EPISODE 52: DR. DANIEL UZBELGER FELDMAN TALKING ABOUT TELEDENTISTRY IN LATAM

Episode’s transcript

Julio Martinez: 0:00

Welcome to the Latin MedTech Leaders podcast, a conversation with MedTech leaders who have succeeded or plan to succeed in Latin America. Please subscribe on your favorite podcasting platform. Apple Podcast, Spotify, Google Podcast. Amazon Music is teacher Tune in iHeart Radio, Pandora or leisure , er . Welcome to the Alta MedTech Leaders Podcast. Today our guest is Dr. Daniel Berger Mann , director of the Denist in Espanol. Dr. Berger Felman is the first Hispanic dentist adopting Teledentistry and the first dentist implementing it in Ohio, Pennsylvania, Minnesota, and South Dakota. Since July, 2018, Daniel has been grant granted with Cheryl Awards on his patented cinematic radiography and lower the Asian dose Neo Imaging breakthrough. In 2014, this concept received the medical device and diagnostic industry there to design Reader's Choice Award. He is the 2013 William h Rollings Award recipient to recognize and individual with an outstanding body of research in the field of dental radiology. With 25 years of experience, he's introducing and expanding, pioneering teledentistry and dental aligners services. Daniel, it's great to have you here today. Welcome to the show.

Daniel Uzbelger Feldman: 1:30

Thank you very much. It is a pleasure to be here.

Julio Martinez: 1:32

Awesome, Daniel. So let's get started with a quick introduction about your relationship with Latin America on a personal and professional level. Where are you up to these days in terms of Latin America and how do you get involved with the region?

Daniel Uzbelger Feldman: 1:47

Yes, I saw that there is a need for a better dental , uh, care in our countries. When I say our countries, I am , uh, referring to , uh, all Central South America and also Spain. So there is a very high , uh, decay index, periodontal disease, dental health disparities, and also there is a lack of dentists , uh, per population. So all this is telling me that , uh, we need to do something about it and , uh, there is nothing , uh, better right now than introducing Teledentistry in our countries in order , uh, to , uh, solve and help alleviating these problems.

Julio Martinez: 2:31

Fantastic.

Daniel Uzbelger Feldman: 2:32

So , uh, we have been working , uh, very hard trying to get strategic partnerships with , uh, large companies and also small companies in , uh, our countries in order to , uh, provide these , uh, innovative tele dentistry

Julio Martinez: 2:50

Services. Excellent. So you are from Venezuela, right? And you left the country what year?

Daniel Uzbelger Feldman: 2:56

In , uh, 2003. We , we had an opportunity to , uh, work as a faculty at the department of , uh, endo Ontology at Temple University School of Dentistry in Philadelphia, Pennsylvania. This is the root Canals department. So I am still , um, affiliated with them and , uh, we do a research on a yearly basis. And , uh, thanks to this opportunity, I was able to , uh, get my dental license , uh, not only in Pennsylvania, but uh , also later on in , uh, different states. And then in once when I was like switching jobs , uh, I got LinkedIn notification for an interview from a recruiter, and this was a telehealth company, so I was, you know, very curious about the opportunity. And then , uh, after the interview, they told me that they were looking actually for physicians, so they thought that I was a physician. I said , no , I am a dentist. This was in September, 2017. And then I asked them, Hey, is there any company that is, you know, needs dentists for doing a tele dentist ? We say, well, I am not aware of any. And then just one year later I got a contact also by LinkedIn through , uh, from a , this time from a tele history company. And then I say , immediately, yes, because I knew what does , you know, what was , uh, coming ? And then I started working with them. I was one of the first dentists they recruited, and then I helped them organizing the states of Pennsylvania, Ohio, South Dakota, and in Nebraska and also Minnesota. So, and then , uh, I saw the pain in our, in here, in the United States regarding to our Hispanic community , because I noticed that 80% of , uh, our Hispanic community here, they lack of access to dental care when compared to other groups. So that pain, I , I felt the pain in the bottom of my heart. And I had the initiative creating the tele , which is the Spanish speaking version of the tele dentist in order to address the , uh, Hispanics , uh, population in our language in Spanish. So we prepared the website in Spanish of los , we created the Facebook, Twitter, LinkedIn , and Instagram accounts. And then we started looking at what was going on in our countries in Latin America, central America, you know, south America and Spain. And we saw actually more need than here because of the socioeconomic , uh, situations of our countries . So, and then we had the initiative of , uh, doing the expansion of , uh, the tele dentists , or in this case Los tele autologus to our countries. And now we are working very hard , uh, in order to achieve this for

