From Iraq To Board-Certified Orthodontist

Aliyah Dastour 0:30

we are here today, I am here today with Dr. Ammar with Elite Orthodontics, and as you can see, the background is a little bit different because we have a, uh, special, uh, filming session here at his place. So I'm super honored that I was invited to come out here to do this conversation with him. I would love for you to let us know a little bit about you, how you got into orthodontics, and a

Dr Ammar 0:54

little bit about your background story. My name is Ammar Al-Madi. So I always go by my first name because it's a little bit difficult for some people to say it right. Uh, I'm from Iraq originally, and I did my dental school there. Then I moved to the us had to redo a lot of things, and then I moved to Ohio State, and I did my orthodontic program, which was a three years program. Before that, I did one year like fellowship, and then I had to do my board and I became like a board certified orthodontist, which in real life I don't know if it makes a huge difference. But for us orthodontists, it makes a difference because it... what the board actually does, whether you believe in everything in the board or not, but the board does, you know, work on your education as an orthodontist, which we should mostly all have good knowledge background. And then- then- Planning, which is a little bit of vision, and then ability to get to that planned result that you want, which is the skills. So for almost every orthodontist, those three elements need to be there. They have to have education, they have to have a skill, and they have to have vision. I think education, almost all of us have almost the same education, I'm assuming. It's when it comes to the skills, that's kind of a little bit, you know, 50/50. the biggest factor that makes people difference is the vision. If you're able to envision an end from the start, is what makes you a good orthodontist. Now, no matter what your vision is, if your skills is able to take you there and your vision is able to put your face and the smile together, that's the magic that makes an orthodontist different. People think it's just about braces lining teeth. It's a lot deeper than this. But I can't really tell you what's difference if you don't know the difference. Because once you get a treatment, there's only one way to see your treatment outcome. And some of us, some patients sometimes feel like, "Oh, well, maybe I need it to be different." Sometimes the terminology doesn't help them, so they come holding the mirror for 10, 15 minutes trying to tell you something they're already looking at, you already know what's the term for it. So sometimes that works with my patients. Sorry, I side tracked from that, but, uh- So technically, that's what I, I finished my board, and then, um, I knew I wanna come to Virginia. This is where I have a lot of friends, and it was the first base for me when I came to the US. I'm assuming you always wanna go somewhere like you feel it belongs, and I have a lot of friends living here. Um, my wife likes it. Almost bought a practice in Ohio, practiced there for about nine months. But we ended up actually But we ended up actually coming back to Virginia, had to start from scratch. I worked as an associate. It was kind of like two hours away 'cause I knew I'm gonna be in Northern Virginia, and most of the time you kinda get non-compete, So I, wanted to make sure that I cleared that out. So for about, a, I would say a year and a half, I was, "Mm, sorry, I take it back. It was one year." And I did it. I was doing about an hour-and-a-half drive. Then I was, you know, dreaming about opening my practice. You know, the design, the colors, everything in your mind. It's always that first practice It's where your passion goes into it really heavy. So that one I decided to put in the Fair Oaks Mall. People ask me, Why did you do it in a mall?" I didn't know business that much by then, and believe it or not, even now it's still like a, a factor that I'm looking at. But it was like just to feel like there's people around you. makes it feel a little bit more positive, more, um, I would say, um, warm. So we opened our mall location, and then we happened to find a retired orthodontist who gave me his practice in Falls Church. So I was happy with this even though it was a little bit higher risk for somebody just starting from scratch. But there was a practice, there were patients, and then I'm able to get my team as a full-time job. That is actually a little tricky game because sometimes dentists open a practice and they hire their staff, and those team members, they live paycheck to paycheck. So if I can afford to do few days here and there and make living, which what was the sit- situation for me, I had like a little small home, like a town home, and I was able to afford, like, paying my student loans and all that stuff all from like, two days a week job. But for a staff member like an assistant or receptionist, it's not gonna be doable. And if you want them to believe in you, you have to kinda give something for them. Now, Some of them will take it for granted, some of them will really see this as a valuable. But then I-- when I took those locat- two locations with my slight job on the side, I was able to get them a f- full-time job. And if I tell you at the beginning, I used to drive with my front desk, which happened to be my treatment coordinator manager, and I have cupcakes, cookies in my trunk and going all over every dentist office, introduce myself, learning a lot. I learned a lot.

