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1257 A.I. Powered Cosmetic Dentistry with Dr. Kyle Stanley : Dentistry Uncensored with Howard Farran

1257 A.I. Powered Cosmetic Dentistry with Dr. Kyle Stanley : Dentistry Uncensored with Howard Farran

9/24/2019 6:00:00 AM   |   Comments: 0   |   Views: 204
Dr. Kyle Stanley, named as "The Next Generation of Cosmetic Dentistry" by the AACD in 2015 and "Top 10 Young Educators in Dentistry" by the Seattle Study Club, graduated Magna Cum Laude from the Herman Ostrow School of Dentistry of USC and then completed a dental implant residency along with a dental implant specialty in Brazil. While at USC, Dr. Stanley completed an Esthetic mini-residency with a world leader, Dr. Pascal Magne, and was honored with the Charles L. Pincus Award for outstanding achievements in esthetic dentistry by the American Academy of Esthetic Dentistry. He is also a dedicated researcher who has published in some of the top international dental journals about topics relating to esthetics, dental implants, and smile design. Dr. Stanley is a KOL for many well-respected companies and has presented on five continents as a highly in-demand speaker. With his company Pearl, he is changing the way patients are treated through artificial intelligence and is a leader in this field. Dr. Stanley maintains an exclusive private practice in Beverly Hills, CA.


VIDEO - DUwHF #1257 - Kyle Stanley



AUDIO - DUwHF #1257 - Kyle Stanley




Howard: it's just a huge honor for me today to be podcasting Dr. Kyle Stanley: named as the next generation of cosmetic dentists by the AACD in 2015 and top ten young educators in dentistry by the seattle study club graduated magna log from the hermann australia dentistry of USC then completed a dental implant residency along with a dental implant especially in Brazil while USC dr. Stanley completed anesthetic met many residency with a world leader dr. Pascal magnae and was honoured with the Charles L Pincus Award for outstanding achievements in aesthetic dentistry by the American Academy of industry he is also a dedicated researcher as published in some of the top international dental journals about topics relating to esthetics dental implants smile design dr. Stanley is a key opinion leader for many well respected companies and has presented on five continents as a highly in demand speaker with this company pearl he is changing the way patients are treated through artificial intelligence and as a leader in this field a doctor certainly means an exclusive practice in Beverly Hills California my god I am in preparing for this podcast I mean you've lived like five dental lifetimes and you're still in your 30s how my god is just an honor to I meet you today how are you doing

Dr. Kyle Stanley:  thanks so much yeah I'm doing well you know I have been lucky to have some good mentors which have helped maybe propel me into a faster position that I'm in I've been just really lucky to be on the coattails and some great people 

Howard: Wow well that's a humble way to say that you're just born on third base and genius intelligence and I've been rocking and rolling ever since I mean my and you're even on top of AI so so first of all and let's get started with I want to start with purl because you're the chief clinical officer a purl and that's probably most of the people listening right now might not have heard a pearl and and civilian with gumgum dental so let's start with just what is Pearl

Dr. Kyle Stanley:  yeah so Pearl is a company I'm a partner and then we do artificial intelligence for dentistry specifically and a few different places in dentistry we were spun out from a previous company called gum gum and so one of my patients started that company it's an artificial intelligence company that's using something called computer vision and they were doing that for the marketing space and then he brought me in and said hey you know I want to do some things for dentistry would you help me and I said well I don't know anything about computer vision but I know no I know a few things about dentistry that was about three and a half years ago we ended up spinning the company out we raised the 11 million dollars have some toffee C's and now we're trying to automate a lot of things in dentistry to reduce stress reduce liability makes things faster more predictable from labs from patients or Purdy Essos for universities it's it's an exciting time to be in dentistry 

Howard: well you know and that's kind of what we have in common when I was uh you know the first wave I threw my surfboard on and surf was being a dentist my next-door neighbor was a dentist I surf that first base and then when I got to first base and was playing all things dentistry I noticed this big thing the internet was coming on and we started dental town and I surf that all the way to second base but now it's beyond a doubt that the the internet revolution which was like from 94 till you know now that third base is gonna be artificial intelligence coming from big data from elastic cloud comparing and the Internet of Things and and so you are on that wave and I don't think 99% of the dentists have even given it a second thought so do you believe those are the four pillars AI Big Data things last a cloud computing yeah 

Dr. Kyle Stanley: yeah one of those one of the other components is GPUs as well so you have like you said big data you have now GPUs so better processing that's happening faster so what do you mean that's that's just the the amount of processing that can happen in a computer and so you have technology increasing big data finally having access to it because of like you're saying the Internet of Things everything's connected and then this new form of AI which is which is called deep learning and you bring all those together and we're really going to be able to process things at superhuman speeds of superhuman levels and start making these predictive statistics to really help patients you know like um one of the things that we're working on is incorporating oral health care to systemic healthcare and this is something that's really been missing for a long time you know there's a few articles about stroke or heart disease but we don't know necessarily if you're let's say a 37 year old female and you're missing two to three teeth and you have one to two millimeters of bone loss and you're taking a certain drug what the connection is but with computer vision and with something called natural language processing we can bring these two together and start making predictive statistics and tell this 37 year old email that you're 15 percent more likely to have X Y or Z and I like say I really don't think the dentist'

Howard: s he was here is coming but I mean it's it's gonna be like when I started dental town when I already started programming at 98 I didn't find one dentist who told me that was a good idea in fact in fact most of my close friends did everything they could to talk me out of it and this artificial intelligence I mean I mean your your your I mean it's gonna be the game changer it's gonna be so game changer you got people like Elon Musk saying that we shouldn't even develop it because you know a human being couldn't even compete with artificial intelligence but these dentists don't know their numbers they don't know the health history of the patient I mean I mean how how how close what what is the first realistic thing that this dentist could see versus all the fairytale stuff that'll be here in ten to twenty years hi 

Dr. Kyle Stanley: yeah well first of all I have to say that dental town for me so I did my residency in Brazil and you know I was in Brazil by myself basically I dental town was my business school so during my year in my residency I read all of Scott Lunas posts I read all of you know everybody that was talking about business and so I oh actually a lot to dental town it was like my MBA forum so I just want to say that before I go on for AI the first aspect that people are gonna see a big change in is reading radiographs this is one of the things that we're pretty far down with the FDA is looking at radiographs and reading them with the eyes of an expert so you know you or I may look at something and we may see it but we may miss carries on dis old nineteen or we may miss bone loss in between here here is something that we're not sure of like let's say cancer or convinced eos di it is something like that when you have AI looking at this and you get it to a certain threshold it won't miss this and so you can have things where patients are getting better treatment you can also have a second opinion with this so I know this happened to you it's happened to me patients come to you you tell them they need something and then they say you know I'd really like to get a second opinion and now you have that it'll be built-in you know you can basically say a thousand dental brains have looked at this from around the world and they would agree that you have a carry sir what I what I don't understand is 

