help them. So it's been a great partnership. We started with them and literally in six months we doubled their whitening business and we've been growing with them ever since. It's a lot of when you have a big brother like them giving you a bear hug, it's trust and just like you said, multiple generations, private company, there's a lot of relationship that builds because it's not always the wind is at your back. A lot of times the wind can get in your face and you build too much inventory or whatever, and they've been just unbelievable partner. So today we have about sixteen direct-selling reps going up to thirty by the end of the year. We sell with their reps. They have over four hundred reps now. It's a good-looking product, it makes a lot of sense, it takes half the time, none of the sensitivity, so it's stress-free whitening. Most whitening causes too much heat, like the Zoom, I hate to say names, excuse me, but the professional whitening light. The tray and gels have been messy for years, so it's a very good innovative answer and it's an in-office whitening, plus you take the device home so you have maintenance and you've follow up. The key is the mouthpiece is temperature-controlled, so you get the amplification of the temperature, so you raise ten degrees up, doubles the reaction rate. That's the basic chemistry. So if it goes ten degrees warmer, that peroxide breakdown doubles, you get more whitening oxygens and the mouthpiece keeps it on the teeth longer as a closed system. So you start using a bunch of these things that intensifies whitening and it's shortens the wearer time. Shortening wear time decreases the sensitivity. So it's been a great relationship with them, and in fact they turned us onto Burkhart. We also work with Burkhart. They have like a kind of big brother-little brother relationship with our direct sales and we're growing into professionals nicely with them.

Howard: What'd you say about Burkhart again? Did you say Benco or-

Jonathan: I'm sorry, Howard?

Howard: You were talking about Benco-

Jonathan: We're at Benco and also Burkhart on the West Coast, and Benco actually introduced us. Yeah, they have a nice relationship.

Howard: Well, I always thought that'd be the perfect mergers and acquisition. Wouldn't it though? Burkhart is big out on the west and Benco rules the east. Wouldn't that be a great M&A activity?

Jonathan: I think so. I know nothing about what they’re thinking, but ...

Howard: Come on you’re in New York City you should go find some Wall Street broker to throw that together. So this is Dentistry Uncensored. They come out of school, they're formally trained that these bleaching lights do nothing. So yours does or does not use a light?

Jonathan: So the LED light, the energy of the light does nothing. It's the heat that comes off of these super bright LEDs that are in these professional whitening lights. If you put a laser thermometer on the teeth during these professional whitening lights that sit outside the light, without mentioning names, it gets to about sixty-seven degrees centigrade — that's almost a hundred and forty degrees Fahrenheit. That causes a lot of heat, intrapulpal pressure, and that's where the zingers come from. So if you control that heat and get the temperature up, but only ten, fifteen, twenty degrees (unclear 00:22:32), you don't get to the threshold that causes pain, but you create an amplification, an increased breakdown of the hydrogen peroxide, if I made myself clear. So you're taking the compromise that exists and at the end of the day we took the best of professional whitening, which is the warming heat. In our mouthpiece, we have heat resistors and the LED lights basically says the mouthpiece is on. It's the heat resistance that warms, but it's a closed system that keeps the hydrogen peroxide, the oxygens in the mouth and our controller controls the temperature and that's how our system works and there are only eight-minute intervals. So three or four eight-minute intervals, twenty-four minutes and thirty-two minutes, you've just done professional in-office whitening. You literally get five shades every time. If you have a starting shade anywhere from eighty-one, eighty-two that you can go to the five shades of bleach and then we like to send the patient home with the device for an at home regimen based on their age and their starting shade and their expectations. 

Howard: So you're saying that the most important thing is the heat and it's not the light. The only thing the light is doing- That is the heat. 

Jonathan: We've known this for years, for years, and there's the threshold. You do not want to go above fifty-two degrees centigrade. So we've written a white paper on whitening, we have our team who are the great hygienists, just wrote a nice article in one of the dental hygiene mags, and `it's really clear. We've known it from Yarbrough's work with lasers in the nineties. You'd never want to go over that threshold of fifty-two degrees centigrade because it creates too much warmth, too much inflammation and intrapulpal pressure, and so you got to be careful with getting too hot and the heat comes off with these little lights, these super bright LEDs that the professional lighting lights, they get too hot, and they don't control the temperature. 

Howard: You know, in just the last thirty seconds when you're talking about temperature, you've jumped from Kelvin to Celsius- I mean, from Fahrenheit to Celsius. So now you have to go all the way and throw in a Kelvin unit. Let's see, average body temperature is thirty-seven degree Celsius. That's three hundred and ten Kelvin. So how many Kelvin would be the-

Jonathan: It's not that hot. It's nine-fifths plus thirty-two, so it's nine-fifths of fifty-two plus thirty-two. So if you're at sixty, seventy degrees centigrade as your ceiling, that is equivalent to about a hundred and thirty-eight degrees Fahrenheit. So I think the United States, we understand that pretty well. A hundred degrees Fahrenheit, a hundred and thirty-eight degrees Fahrenheit. That's getting hot.