Julio Martinez: 6:08

Fantastic story. Uh , Danielle , so I understand , um, you have some slides , uh, to present , uh, today to talk about that will facilitate the discussion. Um,

Daniel Uzbelger Feldman: 6:22

Sure. I'll be more than happy to share them with you. Lemme go here. So the first slide , uh, explains the market size. The South and Central America tele dentistry market is expected to reach 77 , uh, million dollars in 2027, from $21 million in 2019. And this market is , uh, growing in a 15.7% from 2020 to 2027. It is just , uh, a slight , uh, lower this growth when compared to the global tele three market, which is , uh, 17.1% of , uh, growth. So , uh, the second slide talks a little bit about why the market in our countries is so in need of these services, is because if we look at the caries index, we can see that in our countries patients, they have more cavities when compared to the United States patients. So what happens when you have more cavities? When you have more cavities, your teeth can break, you can have a nerve exposure, you can have a lot of pain, and you can have a swelling in the face. So actually this is the most , uh, common reason for patients for calling the dentist or for visiting the dentist. So if we see the map, the , uh, caries index in our countries is higher when compared to the index in , uh, the United States. And what happens when the caries index is higher? Well, patients call the dentist more. So this is , uh, direct proportional ratio, and this is why we believe that there is a , a large need of teledentistry in our countries. And in addition to the caries index, there is another very interesting , uh, map which talks about periodontal disease. So periodontal disease is when you have problems in the gums, when your gums are bleeding, when you have a gums inflammation or a gums infection, or your teeth are loose. So, and we also discovered that if there is a ratio there, that if the higher the cases of periodontitis, which is, you know, higher in our countries when compared to the United States, the more , uh, dental need is , uh, required for the patient . So there is a , a huge need because of this periodontal disease. Also, there is another map here, which shows the number of dentists per population number, which means that , uh, it is ideal for a country to have, you know, the higher the number of dentists per population, the better. So as for instance, like here in the United States, but unfortunately in our countries, this ratio is not the same. So in this case, it is inversely proportional because the number of dentists is lower than that means that there are more dental emergencies because there is a lack of dentists. There is another very interesting map , which shows the population health disparities , uh, that happens a lot here in the United States. When I gave the example of the 80% of Hispanics that they lack , uh, of access to dental care, I'm talking about 41 million of Hispanics here in this country. Well, very similar situations in our countries, and in this case, the , uh, higher the disparities , uh, the more dental emergencies we will have. Uh , the good news is that some efforts have been made by the Pan-American Health Organization and also the World Health Organization, as we can see in the other slide, because they are promoting the use of cost effective and simple technologies for helping increasing the access to dental care. So , uh, there is a interesting work is a thesis , uh, made last year. And , uh, this , uh, work shows how , uh, our countries, they have been trying to catch up with this situation, and they believe that TELEDENTISTRY is one of the solutions for this problem . For instance, the first country that develop a policy for implementing Teledentistry was Brazil. That was done , uh, actually , uh, in March last year , so over one year ago. Right. But they were the pioneers on , uh, implementing teledentistry , uh, policies. So, which means a little , you know, to make it official for the country. Chile was the second , uh, country doing , uh, the same, eh , they did it , uh, in , uh, April last year. Then on May, Colombia and Peru, they follow creating also policies , uh, promoting the use of Teledentistry in their countries. And then Argentina was the last one following this study. So the way they did it is first they made an assessment of the impact of the COVID-19 in their countries, and then they created resources and guidelines with , you know, from evidence in order to prevent the spread of COVID-19. They provide all this information to the Ministry of Health, and then they met together with dental representatives, universities, and also federations. And finally they came out with these , uh, policies in order to provide the recommendations and guidelines to prevent and reduce the risk of , uh, COVID-19 during the reopening. And this of course includes , uh, teledentistry as one of the main policies. So this is a good news. Uh , our countries, they have the same concern that we have. So, and I think that the availability of these policies in each country will facilitate the introduction of a tele industry.

Julio Martinez: 12:32

Hmm . That's really, really encouraging for the industry in Latin America. That's great news. Uh, Daniel , so , um, couple questions. One is , uh, what do you think , uh, the ratio of , uh, dentists versus the general population is so low in Latin America? What's happening? Why is it that we don't have more dentists?