Howard: like when you read things for the military like say a say a submarine goes underwater and it's not surface for six months and now they have you know one of the 600 souls on board has got these think well they're not surfacing because Kyle has a fever you know I mean so they go to AI and they've been doing this for decades and and for the last two decades before there was any IAI or any cloud computing or in any that amazing stuff but they were already showing that that computer had a 92 93 94 percent accuracy and that a real human would have been in the high 80s and then it gets further off where if I am a Irish male I all be better diagnosing Irish Mel's and say I was a female Navajo Indian yeah because I obviously if I had a choice between reading being Irish if I had a choice of reading between prostate cancer and alcoholism versus female reproductive parts you know so so they they it's already been proven better than a human I mean who would want to add one of the eight billion humans their medical problem when you could ask an AI computer yeah that could rip through everything known to man in a millisecond yet 

Dr. Kyle Stanley: yeah that's exactly right it's we we've done this with radiographs first we get to this superhuman level where you can't compete with it and one thing that our CEO says Oh fear is dentists we do so many things right we're doing we're doing we're doing anesthesia we're doing a kind of lab stuff we're also in the mouse but then we're also part time radiologists you know there's not a lot of medical professions that are do part-time radiology and most of us can miss things and there was even some studies recently that showed that you know later in the day we don't diagnose as well right we've done some studies where we only agree with ourself about 70% of the time so if you looked at an x-ray today and then I showed you next week or let's say in a month you would only agree with yourself seventy percent of the time right and the AI will be really statistically significantly better and it is already so that means if I had four boys if I had to do all over again I'd only have three maybe that's what I heard baby what's that the baby Zach would that be my past when Zach I always I was T sem

Howard: i I always tell Ryan he's my third that he's the poster child for why people should only have two children and then I tell Zach my fourth he's supposed to or why everyone shall I have three so so reading x-rays I mean there's a human eye I mean it's it's an API I mean the smallest thing it can see is 50 microns is there there would be no one doubting that the physics of a computer could not see better than a and a monkey without a tail is that gonna be one of the first things that gets replaced is that especially all these CBC T's which you know I I am - there's three dentists in my practice that a lot of time we look at a CBC T it looks like something from deep deep space Hubble I mean I mean when you got three doctors looking at something you say what's that and three guys are saying I have no idea so is that the one of the first ones up to bat – 

Dr. Kyle Stanley: yeah yeah we we've started with two dimensions so we've started with bite wings and period coats but we've also collected a giant amount of CBC T's and our training on that right now so that's something that we'll be releasing as well one of the other things we're working on is well there's two other other places one is insurance dental insurance the other one is labs you have a preference for which one you'd like to hear about first well before we go into labs I want to see one of the 

Howard: UM what are the things that makes people afraid to write articles in post original content because all the data shows that about 1% of humans in any sector produce original contact about 9% engage like I you know whatever lol I agree sorry but 90% don't do anything because they're always afraid that they'll be wrong or someone will say you know but but I actually enjoyed that the most in my career every time I write an article and I was wrong my god I for free it's deleted out of my mind people spend their own time and energy explaining me I'm wrong so let me get their asses about because I might understand this one I've been told that with machine learning artificial intelligence that the bigger the data set the better so when you scan your first impression the computer the AI is not going to be nearly as smart as after I've scanned a hundred when I'm skinned my first impression they could just compare me to the pool but after a while they go oh this is Howard so we know which ones you scan which ones had to be we're finally getting to understand Howard it so the more bigger the data set the more AI can do its job as a well some guy said you know if you wrote a machine learning program you know you can't test drive your car when it's in the garage you need to get the car out and you need to take up for so is when I'm using oral digital scanning yeah is it better at the hundredth impression than the first is it better at 1010 or 100 is this skill like the answer

Dr. Kyle Stanley:  the answer is kind of both because when something is released for example when we when we release any product it's been trained on let's say hundreds of thousands or even millions of x-rays or scans whatever it is but every single time that it gets input it's getting better so what happens is you have this big ramp up when your trick when you're training it right it's going up wow wow wow and then it gets to a point where then it's kind of just barely going up over time and so most of the time when we would release a product into the wild it'll already be at that that high level so let's say we may be at 97% accuracy now to get from 97 to 99 takes a lot of time but every single time we get feedback you're exactly right it's gonna learn so more data is more data better

Howard:  so you and Oh fer who was the founder of this AI he both had a dentist as a father yeah yeah so fears d

Dr. Kyle Stanley: ad as a dentist or was about this he's retired my dad just retired in October my my brother's adventists as well so we both come from dental backgrounds well here's a little smarter than you and I Howard and that he didn't go into dentistry to you know went to Carnegie Mellon and studied computer vision and AI so yeah he went you went the other way and now look he's back in dentistry so is he is the language still gonna be Python for all things AI is that pretty much things in Python there's some other open-source formats that we're using but Python is one of them 

Howard: well I mean I I've been you know like say I jumped on the internet in 94 was an AOL dial-up and I would and I remember my dad and my youngest sister spent the entire day in my kitchen because at that time I paid off all my bills and had 1 million the savings account and when I decided I was gonna commit to this dental town thing before it was launched I had gone from a million in cash at no debt to 1 million in debt in bed and Middletown with this dial-up thing on AOL and I kept telling him the vision is selfish it's totally selfish I want to I'm practicing all by myself I'm alone right I want to talk to another dentist so bad and to show them an x-ray to show them a picture that I want this for me so bad I I get it if you don't get it you don't have this problem and then when you look at AI I mean my god these dentists I mean if you go into a hundred percent of all the dental office in America and you watch them come out of the room after they just had to mo D composites for one hour and you say okay doc you are in there for an hour you did two mo d composites did you net 48 dollars after taxes or did you lose six bucks not one person knows on earth and and then you go to these DSOs and you think oh my god they're really sophisticated well they're not using any over-the-counter software they're programming their own and their lately in dentistry there's not one dental practice - offer denture it's easy they don't open up not one will even hook up to some any accounting package like quicken or QuickBooks Pro or Microsoft bought Great Plains or or anything so I mean we're really we're in my mind on a I could take us from the Flintstones to the Jetsons I mean one thing could take us from the Flintstones and I don't want to use cartoons because I know you star in South Park and you're in Stanley how did you get the two lead parts in South Park Parker because I seriously I see dentistry as the Flintstones and I know what they could do which is the Jetsons and I'm looking at AI and thinking my gosh this one company this Hello pearl could never could just fill in so many gaps what what has got you the most excited right now