Aliyah Dastour 5:36

Like

Building Practices Through Relationships

Dr Ammar 5:37

to a, a point I was able to actually profile a practice from the first like 10 seconds there. You can see what kind of culture they have, what kind of employees they have, what kind of boss they have, which happened to be the dentist. Um, so a lot of things you learn from this. I did it for so long that I have a drawer, you open it, there's like business cards of- dentists, like almost that big. The one part I did, which I realized three, four years later that wasn't the best way, is I would do a lunch and learn with them. So I would say, "Okay, can I schedule a lunch?" I'll come with maybe one of my TCs or my manager, and then I'll do a presentation, which by then means I was, uh, right away going, "Hey," or shaking hands, putting my laptop, connect it to their TVs if it's possible, and then, uh, I start presenting cases. Then I see, like, all their assistants, their staff, like, their eye blowing up looking at those crazy cases that I'm- posting. But then I realized that I wasn't making too much connections 'cause I was just going there presenting what I'm doing. Um, it's something I still do, honestly. That's why I said, Because in, in our business of dentistry, a lot of people do it based on relationships. Mm-hmm. Back in the old days, and I'm trying to say it in a very political correct way, people were more into, uh, settle more for quality and, yes, relationships. But quality was standards of measurements. Like if a dentist wanna refer to a surgeon or orthodontist, it used to be a lot, especially in small towns, all that stuff. It's based on this guy does a good work, and he's happened to be a nice guy that I like. But nowadays because of competition, changes, which I feel the negative side of social media, and all that stuff, people puts too much in the image, less in the real core value. So so much image, less values. So then what I notice is when you're doing that like, you building those relationship with the practitioners, you would assume they wanna refer to the best doctor. but then the relationship ended up being few of them, yes, some of them not. I ended up being, for example, my practice, I almost the referral for every single dentist for his families. But we get a lot of dentists as well doing Invisalign aligners, and all that stuff. So the, the dynamics of orthodontists have changed recently, and there was a lot of politics happening before where specialists just wanna flow, you know, with the, with the general theme. like, okay, I wanna make sure my referral is happy. But sometimes we as a specialist have to tell our referring party what we are able to do for the patient, regardless of what business is happening. Like if a patient have a wisdom teeth, and they're missing some adult teeth, I'm not gonna recommend removing the wisdom teeth and putting implants if I'm able to keep those teeth in a place since they're doing orthodontics anyway. Sometimes that could be-- cause a lot of friction of business, which I think a, a specialist's moral responsibility is to actually tell what they wanna do. So then I learned after years that not every referring party is gonna be your party. You wanna work with the ones that match with you. And if you lose someone who's not in the care, don't feel bad about it because they teach a lot in the business side. You have to win everybody. You can't win everybody. It's like we know it from history, like everything. Like you can't-- have Like a historically, prophecies, prophets, they couldn't actually make everybody happy with them. So same thing, you wanna have your core value, you wanna practice it, you wanna talk about it, which I think We do good about that, and that's, I'm not ashamed. Some people says, "You put yourself on social media. You show stuff." But that's better than hide and just do, like, kinda black market kinda relationships. You have a lot of educational content, though, that you put on social media. Exactly. you're educating Yeah. So I'm not Yeah, I'm not dancing, and flipping around. Yeah. I wish I can do that, but, I, in reality is like I'm not showing, like, all lifestyle stuff because nowadays I see, um, a lot of dentists pushing more of their agenda of like image, or Mm-hmm ...a lot of them. push of their, um, you know, whether they do funny stuff. I think they are cool, but I think a doctor should always attach to the, you know, the authority of presentation of, what can I do for my patients? Mm-hmm. Now, that might not be the most cool. You're not getting thousand Like Like, we have posts in my practice where my team do funny stuff. They get a lot more views and all that stuff than what I do. I bring a tooth from here to put it here, and I get like 10 likes, but that's okay because what you're presenting is material that people can benefit self. Now, 90% of the time people, you know, flip through and they, you know, if they're not into orthodontics and dentistry. They wouldn't care much. But there are people who are looking into this, and if you can teach them something, whether they do it in your practice or someone else, you're elevating the specialty, which is what I think is very important. Uh, I've been doing it. There are people who are on the opposite side or aspect of my philosophy. I'm big on airway.

Branding With Education, Not Hype

Dr Ammar 10:37

I love

Aliyah Dastour 10:37

expansion. Before we get into all that Yeah ...I almost feel like you have a podcast or something. You're so good at talking. You talked to me about talking. You think it. You remember we had that phone call about this? So can- I- Wait, before you go into the airway stuff- Yeah I just wanna make that note. It seems like you are very conscious of your brand, though, and the content that you do put out there because you could easily create the dancing type of videos- Yeah ...or you could easily do stuff to get likes and views, but that's not your focus. Your focus is you want ...you're intentionally creating content that is beneficial to your future prospective patients, um, and you're wanting to uplift the industry overall by sharing. I mean, some of your videos have gotten a lot of views- but it was Yeah ...actually educational content- Yeah of something that you've done. So it's just cool to point that out.