Howard: Going back to the problem. I remember when the all these bleaching systems came out. You've mentioned one, Zoom. When a lot of people said the light didn't do anything, it was already too late because like Ultra when they came out of bleach, Dan (unclear 00:25:38) said he wasn't going to lie because he couldn't prove that it did anything. But the problem is in the marketplace, people come in and they say, "I want laser bleaching or I want…" They see these pictures of people with the tray, so if you sat down and had a chair side conversation and said, "Well, that light doesn't do anything," then they think you're as crazy and you don't have one, and so you're trying to talk them out. So it's very weird when the dentist has the science, but the consumers already made up their mind and a lot of them come in and say, "I want laser bleaching," so if you do in-office bleaching and you don't have some shiny light, it doesn't have the buzz. Even when you go get a mani pedi. So how do you balance science, light, laser-

Jonathan: Howard, that's exactly right what you just said. There's a lot of confusion in the marketplace because there's a lot of knockoff consumer whitening lights. At the end of the day, we have to have products that also was designed well, like anything else. Why do we buy a car? It has to have a little bit of a cool factor and then there's science behind it, but it's got to work. There's got to be efficacy. With whitening, if there's no sensitivity, it's fast and it works. You hit the home run and it's understanding the science that will allow you to get there. Trays and gels are twenty-five years old. The whitening professional lights that Eric Montgomery created for Bright Smile and then Zoom knocked off is sixteen years old.

Howard: Bright Smile and Zoom?

Jonathan: What happened was Zoom used their patents and then Zoom sued Bright Smile and Bright Smile went out of business, then they ended up buying Bright Smile. That's Zoom and then Phillips and ended up buying Zoom if you remember the order of events. But at the end of the day it's old technology. The old technology, if you remember the days of Bright Smile, they were retail centers and they used the whitening light that looked very similar to what is today's Zoom light and they're super bright LEDs that sat about two and a half, three inches away from the tooth's surface and (inaudible 00:27:57) peroxide gel is put on the teeth. Now when the gel is put on the teeth, the only thing that's whitening, here's the science, is the leading edge of the gel sitting on the teeth. Everything behind that leading edge is going out in the atmosphere. It gets hot and it works, but it's the short, high-intensity whitening. They started with four twenty minutes and they went down to four sixteen. (inaudible 00:28:20) you took a laser thermometer, sixty-seven degrees centigrade. I just talked about one forty degrees Fahrenheit. The same dentist-administered were also done for tray and gels. Took the impressions, made custom trade, put the gel in the trays and it works. It's a closed system, but you've got to wear it for hours, sometimes people sleep with at night. Most of the gels are a combination of hydrogen peroxide and another one called carbamide, which has an ammonia breakdown byproduct. Not great, but you're bathing the soft tissue and it's long wear, a lot of sensitivity and compliance is not great. So that was our dentist-administered formulations the last fifteen, fourteen years and technology and innovation is going to win. And what we said is we think there's a better way. So we focused on controlling the temperature and we focused on warming the gel, but closing the system in a universally sized mouthpiece, which means the dentist doesn't have to take impression. The mouthpiece fits the cosmetic area. That same device, that medical device, now the patient takes home, uses it for a couple of the eight-minute applications in a row, five days in a row, and then they have it for maintenance.

A very funny thing happened, Howard, when we ran our studies at Boston University. All of the participants' soft tissue gums in five days when they went home with the device got healthy and we realized that the mouthpiece and the warming heat with hydrogen peroxide killed the bugs and we then went after what is the best formula to use for gum health. And that launched a whole new line of products that we've brought out this past year called ECO Balance, and the science on it has been very impressive. We had some really great studies at Foresight Dental where we showed that the formulation does a great job at controlling inflammation. At the end of the day, you start at one place and that's how we got twenty, twenty-six patents at this point and we end up in different places depending on where the journey takes us, where the discovery take us. We started in whitening and now we have a whole whitening side of our business, but we also have a therapeutic side of our business. 

Howard: That was going to be my next question because I've always thought- This industry started, believe it or not, it was thirty years ago. It started by Omni. Do you remember on Omni? Was it out of-

Jonathan: Omni Dental.

Howard: Omni Dental out of Arkansas. And just by random coincidence, just by no luck of my own, the Omni rep for Phoenix, Arizona, the first rep to have in Arizona was two blocks away. I think it was David Keegan, and I remember seeing this van parked out in front of his truck, Omni Whitening. So I've been doing this for thirty years. It always seems like it really helped. When someone is soaking their teeth and trades, it just really seems like it really helps clean up periodontal disease or gingivitis. Do you believe that? 

Jonathan: Yeah, absolutely.

Howard: I mean how can you soak your gums and teeth in hydrogen peroxide and not have it kill bugs? I mean, it's pretty obvious.