Dr. Kyle Stanley:  well there's there's a there's those two that are right now really exciting and really taking off one is the insurance aspect so we're working with dental insurance companies automate insurance claims and also we're doing something called resubmission fraud so we're gonna weed out all of the dentists that are you know bullshitting everybody and committing fraud so what we can do is every time an image is is given to an insurance company we can put a fingerprint on that image and now if that image is ever resubmitted for another patient it's gonna get flagged yeah and you'd be surprised on how insurances have no idea how much fraud there is and in the same way we can really just bring a truth to the industry because I know for dentists most dentists hate insurances you know assurances have a hard time with dentists and so we just want to bring truth to that with computer vision and we're working on something that's that's automatic claims approval and this is basically you're in the chair you tell your patients they need X Y or Z you submit your radiographed with you know and it's read with computer vision the patient does exactly right then how much they have to pay if it's covered if it's not you can start work right then and we think that this will allow patients to get you know faster treatment better treatment the treatment they need and not have this ambiguity of if they have to pay for if they don't have to pay for it 

Howard: well you know a lot of people have you know a lot of people think like if you see something bad about America that you're not America well America wouldn't be a great country if everybody's sugar coated you know when you can have an honest conversation about everything that's wrong and I remember when an Israeli company you know you're when you're my age you've seen all these rodeos before the first rodeo I saw in this was an array in Israeli company who wrote an algorithm and and if you knew the name of the man who invented the algorithm and realized that that's how we butchered the name that we call it algorithm after this this guy a thousand years ago but anyway um he would just simply wrote Algar said you know 96% of crowns or build one at a time so he did algorithm that just cut it off at like half the crowns are build two at a time and it picked off a guy that was practicing right up the street for me who went to jail for five years and he was just a lovely guy who's telling their patients well you know Kyle I'm if I just say we're gonna do two crowds but just do one they'll pay half a boat so they don't have to pay anything out of pocket he was a really nice lovely guy and he just blew his family apart because you had to go City cancer five years and it's and it's gonna get worse and worse and worse worse oh but but the dentist I'm gonna say that the fact that they don't like insurance companies just they're complete and maturity in every other industry the whole value chain works together they all get a concert we just had the CDA meeting last weekend in San Francisco so the CEO Delta who sells a billion dollars a year of dentistry did he get a speak then he likes you oh no no oh no but but how many lectures do they have we're in the headline it says you know how to get off insurance how to be insurance so this this deal that dentists walk on water and that at all of our patients and the dental insurance companies and the fortune 500 paying for all this dental insurance like like they're not worthy of sitting at the table or you know what other company like when I buy this iPhone I whip out a thousand dollars I pay a thousand dollars Dennis expect that you won an iPhone but your employer should pay for it are the government should pay for you know I mean if you can't get people to pay with their own money for your services your your coddled your immature but I'm so I call this dentistry uncensored I'm the first to punch my dentist the nose because that's competitions what's good for an industry and I think I think AI in when I think of insurance what I cannot stand is that here's Delta they got Delta when they come in they have to bring a piece of paper and I have to call I have to pay a human being to call Delta to make sure that he's covered all the dealers and I'm like why doesn't Delta have an app on the iPhone it comes in and scans it says oh this is kyle Stanley here's everything he's covered I mean and then and then during the during the health care debates every time someone would say a 30% of our insurance cost is paperwork which is 

Dr. Kyle Stanley: totally true you have you know on some of these people have tens of millions of claims and they don't have enough people to look at them and the ones that they do could be the ones that are the easiest ones that could be automated so what we can do is is automate the easy ones and the hard ones that really need to be seen by a human to a human and still have that human in the loop for the ones that we needed s

Howard:o is this right now is this publicly-traded is this on VC funded where someday you'll do an IPO what is the exit strategy for gumgum which is is is gumgum is hello so so pearl is the company that was spun out from dumb gum so so pearl is its own entity now

Dr. Kyle Stanley:  yeah like I said we raised eleven million dollars from a really really strong DC group called crack ventures who is led by David Sachs who was one of the founders of PayPal he sold the Yammer he's just a really big no VC very well-known in in Silicon Valley they let our round so you know the exit we don't know what the exit will be but it's it's been pretty exciting so far on how fast things are progressing cuz you know I'm a dentist like I said a few years ago I didn't know anything about computer vision you know about GPUs and AI had to learn all this stuff but now understanding it it's crazy at how like you said this is gonna be the next wave a really technology but also in dentistry because there's things that that we're not doing that there's other companies doing regarding AI that can also really help the practice of Dentistry

Howard:  so then is offer still the CEO of gum gum is gum gums oh

Dr. Kyle Stanley:  so over if you're actually stepped down as a CEO gum gum which is kind of crazy you know it's a company that does hundreds of millions of dollars a year and he believes so much in what we're doing with pearl that he stepped down to be the CEO of pearl and so now who's the CEO of them of gum gum they have a an interim CEO right now does that Bend plumb iam ya know so bent Ben actually is the CMO yeah so he does all the marketing yeah he's a illustrator Phil yep exactly it's Fisher 

Howard: so now Ophir is gonna be purely on dental yep yeah it's funny April it's funny because with the name gum gum I'm always gonna think serendipitous is gum gum basically gonna be AI but not dental related it's gonna be exactly 