Daniel Uzbelger Feldman: 12:54

It is very hard to say. Maybe it's the lack of enough , uh, dental schools or dental programs. I think that could be one of the reasons when compared to the United States.

Julio Martinez: 13:04

Wow. And they are also very expensive. I understand going to dental school is , uh,

Daniel Uzbelger Feldman: 13:09

Yes, it is. But in some of , of our countries, the , uh, dental schools are public schools. That was the case of my particular school in Venezuela. So , uh, the cost of the school was, you know, very , uh, accessible and affordable for everybody . Um , the only thing is the materials and the instruments that you need to buy . So that's expensive. And if you don't have resources, then it could be a little bit difficult for you to , uh, pursue a dental education.

Julio Martinez: 13:40

That's a barrier, yeah. In itself . Hmm . Okay. And , um, the other question I have is what's a business model or the patient journey in , uh, teledentistry setup ? In other words, when I first encountered this industry, I didn't know it existed until I connected with you on LinkedIn and you and I had our initial prerecording meeting. I learned about the topic and thanks to you, and I was fascinated by the possibility. But I'm curious about how can a a , a patient get treated if dentistry is associated with the real and the actual manual labor involved in treating a caries or , or something, a cavity. I'm sorry.

Daniel Uzbelger Feldman: 14:26

Right. That's a very good question. And actually it's very interesting that, you know , uh, teledentistry is one of the newest, the most recent specialties of telemedicine, as you know, telemedicine. Uh , it has several specialties at this point, including , uh, teledermatology. For instance, if you have like , uh, some problem in the skin, you can show the doctors through the camera and the doctor can make an assessment on the recommendations to you. Also, you know, telemedicine for children, there are many, many specialties. There is one which is called telegenic , you know, that I don't know how they do <laugh> , but the bottom line is that Teledentistry, the patient experience follows the same guidelines that the other telemedicine , uh, specialties do. The first step is the patient, they need to , uh, log in into the portal with the email, and then a password. Once they access the portal, they start onboarding through their medical history and the dental history, and the reason for the consultation. Once we put all that, which includes allergies and medications that they are currently taking, then they go to the pharmacy part in which they will include the address of the pharmacy, which is closer to their location in case we need to prescribe , uh, medications. And finally, they will make a payment through a very secure , uh, rapid, you know, portal. And once that they do all this together, that takes only a few minutes then , and they will go to the waiting room. Um , one of the tele dentists that we have, doctors in practically every single state here in the US will see the patient and the patient should be able to show them through the camera in what we call a synchronous consultation, which is in real time should be able to provide , uh, the information that the dentists need in addition to the , uh, review of the medical history and all these regular dental , uh, steps that we do every day when we see patients. And then we will provide the patient with the best recommendations and advice regarding to the next steps if the patient needs medications, excluding narcotics, of course, so we can prescribe antibiotics or medications for pain. Also, we can , uh, help the , uh, patient scheduling an appointment with a dentist nearby his or her location, because for us, it is very important for the patient to follow up with a dentist. We can do that next day or next two days. So it's very , uh, we have A-A-C-S-R , like a customer service representative who is very , uh, an expert , uh, scaling appointment with dentists. And also we make sure that the dentists accept the insurance if the patient has insurance. So all these together made the Asian experience with us, which is also HIPAA compliant. As you know , privacy and security is very important in our country , and it is not the same when you, you know, talk with your dentist through WhatsApp or you know, or messenger when, where you don't have a medical history, you don't have any , uh, pharmacy address, or you don't have any privacy and security. So it is , uh, this is why we always love to promote our platform because it's like a virtual clinic for you.

Julio Martinez: 18:16

So I , I will say, correct me if I'm wrong, that the majority of consultations that you guys see are for emergency type of , uh, questions, right? Somebody who is in pain and they need a quick fix, a quick medication and the CVS or Walgreens in the corner, and they can manage the pain for one or two or three days until they see an actual physical dentist, right?

Daniel Uzbelger Feldman: 18:41

Correct. The most common issues are swelling in the face or a , a toothache or bleeding gums or gums, inflammation. Lots of patient with TMJ problems. That's the , uh, articulation or the joint. Also patients that they cracked the tooth or you know, their kid was playing and then they hit the tooth and the the tooth is loose and the mom or the dad , they don't know what to do. Patients with dentures that the denture broke off. They don't know how to, you know, what to do. In the meantime, they get the appointment with the dentist. So, okay.