Jonathan: That's right, and if you remember how it was formed, there was an aha moment by Heyman in North Carolina that was putting these gels, carbamide peroxide gels that were over the counter that healed the cold sores in the mouthpiece to heal some of the sores in their mouth from the brackets and the wires from the orthodontics, and they realized that the teeth got lighter and that was 10% carbamide peroxide, which is 3.3% hydrogen peroxide. That led us thirty years ago on this road of whitening teeth with carbamide peroxide is the stabilized formulation of hydrogen peroxide. So it's a three to one ratio. The breakdown byproduct from carbamide, is hydrogen peroxide plus ammonia. Since then we've created delivery systems that you could use purified hydroperoxide, so it's safer like a crest white strip or like a little ampule that has a hermetically sealed bio, but it's generated a whole industry. That moment in time generated a whole industry of whitening for both the in-office and the take-home whitening. And today my big focus is esthetic dentistry. I'm a prosthodontist. I've been doing esthetic dentistry in my career. Everybody gets whitened. It makes doing veneers easier and you can be more conservative when you don't have to put veneers all over the place, and so everybody gets whitened. Everybody gets a shade taken in my practice, just like a patient gets a periodontal probing in an oral cancer screening. It's just basic protocol and people are excited about it. You do the whitening and immediately improves their smile and then the conversation then moves through to what else can we do? Lightning is a great aspect of the esthetic dental practice for the last twenty years, but innovation will take us way down the road to improve the experience for the patient — less sensitivity, shorter wear time and easier for the clinician, so we don't have to spend so much time at the chair to whiten teeth. 

Howard: When you talk about the oral systemic link, there's so much research on that, but when you go to Dentaltown and you start reading the threads on the oral systemic link, some people always say, "There's a correlation between periodontal disease, but it's not causal." They'll say, "When I wake up in the morning and start a pot of coffee, the sun comes up. They're correlated. They're not causal." But this is dentistry uncensored, so I want to go where nobody agrees. I've seen so many papers that show link to periodontal disease, to Alzheimer's, to heart disease, to diabetes. Where do you see "I'm making a pot of coffee and the sun comes up. They're correlated," versus "I made the coffee and that made the sun come up."

Jonathan: In talking to people who are experts- Let's talk about it. Moise Desvarieux, Bradley Bale, Amy Doneen, who wrote the book, "Beat the Heart Attack Gene", who are very involved with cardiology and taking cardiovascular disease, the number one killer of America, off the list. People who are experts looking at the pathways and the pathogenesis of the disease. Periodontal disease, cardiovascular disease, they are multifactorial if they talk about cardiovascular disease as a constellation of risk factors. So if we say smoking, if we say type A personality, if we say cholesterol levels and lifestyle, if we start adding up all of these risk factors and you have science that shows that the same bugs in the mouth can cause cardiovascular disease and inflammation and they show the pathogenesis of the inflammatory markers, you have to be deaf, dumb and blind not to think that there's a direct relationship to the latest science that came out from Bale and Doneen. And I ask everybody to Google the latest study. It's on the open research. You can download it. They talk about the atherogenic triad, but basically what causes cardiovascular disease, and the direct implication of periodontal disease. You look at the studies from last two or three years, you know that there's a direct relationship. Now, causal would mean by itself, periodontal disease causes cardiovascular disease. You have to have multiple risk factors. It goes for everything and cardiovascular disease because that's just the way it is. It's very hard to run a study and control all of these factors, we call confounding factors, in these studies, but there's been so much research over the last twelve to fourteen years that when you really dig into it, you start saying absolutely it's true. Cardiovascular disease, diabetes, Alzheimer's, pancreatic cancer, right down the list of all these inflammatory type of diseases. You know it's interesting, but now they're realizing from the studies of the microbiology and the microbiome of the gut. You've got trillions of bacteria in the gut. It's a bacterial balancing act of competitive inhibition. My background at Cornell University, I was a microbiology major. It's the same thing in the mouth. We have six hundred species of bugs in the mouth. We have almost seven, eight billion bacteria, and it's an eco static balance. It's a homeostatic balance of good versus bad bacteria. So in the mouth, of course, if you're going to have low pH, if you're not going to have a very stressful lifestyle, if you're going to smoke cigarettes, if you're going to drink alcohol, if your home care is terrible and you have periodontal disease, those bugs are going to work its way into the artery. That's just the way it is. You're going to also have other factors that are gonna add, but there are studies today that as you control periodontal disease — this came out of again, Moise Desvarieux's group on the INVEST studies two years ago — you control cardiovascular disease as measured by the inflammatory markers and the specific ones is tumor necrosis factor and IL-6. We can talk endlessly about it, but there was a direct correlation with science on the pathogenesis of the disease as measured by these inflammatory markers. It's really incredible, so the dentist has such an incredible opportunity today to work together with the physician and the physician with the dentist to do these cross-relationships to refer to each other. 

The problem is nobody refers to each other and the physicians don't have protocols that say, "Hey, you look like you have inflammation in the mouth. We have to control it." You know, dentistry now, we can do salivary diagnostics. I'm going to talk about oral DNA for a second because oral DNA we can look at specifically the bugs and we could look at the inflammatory markers and if they have a high IL-6 or they have a high AA and PG, the big pathogens (inaudible 00:38:26) make the referral and make sure that they don't have hot arteries and check out their cardiovascular system and send them to the internist and cardiologist and vice versa. So we have to come a long way between our disciplines. What bugs me and drives me crazy is that dentistry and medicine is so separated and when you do the science and the research on it, you realize that it all happened back when the schools got formed in the late 1800s and early 1900s where down in Baltimore, they said, "Hey dental school, you start your own school. You're not coming into medical school." It's extremely well outlined by a book called "The Dental Diet" by Steven Lin and it's really well-articulated there. Also a great writer from the New York Times wrote a great book and talked about this called "Teeth". She did a great job on it, but since then it’s always been separate.

Howard: What's the name of the book? "Teeth"?

Jonathan: Yeah, "Teeth". She's a New York Times writer. Great, great book.