Dr. Kyle Stanley: yeah so Gundam started at was really a computer vision holding company but really started focusing on marketing and so they basically look at every image on the internet and analyze it in real time and can put little ads on top of it and they've really focused on marketing so when we incubated Pearl within gum gum we realized that it really needed to be its own entity so we spun it out you know at the board level and got an independent financing and and so now and so now o fear is gonna be there be with you guys full-time yeah he's been full-time since April ha that is amazingly awesome app so so again what would products on you you talked about them so to put them in order what you're most excited about you're talking about okay so I think that the digital radiography with AI will eventually be in every in every practice within a few years we are in the throes of the FDA right now so we have to wait a little bit so what we're focusing on now what's really been taking off is the insurance products like I told you with resubmission fraud and also automatic claims approval and the other thing is with labs so what we're doing with labs are two things one is called scan clarity score so first it was first was radiography yes and second was in church insurance yes and third is there is intraoral scans and specifically for labs internal scans for life for digital digital internal scanning for labs yeah okay if what we do with that there's two products one is called scan clarity score and what we do is analyze an STL file at the prep tooth level to figure out the quality of the scan and the quality of the margin so did the use retraction cord is the margin of feather edge is it you know really nice blood joints did you capture the contacts you have enough production and then from there we can give you a score zero to a hundred if you want to automatically scan the margin sorry automatically mark the margin we can automatically mark the margin for you so let me give you how this is being used right now in in some of our our lab partners we work with some of the biggest labs that you know all the names that you know let's say they get five thousand scans a day they can take all those scans and Buckett them into scores right let's say eighty to a hundred you know one that's thirty percent thirty two eighty whatever you want to do then they can distribute those scans where they want to if it's at a certain threshold that they're happy with they can automatically mark the margins and send them to design I don't know if you know but many of these labs have like armies of people that all they do all day is mark margins digitally and sometimes they're in close to Rico sometimes are in China sometimes they're here so we can automate a lot of that let's say they want to automatically send an email back to the dentist for twenty percent in lower basically you sent us a crappy impression we can't see the margin what do you want us to do they can automatically have that sense so they don't have to have someone physically call them and then the middle ones we can mark the margin but they may still want a human in the loop that says okay let me just double check this margins okay so automating that we're giving the labs an ability to vet their doctors and say who's skin who's sending me good scans who's sending me bad scans and so now what some of our DSL partners are doing is they're doing the same thing in vetting their doctors not just on you know how much are you selling or how good are you at dentistry but actually at the prep too level how good are your margins are they visible are you gonna have open margins because you're not using a retraction cord good or not or you're prepping too far subgingival and it's really getting down to unbiased vetting of doctors that is um and

Howard:  that is something that I'm sure most dentists don't want on there to exist they don't people don't I mean Dennis they just don't like competition I mean they yeah they go crazy when someone disagrees with them I mean so sometimes you can disagree with the dentist and and he'll you can tell he has difficulty breathing it's like he lives in such a bubble that just someone calling on what he just said and and they're like they're like having a hard time breathing so that would be so second opinion that that's all the x-ray and then the practice intelligence is all the insurance 

Dr. Kyle Stanley: so practice intelligence is actually kind of the backend of second opinion so practice intelligence what we can do is like in my practice we could go through scan all of the radiographs in my practice and allow you to have it be queryable so you could say how many patients do I have that have one to two millimeters of bone loss how many patients do I have that are missing one to three teeth do I need to bring a specialist in do I need to get more training do I need to buy a laser do I need to do marketing for this specific case it really gives you data on what's happening in your practice from the radiographs and so what we're using this now for and what some of the DSOs are using this for is when they're acquiring practices instead of going through and having someone physically look at charts they can go through analyze all the radiographs and it's like 5-10 minutes have that queryable and say is there treatment to do here or is there hasn't been over treatment are they pumping up their numbers to sell it and it's really again just bringing truth into the industry you know appear likes to say we we don't service anybody we're not here for the insurance company we're not here for the DSOs we're not here for the patients when I for the doctor we're just kind of a switch that is bringing truths telling you what's happening in the data and you can do with it what you'd like yeah and and Dennis have a hard time with data because like truth where I got out of school I mean I thought dentistry lasted longer I mean it was basically silver fillings and gold crowns and P FM's and then we replaced all those amalgams with inert plastic composite while believing that in their hands their sacred 

Howard: magical ursula disney hands that their their posterior composites are permanent and the amalgams didn't last very long because you know someone and they use that scientific terms like like they crack the teeth and there's blacks cuz underneath it's like you're a doctor and you say scuzz is it living biofilm do you know the back here because you look at data and you say okay here's here's you know a bunch of studies that say amalgams last on average you know 14 to 28 years and then here's a whole basket of studies saying they last six and a half years and me being a dentist when i would take out m OD amalgam yeaow is because the cost off it needs a full restoration but i all take out mo d composites where there's marsha underneath a you take a number four round burn you're cleaning out old mill and you can tell that the exact because bacteria are alive and so we're filling us half mercury they never put mercury in the multivitamin so i i think it would have to be again Slifer and the other half silver will silver diamond fluoride I'm 10 well Stannis for I mean everything in her Malcolm was antibacterial so I I and then the other thing I didn't like about practice range of software is is it wasn't doing research on the materials were using I could just say okay I put in a filling well it should have been asking what filler what brand name what lotsa filler content yes so that after there's two hundred eleven thousand Americans alive today that other legal license to practice dentistry so that in just like a year they'd have like a million data points on some new product and they can start telling everybody hey this is really good and this one really bad and we're just sitting here letting all this stuff yeah and there's so many whenever 

Dr. Kyle Stanley: we were just at the ATA you know up north last weekend and when we tell people that we have an AI company oh you should do it for this and we're like yeah we can there's just so many opportunities in AI and we're just trying to be really laser beam focus on you know maybe the five things that we're doing but yeah there's there's so many opportunities when you have big data you can start really getting data-driven analysis instead of opinion driven analysis because it's like practice intelligence what we were just talking about if I were to when we bought our practice we went through look through charts said you know okay what does it look like things are happening but had we had something that analyzed all the radiographs and told us exactly what's happening had it queryable by age by how many teeth are missing you know medical histories weird really much better much better information to make an informed decision yeah and you need the big data points for that and

Howard:  like like the insurance like they don't realize that they don't know their customer so that they'll sign up for a PPO that says I'll give you a hundred bucks for a filling and then so then you got to make some decisions maybe in your office where most of all your costs are fixed costs from I mean variable cost of labor lab supplies maybe they'll come and they'll say okay the way you practice dentistry you're gonna spend an hour doing these two fillings and your overhead and so you're gonna do them for a hundred each but your overhead for a filling is honor and ten so you'll lose twenty dollars at our and then they'd have clarity to say okay well then I can't spend our doing - mo decomposes I got to spend a half an hour doing - mo D amalgams or drop this video but what I see in so many dental practices is they're getting paid for a Ford Taurus but they're selling a Cadillac and there's nothing wrong with the Cadillac and there's nothing wrong with a Ford Taurus it's like it's like they could go visit you on a Southwest Airlines for 200 bucks I can also charter a jet here in town for five thousand dollars an hour they're both fine but I need but I don't want to go I don't want to go thinking I'm paying for Southwest Airlines and get billed for a five thousand dollar project and dentists are always there always making a car that's nicer than they're getting paid for because they don't know any of their numbers and if they just had their numbers they'd have clarity to sit here and say you know we're not making a Mercedes Benz so no we're gonna have to say no to this little feature so true it's it's this whole idea –