Dr Ammar 11:22

Like, you're very intentional about what you're, you're building. Definitely. Definitely in it. Well, am I smart about it? I don't know how that works, but because social media itself is it's on its own specialty. I feel like. I've learned this Instagram just like seven, eight years ago. So I still don't know the algorithms, how we do things. Basically, I've learned a little bit about it now, learning a little bit and thanks for your advice as well. But in reality, content-wise, I always want a valuable content. We are within the- a very narrow area, which is orthodontics, Again, not everybody will look at it. But I felt like it's so important to create, uh, contents where dentists can benefit, orthodontists

Aliyah Dastour 12:01

orthodontists gain

Dr Ammar 12:01

benefit, and patients can benefit. 'Cause patients sometimes they don't know what they don't know, and sometimes even with general dentists, they don't know what they don't know. And unfortunately, sometimes in orthodontics, there are people who don't know what they don't know. So if you show them what you're capable of doing, then you're gonna affect the colleagues to do it. Like I've noticed since I've been talking about airway for a few years, a lot of my neighbor orthodontists are doing it. Now is that competition whatever, but that's great because I want to see those children get expanded. I want those things to happen. So the focus of my branding was always to say, like I want it to be based on good care. Uh, by the way, this is kind of funny, but it, some business advisors tells you that's not a good way because you wanna prac- you wanna brand the practice more than yourself. Mm-hmm. Which I think if anybody knows me in person, I don't have that ego like I want be like the center of the world. That's not my really culture. Well, and then also Yeah ...just to interrupt for one

Aliyah Dastour 13:01

second, you're-- you've only mentioned two of the practice that you have. You have more than two practices. Um, you are not

Dr Ammar 13:08

looking to At least in the short term, sell your practice. A lot of that advice is given because these bigger companies will come up and buy up the practice- That's true and the dentist or orthodontist wants to be

Aliyah Dastour 13:20

able to step out of it. So you are

Dr Ammar 13:23

building something bigger. I'm surprised that you

Aliyah Dastour 13:24

know that. I've talked, I've talked to a lot of orthodontists, Yeah, that's very true.

Dr Ammar 13:29

Actually, we're very few of us not sold. I know. And very few. A lot of them, And very- either they have sold or they're in the talks of selling. Yeah. So that's a whole different topic. I'm not looking at this, I, and I don't think I will end up being with a corporation. This might be publicly not the smartest way when people talk about it, but two things. I think they're a tricky contract, and second, um, I feel like it kills the culture of a good orthodontist. They teach you how to do business when it's moderate, but it can work without you. Mm-hmm. Which, uh, and again, it's not about me, but it's about what I'm able to do. If I have a doctor who works with me and he's able to deliver same style better, then I'll be happy. But if we just make it so moderate, but then we have good customer service, uh, good financial plans and all that stuff, then what difference we're doing for our specialty? There's a lot in orthodontics that been going down actually in the US because we are making things more to the system, less to the quality individually. So we're doing more quantity on a moderate base, but we're not doing high quality on a lower like, base. Now, it's okay to mix and match. So in my practice you will see I have the 80% of the patients who are simple cases, a lot of orthodontists can handle them, but I have those 20% of cases where I think we're doing a difference, and I think that's the unique When I'm treating a child and his mom, she need implant, she need a jaw surgery, she needs a lot of setups to get to that perfect 5 10%. And a lot of people will send you the toughest cases that they can't- Yeah, that's what happening with me now ...they can't figure out. Like They're like, "Just send him to Dr. Ammar." Oh my God. And by the way, this is what's happening, in dentistry in general, Yeah. like I get a lot of referrals as well, and the referrals a lot of the time are the complex cases Where the others are not doing them. I had a lot of general dentists, says, "Hey, I'm helping the guy in my town," which I kinda see it, She refers to him. But then this case, is kinda your type of case. So could you take care of him? I used to always tell, her, look, those usually are adult cases, a lot of communications. Give me some easy stuff while I'm doing this. Because it's, a lot of the time it's a back and forth emails- Yeah and all that stuff. And you are, I think you've been in braces before, isn't it? You had, you had braces recently? Three times. Three times. I've been in braces three times. Now you know as an adult patient, you, you see, y- you tend to be a lot harder than a kid. Yeah. Like, as you guys have a lot of questions. Uh, adults tend to have a busy life, and they, the worst for them. is waiting with metals, their teeth behind the bars for a couple years Like, just- Or they don't put in the liner or the aligners. Yeah. They don't, they're not good patients, or at least I wasn't. And they're not happy about it. Like- you know, Yeah the, that's a funny part. I always talk to my team, I says, "Guys, make sure you ask moms, you know, if they have happy experience? Share it on Google." Like we want them to tell. Because 99% the happy ones will just do nothing. Mm-hmm. The unhappy ones will go write something about it. Write something. And there's always reasons for being unhappy. Now, knock on the wood, I never had a clinical- problem in my practice, Like I've been always so centered in my clinicals, I didn't feel like I've ever had a clinical problem or actually had a clinical problem. It- most of the issues if they happen, it's more like communication or, like, uh, interaction with the team or maybe with myself. Had a patient one time she said, "You were laughing at every chair except mine." And I felt bad. I was like, I told her, "I'm sorry." How rude. Yeah. And honestly, I said, "I'm human. I could be something came in my mind." She said you were laughing at every chair? So I was laughing to everybody smiling and, but when I was on her chair I was just working I didn't interact with her. Aw. She felt bad about it. Isn't that crazy though how, you know, the client, the patient experience-