Howard: Can you find it, "Teeth"?

Jonathan: Yeah “Teeth” and the other great book that is wonderful from this Australian dentist who came to the US and been touring, Steven Lin, called "The Dental Diet".

Howard: We had him on the show. An amazing man.

Jonathan: He's terrific, he’s terrific. So two places, where here I am in my third decade in my profession, is oral systemic medicine and the other place, because I'm so esthetically focused, is I work with an amazing plastic surgeon here in New York and we designed three-dimensionally, diagnostically where we work with moving the lips because thirty to sixty of the lips drop so that we could make normal-shaped teeth and the teeth don't have to be so big to show a youthful display. Again, plastic surgeons don't work that closely with esthetic dentists just like just physicians don't work with dentists. So we have a lot of opportunity to create more of a collaborative environment between our professions, both on the science and the health side, but also on the esthetic side, and so those are for me the two areas that I'm very focused on today. 

Howard: Yeah, I've had Dr. Lin on the show, but this Mary Otto, I've reached out to her for the book "Teeth". She's never replied. Do you actually know her?

Jonathan: Mary Otto, exactly. She’s great. You know, I do not, I do not, but she’s terrific. She wrote a great book, she did wonderful research and she is shedding a light on the oral health crisis. We started a foundation seven years ago when we started to Glo Science called Glo Good Foundation, and we go down to Eleuthera now. My patient friend asked us to come down there and we took our whole practice plus physicians last December. We had fifty-two people, went for four and a half days, we treated about four hundred people and it's an oral health crisis when you don't have access to care and we have it all over the globe. We have it all over the US and she's done a great job, really delineating it and really describing it well. Fantastic book.

Howard: You also talk about the future of artificial intelligence coming into dentistry. I'm dying to see what someone with twenty-seven patents in dentistry- I've seen a couple of entry-level products. One's trying to diagnose decay through a CBCT. Where do you see artificial intelligence coming into dentistry, AI? 

Jonathan: Yeah, artificial intelligence and the exponential growth and I've spent some time with the folks on the West Coast, Singularity University in Exponential Medicine. I was asked to speak at an innovation summit and when you look at robotic-assisted surgeries, which is now happening with a company called Neocis, and we look at computational science, it's something called quantum computing, where now our computers could generate so fast, equations and allows these machines to learn. I think it's not the fear that it's going to replace us. It's more that it's going to make us better, and so we say AI is IA: intelligent amplification. It can amplify what we do, we can do it better and it's an exciting, exciting future. So I really think we have to embrace it. The fear of the robot replacing us dentists and then we're out of business, I don't think that's the gig. The gig is that they're going to just make us that much better. We could diagnose better, our science is better. In 1950 it took fifty years to double the medical knowledge. In 2020, it's going to take seventy-two days and that's the truth, and that comes out of exponential medicine. Daniel Kraft on the West Coast, Ray Kurzweil, the Singularity Group, and you realize how fast everything is moving. It's exciting and I think it's an opportunity for us, especially us guys, we're the baby boomers, to really embrace it. 

Howard: What was the company you mentioned? Did you say Neocis?

Jonathan: Neocis, N-E-O-C-I-S. They're amazing. You should get them on the show. The inventors in MIT, young man, his father was an endodontist. They have created a robotic-assisted machine. I was lucky to be one of the first people to see it. They put it in fifteen locations in the country in the last year and they're constantly fine tuning it. They also built one for orthopedics and they sold it to Stryker. So they're on robotic-assisted surgery now and it's pretty amazing, but it's to assist. It's not to do it, and it's all based on the software planning based on the CBCT. Amazing, truly amazing.

Howard: And you know these guys?

Jonathan: I do. Would you like me to make an intro, it’ll be my pleasure.

Howard: Well, yeah, introduce us. Put it on the show. Also, on Twitter, he's @yomirobot, Y-O-M-I-R-O-B-O-T.

Jonathan: Yeah, that's the robot, Yomi, yeah.

Howard: And one of his last tweets, "Why is By Design Dental Implant Center offering a YomiRobot Robot-Assisted Dental Surgery?" That is just amazing. From Robert Mogyoros? That is amazing. I love this. I posted this on Dentaltown yesterday. I'm just reading it under the artificial intelligence thread, but it said, "1950 was a Turing test. It goes on slowly, not much going on. Then 1997, it just starts ramping up: Deep Blue. And then 1990, Kismet, and then 1998, AIBO. Then 2002, Roomba. 2011, Siri. 2011, Watson. 2014, Eugene. 2014, Alexa. 2016, Tay. 2017, AlphaGo. I mean, you can tell that, basically in a nutshell, from the first thought of it in 1950 to 1997, not much happened, but from 1997 to 2017, it's kind of like a mushroom cloud explosion. 

Jonathan: Exactly right. It's computational science and how fast we can compute. There are guys that are putting this robot-assisted Neocis Tomi machine in their centers. There's one oral surgeon, Uday Reebye, you got to get him on the show and he's on the board with me at Boston University. He's a Goldman School grad M.D. oral surgeon and he's created an unbelievable center down there and we're putting together the guys to create an association of robotic dentistry. It's going to be a tremendous future. Imagine to be able to prepare the perfect preparation and to have veneers that are done off of a digital smile design and you can do it all in one visit and no impression. There is such a great future with this. We already have it with First Fit and it just needs to be combined with the robotic assist. So it's very exciting stuff, and the only thing we got to do is stay nice and healthy, Howard.