Dr. Kyle Stanley:  that we spent four years how to be a dentist and then we learn how to do business on our own you know I basically had to kind of train myself and luckily I had a business partner that had already opened a practice and he knew a little bit cuz I really knew nothing and like I said I learned everything from dental down because they don't teach us any of that in dental school yeah and I mean and it's it's got so far to go because like I was having a conversation yesterday with a young Dennis out of school and he seriously believes he should just get an hourly rate so when he's an associate he wouldn't have to worry about any of this stuff which he's just like like he's beyond that he should just be doing what's right for the patient I'm like I mean do they do that with cars do they do that with housing where do they do this for I mean where where does this complete

Howard: I mean my first thought was I'm you know are you is there any chance you're on mushrooms right now I mean can you I mean where where does this this come from and a lot of its just because they don't have any data give them more day so so I have so much faith in this company I mean so uh how is it going

Dr. Kyle Stanley:  it's been really like a whirlwind to be honest with you we have like I said more opportunities than we can take we have been easily in touch with all the biggest company the biggest players biggest ESO biggest insurance companies and you know we're working through a bunch of pilots we've got things in market a bunch of big labs so and every day it's getting better it's just like like you were saying every time we get feedback the brain gets bigger and just keep growing and growing and growing exciting to see III would assume one of these big labs

Howard:  has got to be Glidewell because it's only you throw a rock and hit it from where you're standing are they are they is I mean Jim's always been very very high-tech um is Jim one of your pilot labs working on a slide well glide

Dr. Kyle Stanley:  well they actually have their own artificial intelligence team and we've been in pretty close contact with them they're you know definitely a leader in this they're doing some cool stuff with crown design as well so you know once we analyze the skin and mark the margin then they can take it and automatically design the restoration and start milling so you can really get to this very soon one touch one touch crown 

Howard: Wow very interesting so your second opinion which is the x-ray practice intelligent smart Margaret and what else what else you see going down the road or wood what else has got you excited yeah so then 

Dr. Kyle Stanley: we've got that skin clarity score which is being used both in DSOs and in labs to analyze analyze the scans and you know those are the things that we're focusing on right now it's it's labs it's insurance companies private practice and it's it's DSOs our next stuff that we're working on that we're kind of training in the background is CB CT and also together medical history and dental data points to start making those oral health care systemic health connections and that's really like the holy grail of all of this it's finally having the medical medical industry understand that there may be some type of connection here 

Howard: yeah so I put the whole we spent a lot of time on just pearl pearl pearl um so there are so many things I could talk about but you're an extremely successful cosmetic and implant dentist in Beverly Hills how's that going with our hell Nejad and Stanley how's that how's that going 

Dr. Kyle Stanley: it's good you know our practice is different than many other practices in the sense that we're out of network we see one patient at a time you know we only had two restorative chairs one hygiene chair for three doctors so we are very like slow take our time rubberdam on every case you know every case is guided surgery CT driven and we're sort of Li driven in fun dentistry so it's it's different than many other practices I think and not to say that it's you know better it's just a different business model we are low volume higher fees out of network and that's the way that I love to practice and 

Howard: what could a Beverly Hills cosmetic dentist share back to some dentist who's practicing in bubble-butt Iowa because I am one thing I don't know I'll be blunt about this if you're listening us on iTunes you need to switch over to YouTube he Kyle is gorgeous he's got better looking hair and I always notice that the guys who are super successful in cosmetic dentistry they're not short fat bald guys I mean I mean they're there's almost a look to be a cosmic guys I mean Dorfman you know he could be a doddle I mean you're you you could be a model do you think having to look is mandatory if you're gonna pull this off in Beverly Hills you know it's a good question I think that patients want to see that you take care yourself just like you'll take care of them and we try to keep with our brand which is of course high-end personal you know down-to-earth quality but I think as long as you're doing good work and you can sit and talk to a patient you can be successful and if you had a married with kids yet that's not 

Dr. Kyle Stanley: I'm married I have a two-year-old boy boy okay so let's say your boy is now 21 he's about to be married and he wants to have movie star teeth and he wants veneers where you're gonna prepare them down take an impression and do an indirect technique but is that as you like 

Howard: I would not let my boys my I'd make my boys do ortho Invisalign bleaching and maybe some direct bonding when I got out of school all the cosmetic dentists were just filing everything down and doing 10 crowns or 10 veneers and then would you say well I see these cases 10 years later and they're not pretty they'd say oh well not mine oh you didn't see my case it was some other person but I have these magical hands where my posterior composites and my veneer but what do you think of when someone is young and they file down all the enamel on their front 10 teeth for veneers how do you think that looks 10 years later you know I 

Dr. Kyle Stanley: my first influence into cosmetic dentistry was through Pascal money and if you know Pascal he's very appreciative of natural dentition we're always trying to recreate natural dentition or trying to save every little enamel rod that we can and so in my case it was my son I would have him go through orthognathic surgery and ortho with Tad's and palpable expanders and everything before we touched it - and that's how it is here you know so we have patients that come in and want to grind everything down and you know do something and we say hey you know we would love if you can just do a little Invisalign then we can just do let's say one veneer two veneers and bonding on your canine or something so yeah we try to do as minimally invasive as possible because I wouldn't want someone to touch my teeth if they don't have to especially if there's another option now sometimes there's no option you know the teacher keep it in the wrong position then the patient says I won't do ortho and the education really wants to do it we try to do as minimally invasive as possible but there's always that you know that I don't know seesaw jigsaw no not just of what's better yet