Aliyah Dastour 17:02

experience,

Dr Ammar 17:03

they get, we get so It's all about how we feel in that chair. I mean- So something as simple as he laughed at everybody except for me- I mean, laughed to everybody. let's say. Yeah. Yeah, yeah. That's what I mean. Like- Yeah joking and Yeah. That's, in- It's in- it's interesting. It's, in- interesting. And then you raise your patients a way. For example, if you give exceptionally too much, they expect that. So- Of course you wanna balance that as well because sometimes someone wanna come at any time, they wanna cancel their appointment at any time, and they wanna show up at any time. But every time I've done it, like, I've done it for years, then my manager would yell at me he's like, "Well, okay, now you made five people wait." Yeah. Now you made one happy, and by the way, she was okay. Yeah. But the five are upset. So then we kinda learned a little bit and now I communicate a little bit better. I used to be like, I would bend, but then you kinda learn like, it's almost like training your kids. You probably witness one of my kids now. I had to work with her hard now. But my wife actually helps with that. And, I've... the same thing I've treated with my patients, and your team, you teach them how to interact with the patient. You, you teach the patient how to interact with you in your practice. Yeah. You set the expectations pretty well. Like somebody panic because of a poky wire, you tell them, "Okay, it's fine. You can put wax. You can use sugar-free gum." But it's not like urgent you have to show up like right now. Yeah. And then, you know, So sometimes they get a little angry with staff. So you kinda get that relationship built, and I feel like after a while- Just like parenting, you get more experience. You're parenting your patients, you're parenting your staff, your practice, your brand. You learn how to interact with the community around you, whether it's a medical, dental, patients, businesses, because we are dentists and we are business owners happen to be.

Aliyah Dastour 18:51

So- Yeah. In terms of

Team Culture, Remote Staff, And AI

Dr Ammar 18:53

team, how many people do you have on your team right now-ish? I think, I think we're over 65. Over 65. Oh wow. But, but some of them are remote. Like, I have a lot of staff members moved out of the States, periodically- And you kept them? I kept them as a front desk. For example, she was an assistant, then I gave her a job as a front desk and she's still working with us. We have at least three or four of those. I have some people remotely. I think I have five, or seven from, uh, not even from the US. Some from Latin America or South Africa. So sometimes we call my office, you feel like that little South African, British accent- Mm-hmm whatever it is. You can feel that some of my remotes. But we get them engaged. We have big WhatsApp group that we are in, and then we interact a lot. And every time I have a post or anything, I share it with them. I do videos with them sometimes. So i- in this way, they feel the spirit of the practice. Uh, we're trying to implement AI as well, but we don't know, so we're gonna figure this out. AI has been tremendously amazing. What I will say- Yeah I get

Aliyah Dastour 19:48

so annoyed whenever... Personally- Yeah I wanted to do it in my own business, but I get annoyed when I talk to the AI person.

Dr Ammar 19:55

Yeah, 'cause you want somebody to feel you. Well, even just- Yeah if you have to repeat yourself and you know it's the AI. Yeah. Well, depends on what AI we're talking to. So let, let's just be honest. I've done some tests. Uh-huh. Sometimes when you call a bank and all that stuff, and it's just kinda... "Let me collect some info," it's a whole different. You can set up your receptionist so much different. Yeah. Like for example, we chose now one with James Bond voice, Mm-hmm. Or you can have it with... And you can have the style differently. Friendly, happy, funny, sarcastic. You can do that. And then you can set it up in a way that it's to the point, so they not waste people time. and you'll be amazed how much they can collect the information much better- No, I- know interact better, and they... For example, I, I called one of the dentists. the, the company gave me the, like, one of the dentist numbers, And I said, "Hey, can you tell me a little bit more about your dentist?" And it was like, "Oh, of course. Let me tell you. He graduate from this and that." You'd be surprised that sometimes some of your team cannot do that. You know what you should do? You should do a test on this. I've done lots of research on the AI. Yeah. Um, I have a little bit of background in it If next time you do a test, which I'm interested- Yeah once you roll it out to know how it goes for you um, do something like, "Hey, by the way, how do you bake a cake?" Ask it a random question. One time I did that just to test somebody else's AI. Yeah. and I was like, "How do you bake a cake?" And it was like, "Well," and it, like, went into a five-minute menu- like how Oh my gosh. That's not a human. Well, I- I I did I did that. I asked the AI one thing, and do you know what she told me? She said, "Well, that's pretty easy. I can pull up some YouTube videos for you. However, let's go back to the topic." Oh, good. "What's going on with your tooth pain?" Yeah. "So I can fill up." That's good. So it was like a really nice... The funny part is you can train it, and it trained itself. Yeah And, um, one of the software that we're working on is actually even gonna analyze my current staff. Uh, it's gonna AI