Julio Martinez: 19:19

That on top of the aligners, right, that you guys are now starting to promote or to address that issue of fixing the , uh, occlusion,

Daniel Uzbelger Feldman: 19:30

Right? Correct. The , uh, two thirds of Americans, they have a mal occlusion. So, and some of them, they either don't have the money to pay expensive braces or aag or maybe they don't have the time to go to the dentist several times to several visits in order to get the alleg . So the good news is that the tele dentistry innovation now allows you to get these invisible aligners and then you from home. So you just take them all at home and then you send them all to the company, and then the , uh, company will of course make an assessment where or not you are eligible for the ALAG nurse , and your case is a case that is , uh, simple or, you know, moderate because severe cases should go to the orthodont, as you can imagine. And then if the case, after doing all these , uh, prescreening and screening and case analysis, it goes to our clinical team and then they make a 3D treatment plan, which is shared with the patient. And then finally it is approved by another dentist expert with expertise in dental aligners . And once we do this , then we start printing the models and manufacturing the aligners . So one , the patients, they just put it at home and yeah .

Julio Martinez: 21:00

Very nice. So going back to Latin America, so the idea is to enter the region with these two services, the regular dentistry consultations, and mostly emergency and then the aligners, right?

Daniel Uzbelger Feldman: 21:19

Correct. This is a good marriage, and again, thanks to Teledentistry, doing aligners at home is feasible.

Julio Martinez: 21:28

All right . Is there anybody else in Latin America doing aligners? I haven't heard about anything yet, at least in Columbia . I haven't.

Daniel Uzbelger Feldman: 21:34

In Mexico, there are three companies doing aligners in Brazil. There are a couple also, but they are now trying to expand to , uh, other countries. So , uh, the dental line market in , uh, our countries is still very , uh, you know , uh, is is very green

Julio Martinez: 21:53

Just starting

Daniel Uzbelger Feldman: 21:55

It . It is just starting, correct. Yeah.

Julio Martinez: 21:58

Wow. Same as selling dentistry, because having seen anything yet in Columbia at least,

Daniel Uzbelger Feldman: 22:03

Yes, in tele dentistry , there is no major order than , you know, some clinics, they have it, some private dentists, they may have it, and , but just for offering the service to their own patients, but not at the national level as we do here in the United States. As you know, the tele dentist is , we are a nationwide level company and we have a partner with a very prestigious companies like Anthem Blue Cross, blue Shield, Cigna with more than 16 million of subscribers. So if one of them has a problem, as soon as they enter into the Cigna website, they will see the link for the tele and then just click. And then we are there for, you know, providing the best service to the patients. Also, we, they made , you know, a strategic alliances with Proctor and Gamble and with several or very large companies.

Julio Martinez: 23:00

I'm very impressed , uh, with, with the possibilities in Latin America. Congratulations. Yeah,

Daniel Uzbelger Feldman: 23:05

Thanks. Exactly. We just need to do the same, you know, copy and paste, that's all. Yeah.

Julio Martinez: 23:11

Replicate the model. Well, let's talk about the model and let's talk about the regulations. You and I had this conversation in the prerecording meeting that you and I had. And would it be possible based on the current regulation to do something similar like in the us like a nationwide virtual only clinic or the regulation is still kind of , uh, protecting the brick and mortar clinics?

Daniel Uzbelger Feldman: 23:34

Yes. Well, actually the good thing about the way we do teledentistry here in the United States is that we're the number one , uh, referrals to dentists now, because as you know, after we, or at the end of the consultation, we always refer the patient to the dentist. So if this is a patient that who had like dental phobia or that didn't visit the dentist in the last 10 years, we encourage the patient to visit the dentist and we help them actually scaling the appointment with a dentist. So we will do the same. We will be a great benefit for dental clinics because they will start getting patients from a new source of referrals that they never had before. This will be great for them because what we don't want Julio, is we don't want the patients to go to the emergency room or going to hospitals for dental care because there are no dentists in the emergency rooms. So we want the patients to be seen and treated by dentists only. So that's our main goal. So I believe that doing this to the masses in , uh, our countries is feasible due to the , uh, regulations that I mentioned before. They have been approved in , uh, all the countries due to the COVID-19 .