Howard:  Pascal magnae D MD ph.d born in Switzerland I've always told that as you know I mean so when an American says that United States the greatest country in the world they've almost never traveled I mean basically just because when you go there exactly right when you go to Switzerland Denmark Finland Norway Tokyo Japan I mean if if colwich Kansas is really the greatest country you've ever seen in your life you need to make friends with a pilot but but I just love the dentists in Switzerland Norway Finland I mean I mean look at the great companies that came out of Copenhagen Denmark and you know three four one you look at Helsinki Finland coming up with Mecca and Mecca but the pasco magnet calls him say he's considered to be the father of biometric dentistry yeah biomedic biomimetic dentistry there's a lot of people listening that I've never heard of that wood is biomimetic dentistry and why is Pascal considered the father of that

Dr. Kyle Stanley: yeah Pascal really brought in dentin bonding to the world so that we can do more minimally invasive things and biomimetic dentistry is you know by in mimetic it's mimicking nature so it's trying to not use materials that are too dense not use materials that don't behave like natural teeth you know natural teeth Bend and and move and behave and oftentimes we say that's but the hardest thing we can't let's put zirconia on the teeth because it's strong that's not natural teeth are so it's bringing bonding protocols in with knowledge of unnatural materials that mimic nature and bringing those together to be as natural as possible and and

Howard:  how was that I'm taking off would you say in the United States well how was that going it's only growing because 

Dr. Kyle Stanley: I think you had the 90s where you had cosmetic dentistry and everyone just wanted like you said to just prep everything right and now I think 20 years later people are realizing that you know we should try to be as minimally invasive as possible so we have a lot of patients that come in asking you know how much are you prepping what materials are using and they know a lot I think the Internet has helped patients be very smart about what they what they know and what they want and so we have a lot of patients coming to us specifically because especially my partner managed odd that's what that's what he does and you know he's he's Pascal's dentist

Howard:  oh is that right yeah so um so in your in your practice what percent of you is when you say implant in cosmetic dentistry is that more cosmetic is a more implant really for me at our practice I do everything that's surgically driven or that involves implant so whether it's a placement implant restoration or whether it's sedation or wisdom teeth or sinus with some bone grafts I kind of focus more on the implant side of it then and a traditional restorative dentistry site so that's when that's when my partner is manage odd and Mark he'll come in now are you placing implants are more restoring I am yes I'm placing as well so I did a full time implant nc specialty in brazil which doesn't really exist here so I do start to finish implants which is I think where the industry is going but you know more GPS place implants than specialists last year there were more implants placed by GPS so in the United States yeah so when you when you go around the world they don't really have this specialty thing like like like 9,000 of the 18,000 orthodontists are all in this one country United States and and 

Howard: and when you look at these publicly traded implant companies like say straumann when they're you know I always say if the company goes public they sell dentistry by the share because if you buy share they have to send you their their 10k annual report or 10-q quarterly and how they talk to Wall Street is very different than how their reps are talking to you at the seize a meeting but what I like about strongman's report is they're saying you know in Korea and Germany three out of four dentists surgically placed a implant last year in the United States that means we have 75 per I mean 75 percent of the dentist didn't place an implant last month I mean no and Wall Street's look into this up girl so why do you think in Brazil Germany Korea three out of four dentists place an implant last month and in America I mean we're I mean every almost every country behind in that

Dr. Kyle Stanley:  I think that it's this whole notion of this referral based system which can work if every person on the team is really really really in good contact but it can be a problem you know the I because I do both sides I train both specialists and I trained or sort of doctors so I have specialists that complain to me you know I place the perfect implant and the restored doctor didn't know what they're doing and now the impact failed and then I had the opposite where I have restorative doctors telling me you know the specialists place the implant in the wrong position and now I have a hard time or storing it when I tell people is if you place the implant yourself you're the one that has to deal with it so you're gonna do it really well and you're gonna make sure that it's at the correct depth si has a good emergence profile it's a correct position where you can have a screw routine crowd you're gonna use the proper materials so that you don't have the implant fail because you have to deal with it when something happens and I think that will catch up eventually but that these other these other countries are you know better at us and some things for sure that was why I went to Brazil you know I mean it's no it's no wonder why dr. Branton mark was teaching in Brazil at the time was because he was training some of these top people and when I was in dental school and I was reading articles so many things I was reading so many articles were coming from Brazil so when I talked to dr. Meunier and I said you know I want to learn implants he said all right you got to go to Brazil you gotta learn Brazilian Portuguese and and go study in Brazil that's what I did 