Aliyah Dastour 21:42

AI

Dr Ammar 21:43

evaluate each one of my front receptionist, their, uh, skills in the phone, abilities to collect information correctly and all that stuff. And it will give me reports- already generated. Yeah, that's beautiful. So I think when it comes to

Aliyah Dastour 21:56

AI,

Dr Ammar 21:58

AI, we're kind of scared of it, and it... sure, but it's coming. Yeah. and and I don't think we can... If we're scared because we're trying to protect our jobs or we're trying to protect our, you know, productivity, I got it. But I think with it will comes more jobs and more opportunities. But what I've noticed, if you utilize AI with your work, it will help makes you better. So I'll give you an example. I had-- We go on Facebook groups, and we always orthodontists fights, airway, and an airway. Like, and this will never end. It's almost like religions. Everybody believe what he believes and it's just hard. Mm-hmm. Mm-hmm. So I had a one time, this comment come in. and They, they kind of approach me again and again, and I'm just tired of trying to write a text that's two meters long and trying to say what I'm saying. So I've been using my ChatGPT a lot, you know, put some of the articles, discuss them and all that stuff. So I went ChatGPT and said, "Hey, I wanna respond to this person about... I want to, you know, use this study, use this and that, and this," and kind of put the response, put it back to him. So he kind of came back to it. It was pretty strong, pretty good, and it to the level that he couldn't fight it because ChatGPT was able to take the emotions away. Mm-hmm. And he told me, "Well, you're using ChatGPT." I was like, "I'm not ashamed of this. I'm just being honest to you. I don't wanna waste my time again and again, Yeah in a fight about this." I- want-" And it can take out the emotions. Yeah. And I can't do that without ChatGPT So I just, I was driving, and I told ChatGPT to write me this while I'm driving. Mm-hmm. I gave you that response. Forget who wrote it. down. What do you think about? it? Mm. That's the point. Yeah. So I, I think, and we kind of went into it, and again, the argument continued to happen. I said like, "I'm, I'm done. Like, I'm not gonna go continue this," because sometimes it's draining. Yeah. You get your point. You show them cases, you talk about it and then that's it. You don't wanna fight it. Now, one of the things I do in dentistry, I remember even when I was in residency, we had some co-residents who were very well-spoken, they they could be politicians, lawyers, whatever. I mean, at the end, I'm not born in the US, So my English could be okay, but it cannot take me to the level that I could just, continue argue with the situations. So- and they could present their case pretty well. But then when you look at the work, huh, okay, not bad, not great. So sometimes when people argue too much, I was like, "Look, here's a case before and after. I want you to look at this one, two, three, four." And I show them all those cases. Let the work talk for itself. Mm. Because sometimes I feel that we live in a society where political correctness, how you waste so much time trying to present your case. How about you show your case? Mm. Just do it. Focus on doing them, and then leave that argument until you have the stage where people give you the space to present your case. Sure, you prep it in the best way you want But that's why if you go to my practice, uh, like Instagram, you're gonna find I put cases. I talk about work, I talk about cases. Uh, a lot of the time if I give the plan, I used to do that on Facebook groups, people would say, "Oh, this is crazy. Never gonna happen." One time I posted this one, and it's an Instagram post with multi pictures, so you have to kinda slide. and one of the ladies, I guess she didn't understand how to swipe. She said, "This will never happen." and I just re- replied, as like, "Can you just swipe?" Continue swiping. Yeah. And then she came back on messages and she said, "I just-- I'm astonished how did you do it." And it's-- And I feel like, and then now I'm able to present my case more because she saw the before and after, and we're trying to present it. And I'm gonna give you an example of this.