Howard: You just walked into a birdie. You just said same day veneers. These kids come out of school and ten years ago they were coming out $250,000 in student loans. Now a lot of these schools are $100,000 a year and they're coming out $400,000 in student loans and they look at a cosmetic dentist (unclear 00:47:25) like you and they want to be all that and a bag of chips. And a lot of them are told that they can do same day veneers if they buy a $150,000 chairside milling machine. Do you think that people could do elite cosmetic dentists like you with the chairside milling machine or do you think you still need to use a lab? And as a prosthodontist, if you came out of school $400,000 in debt, you can raise your student loan debt 50% just by buying the CEREC machine. So I'm going to hold your feet to the fire. Do you recommend these new grads, $400,000 in debt, to buy a $150,000 chairside milling machine?

Jonathan: Here's my data point. I'd been in dentistry thirty years, one of the first people in the country to do porcelain veneers in 1982, ran the advanced esthetics program CE course for the last twelve years, I've been involved with sixteen years. So educating, I have been doing analogue dentistry, I'm going to call it, non-CAD/CAM dentistry my whole career, and it's only the last three years that I have accepted the fact, and I'm talking about esthetic dentistry, I'm not talking about in lays, I have accepted the fact only since I met a fantastic dentist named Christian Coachman who's become a dear friend of mine that we can smile design and we did a course together. We brought in five of the best CAD/CAM ceramists in the world last year at NYU and for the first time CAD/CAM can create esthetics at the same level as layered either feldspathic or press ceramics like E-max. So the short answer is, if you're a young dentist coming out of school and if you want to create a differentiation, a skill set different from the older dentists, learn digital dentistry. Boston University is the first school to go fully digital. They have CEREC machines and milling machines, inlays, crowns, single tooth implants, surgical stents. Yes, from a digital smile design and CAD/CAM, it still is very dependent on high-tech ceramists to understand all of the calibrations you have to do for this milling machine and then you still have to layer it. So the short answer is, if I'm a young dentist, I want to learn of course my fundamentals, because everything is fundamentals. Digital dentistry is not going to make you a great dentist. The fundamentals will. Pankey Institute, Spear Institute, different universities, NYU. But if you learn digital dentistry, how to take scans, how to design on software and how to do CAD/CAM, even single restorations, you are now going to have a point of differentiation and you'll have an advantage over your other graduates and then you're going to be able to get hired either by a dentist looking for an associate who wants to bring digital dentistry in, or by one of these great DSOs that give these young dentists a wonderful opportunity. But as far as esthetic dentistry, that's going to take the fundamentals that take decades to learn and great ceramists that are learning, they're cutting their teeth right now. We're at the very early days of creating beautiful CAD/CAM esthetic restorations that we can do from layer to ceramic. It's just started. Zirkonzahn, Amann Girrbach, CEREC. These are all the milling machines, they're all over the world, that the top people- And it's all out of Brazil and Spain and Europe, not so much out of the United States. The top technicians and ceramists are coming out of Brazil and Spain also, and these guys are amazing, but it's gonna take time for the rest of these technologists to really learn how to do it properly. So it's the early days. I hope that wasn't a long-winded answer. The short answer is the young dentist has to learn digital dentistry for sure.

Howard: Okay, same question. When I talk about dentistry, especially when they come out of school- When you're learning football, you need to learn to block a tackle, a catch, a pass. You don't teach young kids flea flicker play. So when they come out of school, for the first several years, they just need to get their skills up, basic dentistry, but when I look at a hundred million insurance claims filed- I lecture down in Florida to three hundred people from the insurance company and they were showing me all these charts. If you line up the teeth one to thirty-two and you look at all the build procedures, I mean it just goes down. There's just four major spikes on the four, six molars. Three, fourteen, nineteen, thirty. What's the teeth most likely to get a root canal, a crown, a filling, extracted, placed with an implant? Basically half the dentistry in the world is done on four molars. So if that doesn't get you really amped up, to get the best damn sealing on that tooth the minute it erupts- So just on a first molar- You're a prosthodontist, dumb it down to dental kindergarten. She's twenty-five, she's doing a crown on a first molar. Would you recommend a quadrant tray and impregum, or would you recommend an oral scanner? 

Jonathan: Well, let's back it up. Maybe she's taking out an old filling, she's cleaning out decay properly, she's doing it with all the steps that are necessary. Today, there's very little indication, unless you're taking an old crown off, for always prepping full coverage because what happens is if you're taking old silver with E-Max and with these high-strength ceramics, it's like the old days of gold, but you're doing partial coverage, because that is more conservative, and it also creates a better opportunity of success, because you're not prepping the whole tooth down and you're not causing multiple issues and on and on and on. But having said all of that, for a single restoration, to scan it properly and all of the clinchecks, the clinical checks, that a CEREC machine has- They're at it twenty-five years. When they started- Out of the last twenty years, and I had one in my office fifteen years ago, and it didn't last very long, but today, twenty-five plus years together, they have unbelievable software. For a single restoration, I would 100% support either a digital approach or an extremely well-known analog. I have never in my whole career ever taken a quadrant impression for anything except maybe a post and core that I was doing in gold. I always believe in precision dentistry, full occlusion. I want my technicians. Right outside on the other side of that door, I have three technicians. I've been very blessed my whole career. Always, the technicians are on my hip and we have twenty-four people in this practice. We have five docs, five hygienists, seven of us have been together for twenty-five years. So we operate in a multi-dock facility so we can afford having the technicians and having the technology that we want to bring in. The short answer is either one is going to produce a beautiful result. It is all about the devil's in the detail as we know, Howard. How well we scan, how well that technician is at creating beautiful anatomical form, but you have to learn both and for the young dentist, they should absolutely become digital dentist because they're going to add value to any practice they're going to go to.