Howard:yeah when I would try to get on when I started this podcast and I trying to get a brand mark to come on the show and at that time I wasn't feeling very well but he was in Brazil and we're in a city called bauru so it's more like in the south and a little bit more inwards ha but I thought he was going back and forth yeah but what would it what an amazing man where I mean he was still doing his his art his trade his craft held the very end you know his his son is that dennah as an orthopedic surgeon in San Fran I didn't know that yeah I've been trying to get him on the show and I need to work harder on that because his father's really an orthopedic surgeon right yeah serendipitously found that you can't take the screws out of the rabbit's tibia right yeah I mean they they were or they're a family of orthopedic surgeons and is very hard to do hip transplant research on rats when you could just put little spindles into their mandible and so they got into teeth just by a shortcut of doing our hips so um that is uh yeah yes there's so many stories I was trying to think of I had another a question I want to ask you I'm so are you implant agnostic well we talk about the culture and in America we have this culture of a referral based system okay and the other countries done so we're fighting it's at in the education system I mean you've had some amazing honors by like Seattle study club things out but in America the dentists are telling me they're sending me emails a hard to get on time.com and say well I got to pick my implant system first because where I'm at in North Dakota all the trainings provided by the company so I kind of got a pic which implant I'm gonna use before I start doing the training because most of the training is company sponsored company specific yeah so they look at a guy like you they just say give me the short list give me the name of the implant first because that will determine if they have a bunch of training where my tribe is yeah you know it's a good question I would say that this short answer is any implant system can work if it has the correct components for both the restorative side and the surgical side and I have found that a lot of companies don't have both sides so you may say oh I have a great implant design but then they don't have time a SACEUR they don't have custom abutments or they don't have screw routine options I was just restoring a case from like a major general into a company and they didn't have time a sis and I was like you know tie bases that it's crazy that you came out with this without tie basis so explain what a tie basis so a tie base is on top of an implant if you're having a custom zirconia abutment it's what you use to attach the zirconia abutment to the implant because we now like to have titanium titanium connections and then a zirconium bomb and on top of that and they didn't have that so I had to either do full contour titanium or full concert zirconia which you know neither one is my preference so you know it's kind of like if you put a screw into the jaw it's probably gonna integrate but then the reason why I use certain companies is because there were sort of options allow me to connect about the surgical and the restorative aspect the problem is that oftentimes people are teaching like you were saying they're teaching company protocols instead of implant protocols and I know that and you know cuz cuz I speak for companies as well I know that you have to teach they have to know how much torque is on each this company versus this company but many of speakers that I've seen don't know just the general implant protocols and I think that's that's what's important now I would love to be more agnostic and I guess I am but it it's difficult to make a living that way so what is your short listing yeah so for me it's noble vowel care and am I asked those are the two that that I've used that can I can get good results with simple yeah no they don't by dense flight and my guess is ohm identifying yeah okay yeah so no Bell is Danaher is no longer gonna be dinner right yes Danaher is spinning off its dental division that's right and they have a clever name what do you remember the name on it just told me what it was I forgot like and off it's gonna be called like dental systems or something like that I really here let me I really like the name yeah they're spinning out there their dental division which is a little bio care implant erect I think they have some ortho products as well yeah and then K Bakr so it is gonna be a Vista in Vista Holdings in Vista that's right yeah so the so the the New York Stock Exchange symbol will be in VST but let's see again I've seen this rodeo so when I got out of school in 87 there was this other big huge company Siemens it's like the Europe's largest Proctor and Gamble Company the CEO said you know we're two overweighted in healthcare and they had this little dental division company called serac and they were gonna spin that out of Siemens and so when they spun that out you know the the building didn't change employees didn't change but the parent company changed and so now here it is three decades later so instead of having little kids I got little grandkids and now this big monster Danaher saying you know what we got too much health care stuff and we're over weighted we want to be a more other technology so they're just spinning out the whole dental division innovation Vista and and usually it's a good thing because would you want to have a mom and dad who didn't want you when when Siemens spun off there what's it called tip of my tongue they has serac a Serena Sirona one that went seven spun out Sirona Sirona flourished and blossomed because they didn't have these parents that were looking at them like you're not the child I wanted I wanted another high-tech child and so I think all those companies are gonna do so much better well yes it allows them to focus on what they're focused on you're exactly right it allows them to say we're dental company we're gonna focus on doing dental things and it was the same when we did the same thing with pearl you know we said we're gonna only focus on dental and I can do anything based on marketing anymore and well people have no people people don't think about how big dentistry is I mean there's eight billion people and they all have a mouth and United States spends a hundred and ten billion dollars a year in dentistry but there's actually two million dentists and the globe spends half a trillion on dentistry half a trillion a year and it's only gonna go up higher and higher because it's a luxury good meaning the more money when people go for making $1 a day to ten dollars a day they're gonna spend more money so then I want to ask you we went over the hour I'm sure I should be a gentleman and let you go I but I'm this we were talking about Danaher spinning off their dental division and and Beast this week is gonna be another big huge IPO in dentistry with a smiles direct Club I don't think that's an orthodontist who hasn't had at least one ulcer over this how do you hear a Beverly Hills guy you're AI your your your man of the world how do you see smiles direct club how does your brain wrap around this I think that smile direct club is an inevitable thing I think that more and more patients are wanting to take their health care into their own hands this may not be the right way to do it because I think that you're gonna have you're gonna have problems you know it's just like anything you're gonna have cases that are gonna work because it was an easy case and the teeth in the middle of the bone but then you're gonna have these nightmare cases and I know that some of our colleagues already seen these you know teeth being moved out of bone and patients with pareo that are now trying to move teeth and then losing teeth so I you know I'm not mad at smile direct Club because I think it's a great business I think that for a certain sector of the the patient base it's gonna work but I think you're gonna have some some casualties in there some teeth casualties so I think they're gonna do this kind of thing I think they're gonna you know they're going up right now 

Dr. Kyle Stanley: I think they'll have some casualties will come down they'll figure it out they may bring a dentist into the loop a little more but it so it's a great way to get patients to to care about their teeth I mean even for me even them just having marketing out there I think helps dentistry showing like hey you can change your smile and it can help you it can get you a better job it can allow you to start dating so I'm uh I'm on the fence I think from a business standpoint great business I think that there's still they need to bring a dentist in somehow a little bit me with a little more oversight again 

Howard: I've seen this rodeo before I remember back in the 80s when I said what was the name of that company it was they were they were selling the bleaching it was reaching homecare on me international out of out of Arkansas and it was this bleaching kit for nine hundred dollars for six bottles and we were all buying these these bought these six bottles for 900 bucks and we were charging 250 and arch so five hundred dollars a mouth and we had this amazing bleaching company and then crest came out with fifty dollars for and and they showed that competition is good for the industry because we were charging way too much and I notice a smile is very club you know they have five offices out here but when they talk to my orthodontist friends out here smiles dart club screen it gets rid of they they don't do eighty percent of their cases they they want class 1 molar class one canine non-growing adults five millimeter so the orthodontist that thinking hope growth and abundance my god they're down there with cookies and ice cream and cakes trying to get the but the reason I thought a lot of opinion on is because you know they're so mister Wall Street as a teller dentistry play and you're an AI so the AI and Teller dentistry is gonna get bigger and bigger and bigger do you see smiles dirt club is an AI tella dentistry play long-term yeah no for sure I think that you know I don't know the process that they have to go through to get to become a patient but I think there's a lot of things that I do now where you know I'm calling patients I was just in Orlando a few weeks ago and I was talking to a patient on the phone I was looking at their CT scan that you know my my office had sent me and I'm looking at it there and I was basically you know diagnosing doing treatment while I was getting ready to lecture and it's nice for us it's nice to not have to be in the practice every day to do our to do our work and we can plan I do as much planning as I can outside of the practice outside of the chair so that I can do as little planning inside the chair when I'm in the chair for me I'm trying to execute as much as possible and try to do all of my planning outside because like you know the chairs are expensive time the chairs when the patients are nervous and bleeding and numb it's dated so anything that I can do outside I think doing you know like you're saying with teller dentistry I think it's a good idea so