Orthodontics As Art And Craft

Dr Ammar 25:18

In, in residency, we learn a lot of sets. Here's what you do in this case, here's what you do in this case. Uh, we've learned a lot of-- Like, we even put the skull X-ray, and we do numbers and angles and lines, pretty fancy stuff. a lot of doctors use them in their presentation when they do treatment plan because patients see all those angles and names and MFAs and all that stuff. What's, what's the SNA, what's SNB, what's the widths and all that, you know, I'm telling you already it's stuff. Retrognathia, prognathia, proclined teeth, pro... All of this are tool or tools created by humans to help to make things more streamlined. But in reality, you have to have a feeling of it. it's like cooking. Some people use the same recipe, they will cook something it doesn't have a good taste. And someone doesn't even have the recipe by numbers but it will give you great results Y- you're touching the things. And I feel like in orthodontics, there's a lot into this. People put those numbers and angles, and sometimes I post cases, and someone's like, "I wanna see all records. I wanna analyze this and that." And it's like, "Fine. I got you." You're one of those people learn it by numbers, you can't make the decision yourself without making those. But here's my question: All those angles, numbers, all that, they're created by human. Somebody like you and me wanted to think so much, put those into place, so somebody at the moderate level of thinking can utilize them and then work with them. That's not a shame, not bad. but you should not be completely just worshiping the numbers. 'Cause, y- you know, I always say, all of those are tools for us to get to the results, and if you are just worshiping those tools, then you'll forget the spirit of what you're doing. You always have to come back, and eyeball, "Is that looking right?" You know, I've, uh, I was, uh-- When I took over my practice from the retired doctor, um, forgot his name Fleming, Dr. Fleming. He's amazing. He moved to Colorado, but I saw him, like he measure palatal expansions, like 38, 42, like for adults I do this, for kids I do that. And then I was looking, I was like, but every face is different?" Like I have a wide face. Some people have a skinny face. Mm-hmm. Y- you can't just have a measuring, Like, oh, you should be 42. shoes always because you're like that age. Mm-hmm. So I never use that ruler system. You know why? Yeah. It's because I think, I really truly believe that orthodontists are artists. They are not- They should right? I mean, it's like- Yeah it, it really is an art form. It's not just paint by color or paint by numbers where you're just, Yeah ...this is green, this is yellow, this is orange. Yeah. It's like you're looking at it, and you're making all these micro tweaks and assessments to be able to create like the perfect- Finish vision. Yeah. The finished version. Yeah, every time. So You want try to match your vision, which is- Yeah by the way, that's a struggle is if, uh, uh, people set a goal, are they able to achieve the goal with their skills? That's the, that's the game. You know, when I was in dental school, first year they make us do this cube of, uh, wax or soap. And then what we do, we have to carve a tooth exactly same shape and size. And they teach us how to put the marks and all that stuff to get to it. But, uh, s- I've seen some of my friends, they will do all the measurements, stick those paper on it with the mesial and distal, and all that. And at the end, the final product just, it looks pretty good measurement wise, but you put it next to a tooth, it has nothing to do with it. I remember like the third time I was doing it, I wasn't measuring any of that. I would measure after I'm doing it on it. and just look at it. And then I had one of my colleagues actually, he was he starts stepping the t- teeth aside and stepping the teeth aside, and, and then he's going out and carving a full, like, Roman statues and all that stuff, all in a piece of soap, and he was phenomenal. Like, I would say he exceeded everybody, artist b- by nature. Unfortunately, this guy in Oregon now he's not even practicing dentistry. He's, I think he's practicing hygien- h- hygienist. I think he could have been the best plastic surgeon or facial surgeon, just couldn't do it. So a lot of the time we get people who like, book smart, they score well, they go to dental school, medical schools. They will come up with the best scores, but sometimes they, practice-wise, they, don't do great. And you have people, you know, they kinda go through this, they had to do it, but they did it for the purpose of to achieve their art and their work, and I feel like those are the doctors who makes a difference. Um, I know I can talk to the end of it, but I work with a lot of facial surgeons. Most oral surgeons like to do the easy money and do wisdom teeth. Wisdom teeth implants, and I'm working with a specific guy, he's a facial surgeon, but he's more focused on cosmetic stuff. Mm-hmm. And we do a lot of cases, facial asymmetries and all that stuff. the amount of knowledge that he added to my 'Cause what I I've done it a lot when I was at Ohio State, But we were very structured by the book, how we do it before how we do it after, and they kinda set up rules and that's how they follow That guy just went much bigger envelope of treatments. Jawline implants, cheek implants, uh, distraction osteogenesis. We're changing faces case by case. It's phenomenal, even to me. Can you get that covered by, uh, insurance? It, uh, ...Well, by the way- Implants Yeah. Well, Well, let me tell you though, Mm ...part of the surgery is yes. And then when he does those additions, Okay ...he doesn't charge more. Oh, wow. So he's just passionate. Yeah. He just love what he does. That's crazy. And I think he's just escalating his, uh, name. I had, I think, podcast with him actually. We were pos- I was gonna say, was he the one that was on your- Yeah, yeah episode? Yeah, he's phenomenal. I just wanna tell you, like I work with a lot of good ones. With all respect to everybody, please, like you're all great. Like I have, uh, multiple names I don't wanna mention. But, uh, this guy just have the touch. Like, and he never say no. And if I tell him, "Can you do this?" "Yeah, we can do that." "Can we skip that step?" Yeah. we can do that." Like- You know why? It's because a true artist loves the challenge. Yeah. Even you, when you're like, "No, don't worry. You know, I've got some lights here." And I'm like, "No, no, no, no. I wanna bring my own, and I wanna try to figure it out-" "in a new space." I can tell there's a huge difference from what I know. But that's kind of that mindset of like I don't wanna just follow the steps. I want a challenge. You know, whatever you're gonna throw at me, I wanna figure it out. And by the way, this is what makes new stuff that we are used to.