Howard: And you're your JBL for Jonathan Brian — the drinking Martini dog — Levine. Are these partners or do you own the whole office and their associates? 

Jonathan: My team has always been under my umbrella. So I have the PC. I've always tried to create an environment that is very hard to duplicate and we've been together for years. It's not for everybody. If somebody wants to be an owner and "I have to own, I have to have equity, " that's not what I built here. It evolved over time. I have eleven Brazilians here. All the assistants are dentists from Brazil. They're highly trained. They understand software extremely well. Jeff McClendon who is extremely well-known, works with Gunston Arnett on the West Coast. Prosthodontist Kellen Mori, who's a famous Brazilian dentist. She made it in New York, she's been with me twenty-four years. My hygiene team, Georgia, Paula- Paula was my first assistant twenty-eight years ago and she's a hygienist, so we've been together a long time. We treat it like a family. Culture is everything, company is culture and I've tried to create an amazing environment for all of us. I run the practice. I have a great office manager, have been with me seventeen years and we've a great team. Our foundation is very important for us to give back, and so it's just creating a proper culture and having the right people on board. It's not for everybody because if somebody wants to be more of "I want it mine, me, me, me," that would be a different discussion. If I had a great person who wanted to own, I would say, "Let's go open another office downtown," and I'll help you do it, something like that. But this has worked extremely well for myself and my team. 

Howard: When you young kids are listening for information, the first thing you got to do is realize so much information is incentivized and there are so many people talking about how great partnerships are because they're lawyers, they're consultants. This is what they do, they have contracts, but I just want to remind you all on partnerships that when you marry a woman and when you married your lover, you have great sex and children and you have all these glues and Spain holidays and all of this together, that fails half the time. So when you marry another dentist because you're in school and you're like, "This is risky and I think it'd just be easier to start my dental office with my buddy, Shirley, from dental school," and now you're married to someone and you don't have all these glues of making love and children and holidays and weekends and all this and they fail as often as marriages and so many dentists- I know a dentist that sold a partnership for $650,000 for half his practice. Three years later, he spent $800,000 and a lawsuit getting rid of her. You know what I mean? I tell people, only go into a great partnership if it has really great sex. That is the only time you get a lawyer and marry someone, whether it be a spouse, husband, lawyer. If there's no great- That should be your first red flag. Don't marry anyone if you don't have great sex with them. I look at offices like yours and they're natural. It's an org chart. You have an owner. I mean, you go into the military. Here's the general. You're not the general, you're the colonel, you're the infantry. Go into the Catholic Church. You have the pope, the cardinals, the bishops, all the way down to the altar boy and humans work best in an org chart. The other problem I see when you have partners is I go ask, "Jonathan, can we do this?" And you say no. So then just like when you were a little kid, your mom said no, what did you do? You turned around and ran right to your dad. In fact, you would stalk your dad to see when you could ask him something where mom wouldn't hear. You are always trying to split the herd. So then the staffer's confused, the hygienist's confuse. You ask him a question, "What is your office protocol on this?" And they roll their eyes and they say, "Well, it depends. Dr. A says this, Dr. B says this," and it's the same thing with married couples. When I see the spouse being the office manager, those are some of the highest producing netting officers I've ever seen if they're done right, and if they're done right, the office manager's spouse, whether it's the female dentist's husband, or whether it's the male dentist's wife, whatever, they still follow the org chart. So you'll be the doctor and your wife's up front or you're the female doctor, your husband's up front, but the staff come to you. They say, "Dr. J is the owner." So what I'm saying is, you have to have an org chart and you don't see any religions where- Look at the three greatest religions, Judaism, Christianity, Islam. There's one guy going down. What if every religion had two gods and it was thunder and lightning? It just doesn't make sense on an org chart. So I am not a proponent of partnerships and I'm a huge proponent of an org chart. So if the owner doctor says go right and then his wife is the office manager and she's saying go left, then you have staff turnover, it's confusion.

When you're out there and you're a kid and you're out there looking for a job, you're looking for a mentor, but you don't want a mentor on dentistry or prost or lasers or bleach and all that. You want a mentorship on how to run an organization and you have all these employees that have been with you a long time. So they'll call me up and they'll say, "Howard, here's a question that I'm getting now," because you just had six thousand graduates. I know you gave a commencement speech to BU last year, but they're saying, "I'm going back home. I'm going to Lyons, Kansas and there's two associates available and one will pay me 25%, but he pays the lab bill, and the other one will pay me 30% of collection, but I have to pay half the lab bill. Which one should I get?" And it's like, "Dude, you're not even smart enough to know the answer. What if one dentist has been divorced three times and the longest anyone's worked in his office is three years? And then the other office, he's been married for twenty-five years and he's got a half dozen employees and have been with them ten to twenty years?" So you can see these red flags. You want to go in and you want to learn business. You're going to learn your craft, but business and two words is HR. Business is about attracting and retaining great quality people and keeping them ten, twenty, thirty years. That's what you're looking for in a mentorship. So when you go to that interview and they say, "Well, did you ever receive the…" What is that funny- The (unclear 01:01:52), the one I love the most-

Jonathan: The golden thread?