Julio Martinez: 24:52

Fantastic. So , um, dentists in Latin America should fear for something like this. It is just the natural advancement of technology and it will actually benefit them. I mean, because at the beginning, every new breakthrough innovation is seen as a threat to the establishment. Then if you really look at it, the benefits outweigh the potential damage that will perceive that will happen to them. 'cause they're gonna get more referrals, referrals that they are not getting today. So it's really about patients receiving better care, as you correctly said, they don't have to go to an emergency room that is not prepared for dental emergencies. It's not staffed by professional because they don't have a , a dentist 24 7 there. Yeah. So what country Daniel is right now in your priority list? Where do you wanna see this happening tomorrow in Latin America?

Daniel Uzbelger Feldman: 25:49

Yes. We think that countries like , uh, Chile U why Columbia , Peru, Costa Rica and Panama should be , uh, very well prepared for getting teledentistry and also of course Brazil and Mexico. I will add. So I think that if we introduce this innovation or this technology, it should be done in waves. So maybe wave one should include these countries that I just mentioned. And then we should focus on wave two , wave threes .

Julio Martinez: 26:26

Okay. Okay. And , um, the way you are approaching each country, Daniel, is, if I understand correctly, your model is by partnering with local companies, you are not looking to set up an operation yourself at this moment. Is that correct or not ?

Daniel Uzbelger Feldman: 26:46

Yes, actually we are open to both. For instance, right now in Mexico, we are , uh, initiating all the diligences for starting the operations there without any need of partnership.

Julio Martinez: 26:58

Fantastic. So ,

Daniel Uzbelger Feldman: 27:00

Um, you know, we need to set up the company, we need to set up what they call the RFC , the electronic signature. There are many requirements , uh, that the country needs. Uh , however, if there is a company either in Mexico or countries that they already have all that and they just, you know, want to get the platform and the expertise that we have and the training, the recruiting, the capacitation and continu improvement that we can offer. So that would be even easier. So,

Julio Martinez: 27:33

And the technology platform, I mean that's years, years of development. Yeah, correct.

Daniel Uzbelger Feldman: 27:39

And we have everything in Spanish already. Everything is

Julio Martinez: 27:41

Done because you already, with tele autologous in the United States, you already got the , uh, experience language and the technology front. Yeah, I guess , um, the opportunity is huge in Latin America. I'm sure you're gonna be able to find partners because , uh, establishing your own operation in each country is gonna be a very long process, right? I mean, Mexico itself, it will probably take a couple years to, I don't know , I'm just guessing to get established or more <laugh> .

Daniel Uzbelger Feldman: 28:13

Yes, not that much, but it takes several months to do that.

Julio Martinez: 28:19

No, I mean, to get people to learn about the service, to get revenue, to be profitable, I mean, to kind of recuperate investment and , and all that. Oh , I mean, it's not something that's gonna happen tomorrow. That's my point. It will probably happen , uh, in a while. And , um, if you don't work in parallel, which is , uh, also very expensive and and time consuming, even working in parallel. 'cause 33 countries, or as you said, the first wave will probably be the top countries, but still is , uh, setting up your own operation is more difficult. So finding partners is the way to go , uh, in each country as the preferred method. So what happened in Mexico, you guys didn't find a good partner in Mexico. Why do you guys make the decision if you are allowed to disclose this in Mexico?

Daniel Uzbelger Feldman: 29:08

Well, Mexico is the aligners part of the business is what we are doing right now.

Julio Martinez: 29:15

Oh, okay. I see. Oh , okay. Okay. And the other part of the business, the consultations are your guys are waiting for a partner to strike a deal with you. Fantastic. Well, Daniel, we are close to the end of the show. I am so pleased to have you here. Um, I really enjoy our conversation today. And , um, the last question that I like to ask you is, is a question I ask all my guests is, what would you say to the CEO of a medical device or medical technology company or service company that is just starting to look at Latin America as a place to do business? What would be your main advice?

Daniel Uzbelger Feldman: 29:55

Yes, I think that they should look at this maps that I share with you today in which you can see the need of our people to not only to better dental care, also to better , uh, medical services , uh, as well. So , uh, I think that once they will see all these , you know , pain, they will feel it also in the bottom of their heart as we did. And hopefully they will try to do something about it in order to help the people of our country.

Julio Martinez: 30:26

Excellent. All right , Daniel, thank you so much. Oh , how can people get in contact with you, with , uh, your company?

Daniel Uzbelger Feldman: 30:32

Yes, they can find us@teleonautos.com or also the tele com .

Julio Martinez: 30:39

Thank you so much. Have a great day.

Daniel Uzbelger Feldman: 30:41

Thank you . Hug . Thank you very much, byebye.