Aliyah Dastour 31:24

What you're doing right now, I feel that that is a big piece of your success, is you acknowledge others, you. see potential in other people, um, you help them grow. And even when their circumstances change, AKA they're moving, they're going to another state, you don't just wash your hands and say "All right. Good luck." You're like "Hey, well, if we

Dr Ammar 31:46

wanna still work together- Yeah let's figure it out. Let's find a way to make it work." It's hard to disconnect with me. But, uh, in all honesty, I'm gonna mention JJ's name. He's wonderful. He's lovable, high energy, younger guy. He's more into, like, sports as well. I don't know, JJ, if you hear me, you could, you know hi there. We'll get this incident to him. I know you sometimes go to Texas. and I think he's close by. So I, I didn't get the full image. I think he's going with his, one of his relatives who's more into, like, boxing or kickboxing whatever, but he wanted to do his brand. So he's technically with him, and they're doing all of those contents there. But he's been an extreme, uh, energy in my practice. He's very good with content, but he's very good actually with, uh, marketing, uh, dynamics, Google's, how things works, Um-

Aliyah Dastour 32:35

landing

Dr Ammar 32:36

landing pages design. He does the questionnaires. Pretty creative. But the key when you work with those people, you have just to know if you want the creative ones, you have to give him room. So it's not about having him in your place just 8:00 to 5:00. That's not how it works. He's gonna waste some times? Yes. He's gonna work sometimes on the weekend, at night without even charging me? Yes. So as a leader, if you see this in them... 'Cause that's how I believe myself I was. I'm not the greatest employee honestly. I wanna say that. uh, I was suck as an assistant they they almost wanted to, uh, fire me when I did my first assisting job. I just didn't know, like, okay, is that how you do it? So when I know how I perform, and I think I do it well, I always says I complement my part with good admin organized people. That's why my practice has so many managers, because I can't be the manager and the doctor and the insurance specialist. I don't know anything about insurance. Somebody else is doing it. I know what I do, and I think I know how to connect it, and I think those are the things that I'm very good at. And I-- when I see somebody with the same culture, I understand them well. Like, so my, uh, JJ, our lead and our marketer, he, he is the type he's a free soul. You wanna give him the room. If you says, "I want you from this to this," he's not gonna be creative. So when you work with people in a creative projects, you have to give them leeway. And in my practice, the way I work with my team, I give them leeway anyway. I don't follow the business rules all the time. Sometimes it bites you, but 99% of the time you create a culture of loyalty. and um, it happened even in my practice, there are departments where I'm not involved so much, and I felt the difference in the energies. I-- We were talking. I gave them the best manager that I have to make sure she can convey that message, and then I start communicating with them more. But "I can tell you my team who works with me directly, they feel it a lot more. They're going like above and beyond. One time I get-- I woke up in the morning, I think it was, uh, five years ago.

Stress, Systems, And Scaling Locations

Aliyah Dastour 34:38

So

Dr Ammar 34:38

I'm 44. It was when I was 39. And I think I was going so much stress in my career, uh, like a tremendous one. there there was a time where my nails were breaking and failing. I just didn't know it was because of stress. 'Cause again, as I told you, my secret is like I'm great of connecting with people, but I'm not great at getting benefits out of people. So in my practice, I was shy to knock a door on a dentist, "Could you please help my practice? I had so much dignity for this, and I thought I was very good, and I'm do- don't wanna do it. So then I get so super stressed. But then my team, one day I woke up, and everything was like rolling around me. I was like, "What's going on?" It just wasn't new to me. Mm. It was spinning so fast like the fan right there that I almost like throw up. So I thought I have some digestive issue or something going on. And then I wasn't able to go to work. It was like three hours. I thought, "It's gonna get better. I can't, I can't, even sit up." It was, uh, what we call a vertigo. It was a benign vertigo, which I happened to know later. But I know that for a few days I wasn't able to go to my practice. My team were going like crazy to the office. They were calling me to see patients for emergencies. All this. "I say, I can't... We can't do that." Like, you know? and They wanna make sure that the ship is not being rocked. They work so hard sending me pic- pictures and videos. I had to be lying back with my head on the three pillows because that's the only way I can actually be a little bit stable. It would still do like this. Mm. Like, it feels like the ship is sinking or an airplane is rolling. And, you know, few weeks later I did some, uh, therapy and it was able to kinda get me better. Now I kinda get with it. So it happens once here and there. Gotcha. I remember one time I was with a patient and I rolled my head and it came, ooh. and it was like funny for two seconds. Now I go to the gym, I get on the bench, it happens. I don't feel it anymore. doesn't scare me. It was really anxious when it happens first. And they told me this could be related a lot to stress. Yeah. So we're trying to get out of that stress. So you asked me why they have like six locations. Mm-hmm. Well, technically not yet, but, I mean, there are six. Uh, one of them, two, one of them is in fairly new. One of them we didn't open yet. The reason I did those is because I'm so focused and um, I wanna say the right word? I'm obsessed with being independent as a practitioner. I do not wanna rely on referrals. it happens, that we get referrals a lot, but I do not wanna be relying on this. So when I feel like an area is not giving us enough to be full-time, then I open more locations. Then you we grow pretty nicely. Then I, I add the doctors with me, which I feel that's what the difficult part. Yeah. You have to make sure that you continue that same torch with the other, uh, doctors to make sure that they present your ideas. Yeah. So we get into a lot of discussions and all that stuff, but I feel like, I think we're closer to what we are happy with So there's always areas where I feel I can do better.