Howard: No, I was interviewing a hygienist and she was hell-bent, but I actually hired her because of it, all she kept talking about is how she won the Hu-Friedy Golden Scaler Award in her hygiene class, and you could tell by the way she talked about that, that I should get on my hands and knees and I actually did. She was so damn passionate. She was the greatest hygienist I ever had until she got married, had three kids and decided to be a stay-home mom. But the bottom line is, you should be interviewing them when they're saying, "What's your GPA? Do you have experience? Can you do molar root canal?" You should say, "Shut up. I'm interviewing you." Go through every employee that works in his office, tell me how long they've been there. And then when they sit there and say, "The hygienist's been there two years or the other hygienist's been there a year and a half and this is-" And then you'd come back and say, "How come nobody in this office has stayed here ten years when the doctor is sixty-five years old? What do you think the cause of this dysfunction is? Is the doctor dysfunctional?" And then the other red flag is this: the doctor thinks the greatest employee that he can't live without is his office manager who's been there twenty years, but all the other employees have only been there two years because the doctor's too dumb to know that the woman he can't live without is the source of all the dysfunction. And then you go into a place like that and fire her and then get in a functional personality and then come back five years later, and all the staff members are still there. So just look for the human element, the human touch, the HR. So kudos to you. How many people have you kept for ten years? 

Jonathan: You know, I love this conversation. You've got to have me back because I can talk an hour on this. I don't talk outside of my program that much, but we do something called executive development so I've started three companies and I've (inaudible 01:03:40) CEO role, chairman in a couple of them, and what I've learned by making the mistakes and learning from them is that company is culture, your culture is measured by your people, and your people are measured by the quality of their conversations and that is very Darwinian. You have to figure that out over time because you see that you're not going to retain people, you're not going to have a happy place to work. And there's wonderful things to read on this, "E-Myth Revisited" and " An Emotional Intelligence" and "Learning Organization", but there's great things that people can read and take courses in because you'll have to develop the skill set. For me, I have literally seven people here between hygienists and dentists who’ve been with me over twenty-five years, Howard, twenty-five years and the majority of people, most of the team has been with me- My technicians have been with me for twenty years. Two of them are Lindo and Alexandra. I've had technicians my whole career, I've always had technicians. They've either moved away or are still here, but it's about creating this culture and leadership happens as you know at every level. And you're right, people need a coach. You've got to be a coach. You're coaching people up and you want to create an area where people can talk, an environment that allows people to thrive and so it's very exciting because as dentists, we can run these solo proprietorships. You could have people that work with you and everybody could take a different skill. Now, who is that guy? 

Howard: Guess who just woke up? Emma, say good morning. Say, "Good morning, Jonathan."

Jonathan: Good morning.

Howard: She's a slow waker-upper. She is not ready to talk yet. Morning, Emma.

Jonathan: So cute.

Howard: Could you have done what you did if the longest any of your employees stayed with you was three to five years? 

Jonathan: No, no you can't do anything because, just what you said, you're developing. HR is the most important thing. So Jim Collins will say, "You've got to have the right people on the bus in the right seats," and for us, if I turned back the clock twenty-five years ago, I didn't know what I knew now. I'd made all the mistakes, but you've got to learn. It's a learning organization you have to build and you have to create that special environment. So you have to get educated just like you have to be a good clinical dentist, you have to understand how to read people, you have to create an unbelievable culture for people to thrive in, an incredible culture that builds over time. You can't be successful by yourself. Absolutely, Howard, absolutely.

Howard: Yeah, I've got a dozen people that've been with me twenty years and so many people, they always ask, "Man, how do you do it? How do you do it?" Because I got a monthly magazine, Dentaltown and website and Orthotown and website, I got all this stuff. It's like, "Dude, it's easy to do and when you got all these team members that have been there twenty years. You don't micromanage anyone." But we're way over time. We're at an hour and fifteen minutes, but you just mentioned another thing. Ilike you in so many ways, except for all that good-looking hair. I think you should shave your hair and be bald. No, actually, did you know I'm not naturally bald? I actually shaved my head because when I let my hair grow out, everyone thinks I'm Brad Pitt and I get so sick of it.

Jonathan: Goddamn.