Dr. Kyle Stanley:  I think that it's non-direct Club will get it they'll get it and they'll they'll have some problems like they already have but they will go get it and it'll help like you said a certain sector of the community and everyone else will still go to orthodontist I think you know orthodontists are worried that they're not gonna have patients they said the same thing at the Invisalign you know in the in the late 90s I think it was or early 2000s and they said oh my gosh we're not not going to have any patients now they have just as many patients now not more yeah I just say my hours and I say well at the end of the day do you go home and you're bored because you're not tired because you really don't work yes in your office and do checks all day and the girls do all their work they go no madam I go home I'm beat up I'm exhausted I'm like okay so you're working and that yeah so last question I know we're in double trouble every time we've had Chrisman coachmen on the show before an amazing guy you worked with him a lot in this digital smile design and you started you guys are doing the oral facial Club yeah that's right that's right so what so just tell me I give us update on Kristen Carson who by the way you I I think you and Christian need to work together because there's like what 30 dentists and his family tree and your dad's a dentist your brother and yeah don't you think you should use that AI to find the dental genes so we can you know so house Christian coachman and what's the oral facial Club Christian's awesome you know we talk on almost a daily basis we've been lucky to have him as my third mentor it's funny what you said about the difference in American dentistry and international dentistry and all three of my mentors so I have Pascal money a sausage Ivanovitch and the Christian coachman none of them are 

Dr. Kyle Stanley: American so that's interesting how that happens but Christian and I met in Indonesia a few years ago and we're lecturing together I had been a huge fan of his he didn't know who I was of course and I showed something that he liked introducing plastic surgery into dentistry and we started hitting it off and then he was like wait why do you speak Portuguese and we've been just really great friends ever since and so now what we're doing is bringing together other aspects of Medicine with dentistry so not just thinking about okay 

Dr. Kyle Stanley: I'm gonna treat your your your teeth and your gums now we're talking about Howard: lips and cheeks and noses and plastic surgery and dermatology and orthopedics a North Namek surgery and ortho and everybody working together to have and what we call an oral facial team you know I'm gonna look at you and I may not know how to do everything but I'm gonna know what's available so that I can make the correct referral to an ortho netic surgeon or to a plastic surgeon okay and we think this is the future of Dentistry as well and you said you're you're three mentors or Pascal Christian and Sasha Giovanna mix so 

Dr. Kyle Stanley: Sasha Giovanna Beck is for that jo v a n o VI C so do one more time jo v jo v and it's harder and I'm not looking at it and pull up its Khan here and make sure that I'm putting it in right saying it correctly Sashi okay Jo V ay n o v IC and Sasha is you know really famous Perry Adonis one of the guys that one of the really leading experts and guided bone regeneration he was like on the original team 20 years ago that was doing research figuring out what materials work what materials don't for guide a bone regeneration both vertical horizontal I mean just an amazing guy he's got a great Center in Santa Monica California called the guide Center where we do a bunch of courses together and Sasha was introduced to me by Pascal so it's interesting how that works you know one mentor introduces you to the next mentor and because of the personal touch Sasha said yeah sure come and hang out at my practice we became great friends he taught me so so much about surgery and about life so I'm just really indebted to those three guys that is amazing and how many and 

Howrad: what would you invent a year three a Pascal Sasha they're not American what is that what does that tell you 

Dr. Kyle Stanley: yeah I think I always gravitated towards non-americans for some reason I always loved traveling and I always liked learning different languages different cultures and with dentistry I think that Americans have a lot to learn from the international community you know when you go to some of these international meetings you see some of the most amazing surgery the most amazing esthetics the most amazing research and I think like you said Americans need to realize that there's other things out there and we do some things very well and there's something that we do better than other countries and there's some things that other countries do better than us and just to get out there to learn from the international community as well and

Howard:  I'll just end on this one thing but - keeping it real I mean we call this dentistry on center I love dentists but some are more challenging to love than others and they know at the end of World War two about 20 countries started a national health insurance still yeah and that was way back before 1950 and this is 20/20 so then about a decade ago a couple of countries knew the new kids on the block Taiwan Hong Kong Singapore they said well we're gonna do some type of national deal so the so they had 20 they had over 50 years of data to study of all the country's healthcare systems and every one of those countries Singapore Taiwan in Hong Kong when asked well what did you learn from the Americans they said oh the Americans only teach you what not to do and you tell that to an American and they're just like you know some what do you anti-american and I have to tell you that my four boys they're all raised now and they've made my four boys to turn into five nine kids they say that the greatest gift dad gave them is dragging them along to 50 different countries when I was lecturing I mean they've been dr. Brazil Cambodia and the and they just look back and they say you know what in fact two of my patients anyway that I had some patients that started this really big company in Phoenix Arizona in their gazillionaires and I said why you how did you think about that and they said well we were we were military brats so every two years we were in a different going somewhere else and we so we would lay in bed thinking well what's different not good or bad right or wrong with us what's very different between this country and the last one and the next one they said you know what before we were 18 we had doctorates and economics and history and didn't even know it and after they had lived in four or five different countries they said you know okay and it's so funny because lecturing at fifty different country and I've been saying fifty for ten years I don't know how many is now but maybe more because I've done fifty you get to see when you get to see dentistry played out 50 different ways and you've been doing it for three decades it's kind of what comes together all starts making sense and all that's making sense

Dr. Kyle Stanley: but also nice to hear that because I I drag my kid along everywhere you know he's two and a half he's been on 27 flights yeah I hope he'll thank me - and how old is he he's two and a half okay here's the trick this is I'll make this whole podcast work you go when you're taking them on all these places and they're being what a two-year olds you do all you don't you play it their mind you 

Howard:no and then they look around and they so they always compared themselves to everybody in the room little did they know everybody in the room was a dentist and a doctor and older and mature and they just always start comparing themselves to everyone in the room not that other parents I see em all time well I know you're tired I know you I know you know there's five reasons to keep doing what you're doing and I would say well no one else is doing that's right yeah but hey gosh darn em congratulations on on throwing your surfboard into the next big wave of not just dentistry but for the fortune 500 last thing I want apart on is when I was born the in 62 the average S&P; 500 company was over 60 years old and now when I'm almost 60 years old the average age of a fortune 500 company is under 20 and right now artificial intelligence in ten to twenty in in ten to twenty years the average age the S&P; 500 is only gonna be ten years because these companies who get religious just like the companies who got religious on digital implant folk I mean on internet strategies well I mean look at Fang Facebook Apple Netflix Google Microsoft what do they all have in common they got the digital revolution and those Fang socks are about half the market cap and everybody knows that now but they didn't know what 20 years ago well everybody who gets prioritized on AI Big Data Internet of Things elastic cloud computing they're gonna drive the average age of the SMB 500 to under 10 years old because the the people that have that competitive advantage are gonna destroy everyone still doing accounting on QuickBooks Pro so yay I get ran over from behind thank you so much for coming on the show today thanks Aaron's been a pleasure thanks for having me 


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