Howard: But you said Jim Collins and it seems like every time I meet a really smart CEO, their number one business guru is Jim Collins and he wrote four books: "Good to Great", "Built to Last", "Great by Choice", "How the Mighty Fall". Let me just go through, just real quick. "Built to Last" was written in 1994. A lot of those businesses these young millennials, it's too old, but "Good to Great" is just, you have to read it. If you own your own dental office, and you haven't read "Good to Great" in 2001, you're cheating yourself. Then he came out in 2011 with "Great by Choice". That was another classic. He should be coming out with one any soon now because last one was 2011, and then the opposite of his good book- Because he wrote three books, starting "Built to Last", '94, "Good to Great", 2001, "Great by Choice" 2011, but then he challenged himself. He says, "I'm always studying." So what he does, he teaches business in grad school in Colorado, so he'll get a bunch of grad students and they'll collect data and they'll analyze data for like five years, and then he sums it up and he writes a book, but he gave himself the opposite goal. He said, "Let's study the ones that failed," and I love that one the most. It was "How the Mighty Fall" and that was in 2009 and it was also his shortest book because it's not a very long book because the end of the day, it's real simple. If you can't attract and retain great quality employees, you're doomed, and how do the mighty fail? I'd say the last five employees we've hired, we probably interviewed twenty to thirty people. In fact, the one that killed me, it was about four or five employees ago, we interviewed thirty-six people over like two months and then hired the first person that we talked to, so all those other thirty-five interviews were a complete waste of time. But the bottom line, and I'll end it with this, the most competitive sport ever was the New York Yankees, Steinbrenner, and how serious did Steinbrenner take HR?

Jonathan: That was it.

Howard: That was everything. 

Jonathan: He wanted the best players he could put together, but we all know, a lot of times it's not so much the superstars, but it's how well everybody works together. We see that all the time and it's like that with our team. I would add to the list for your readers, there’s a book called "Agile Innovation" by Eric Ries and he talks about how you test things but how you test because you want to fail because you want to take risks and the opportunity for a young dentist to step out because they know the phone. They know social media and digital. They know how they could build a practice through awareness and they can use those technologies along with learning the fundamentals to push the envelope along with the greats like Jim Collins and like Daniel Goleman with "Emotional Intelligence". There's so much great things to read for our own personal mastery, our own skill sets to be successful. And it's like my friend Steve Hanson has restaurants, I mean, overnight success in twenty-five years, thirty years. It happens over time and you have to have patience with it and it's fun. We say dream big, but if you think you're dreaming big, dream even bigger and surround yourself with people that you love. People stay with you and me because we love each other because we put time in each other. I learned that, I played lacrosse in college. 1976, we were national championship. We lost our sophomore year, our junior year. We were undefeated my senior year and I learned a very important lesson and that is to love your teammates and to have each other's back, and that's how I thought about building my practice with people that I love and love me and we're going to grow and get on this journey together. 

Howard: So did you see on ESPN, they always have like the top ten plays of the day or whatever, the lacrosse play was the number -Did you see it the other day? It was like two days ago. The guy, it was a pretend pass and the other guy pretended he had the ball, but the first guy that passes still had it. It's called it the secret pass or something.

Jonathan: Yeah, it's a fake flip and then he still has the ball ...

Howard: Yeah and nobody on the field knew he had the ball. He literally walked- He was like walking slow. He's just like walking, then all of a sudden- But hey, it was an honor for you to come on the show. Thank you much for coming on the show today.

Jonathan: It was great being here, Howard. I love talking to you.

Transform smiles into my practice, creating products and teaching young dentists. But it's not about me, it's about her, and that's Agathe. I met her in Rwanda when I was past of Foundation Rwanda. It's an organization that supports the mothers that were raped in the genocide and their children. Agathe had her teeth knocked out by a machete. She survived the genocide, and when I was there they asked me what I could do and I didn't hesitate to help. So I tried to figure it out. I went back to New York to my clinic. I took a basic impression when I was there in Rwanda and came back a year later and was able to fit a prosthesis in one of the six dental offices for six million people. As she looked at herself in the mirror- And there she is, how she used to cover her hands and those are her eyes looking on, but if she looks at herself in the mirror, I realized that we gave her smile back. But more than her smile, we gave her soul back and the power of the smile and I love what I do, is something special. Well, imagine a future when you walk into a dental office and you're greeted by just a beautiful, sensitive dentist that has all the new technology that has this complete digital workflow and allows this dentist to design your smile in the two hours that normally takes three to four weeks. And the smile is perfect and it's symmetrical, and when you really look closely at this perfect smile that this dentist creates, you can see that the right side is exactly like the left side. That there's this complete symmetry of the sides and the dentist was an AI powered, self-aware robot, and this robot created this smile. But you see the smile is all about imperfection and we called it perfect imperfection. So what we can see next up is this beautiful esthetic that nature shows us and what we do in esthetic dentistry today is we look at the face and we figure out how do we enhance the beauty of the face? How do we make that special?

So it's clear that a robot can't be a dentist, but what the robot's going to do, it's going to help us in my profession, in similar professions, in medicine be so much better at what we do, more effective, more efficient, which means more cost-effective. Of course, we're going to realize there's an excess of care problem and we realized that we've created this foundation where we go to underserved populations. Well, now it's going to become, if you go to dental school, you have to spend X amount of years in these underserved populations and we have the smart technology where we can deliver care efficiently and very effectively. So if you go in the future, I guess and you work it backwards, when you see a smile and it's too perfect, it was probably designed by a robot and we need to say to ourselves, "Well, what really is AI?" It's really IA; it's intelligent amplification. It amplifies what we can do because you still need that creative spirit. You still need the artistry to match the face and the personality for what we do, and a smile is so powerful as an human emotion. It's how we show love. It's a direct connection to our soul.

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