Aliyah Dastour 37:40

But- I think we're close. So you just talked about all the stress. Yeah. And then you talked to us about how you're opening more locations. You have six offices. It sounds like you, do an amazing job at retaining your people and your team and keeping them happy. I mean, I'm sure it's not 100%, but

Dr Ammar 37:56

you know, the fact that you've got such a big team- Yeah and that, uh, loyalty is there is amazing.

Aliyah Dastour 38:01

Um, in terms of like- Systems. Do you have systems that you build this around? Or is it just you sharing your vision and passion and, like, staying in such good communication with them that they slowly absorb it?

Dr Ammar 38:17

Great question. Uh, I think as we speak, we are building more systems, but systems will never stop. You're gonna have to continue to build them. Yeah, sometimes they evolve themselves. Like systems, just, they come and flow like water around your branches just so whatever your vision, system will come around it. But the biggest thing I would say, and I would say that to even practitioners, to not let the system shape your philosophy. Let the philosophy shape your system. And I think this works really well in our practice, not like I'm expert in it, but it just... I kinda pushed the vision onto this, and the system start building around it. And yes, we are building it, and we're changing it all the time 'cause dynamics change. And yes, it helps because when you have one, um, system in the reception area, how they interact with patient, how they interact with issues- How do we practice so they know how to convey information to the patients? Those are system you build, and you work hard on them. And I know I told you minutes ago that we share a lot of like, communication, uh, apps and all that stuff. They help us a lot to be on the same page. And, um, I think those are evolving, and sometimes people with them help us to create that system and refine it, makes it better and better. Every week we are dealing with a new problem, but I look at every problem as an opportunity. We solve it, we learn from it, we declare a new system to the whole team. Next time we don't have that problem. And this is the system that we're building around. But yes, we have systems in marketing, we have systems in patient care, uh, we have systems in customer service, responses, uh, and we're building a lot more as we speak. Like every day there's something in my mind that I wanna make sure we implement.

Aliyah Dastour 40:10

Since you're hiring, since you're growing.

Dr Ammar 40:12

Oh, hi- hiring. By the way, we have an Indeed apps. Uh, Like Indeed, uh, listings are just... We, we don't shut them down. always going out there, yeah. I think we're paying so much money for Indeed for this. But you'd be surprised that I hired a lot of... I enjoy more hiring people that we train than people with so much experience. Um, people with experience, uh, it's, a hazardous. You, you might match, you might be disaster. uh, people you hire, sometimes not even through Indeed, people you meet in the gym, people you like at a store. Um, so many of my hires were not in the- You literally just approached somebody at like Uh, I've done it. Yeah, I don't- ...the store- or the gym and you're like- I would, not- ..."There's something I like about you." Yeah, Yeah. yeah. You wanna apply? I made an interview to one of the guys there, Yosef, you're probably watching us. Um, I think a friend told me about him, and I did the interview at... I was at Lifetime Gym. I finished up, and I put my phone there, and we kinda had a FaceTime. He said, "I used to work in the same gym you're in." I was like, "Oh, you know now I own the gym?" 'cause there was- That's so funny ...that little business like area. Um, but I think I, I find things in people. I like to do that. Our general manager in the office, she's more into systems. She's so systematic. She likes people to be very well organized, and they don't do the mistakes twice. and I think between me and her, we kinda create a very good culture. Sometimes she fire people, and I wanna bring them back, and she will say- ..."You bring them back. I quit." I was like, "Sure, whatever." Or it's the opposite. But I- That's so funny I think, yeah, uh, she's, uh, wonderful. Her name is, uh, Chris. She's behind the scene, almost nobody see her. If you see her, you're, uh, either have a big problem that she's solving. That is, she will be like... E- every time I get emotional with her, like, you know, I tend to manage a little bit with emotions. Like I get a little angry, I want this, I want that, and she just can't... When I get angry, I want her to uplift that, and she will just go very calm. And assert me with what she wants. And I was like, Chris, could you just... I, I want you to feel, I wanna feel like you kinda care about this." she said, "I know, but your way is just gonna make me just everybody angry. I wanted to make it like what we wanna do." have to stop it. Yeah. Yeah. But it's hard when you're a doctor and you're trying to make things, so you become feel in a rush. Yeah. Uh, and usually one of my biggest dilem- But I don't know if this happened with your doctors. Uh, you meet a lot of doctors. Because you work from like 10 to... I work 10:00 to 5:00. And you get all those ideas and you wanna tell them, but you just don't have the time. Sometimes they call in for a patient, "I'm trying to drink water." I was like, "Just give me one second." And then I run. That's how much time and time. And then by 5:00 I'm ready to tell everybody about what I want. Everybody's just packing and going home. And you're like, "Wait, wait, wait. Yeah. But then, then I was like- I need you here all day yeah. And then it's like, well, we have families. We wanna do this. And sometimes I bother on the weekend, and all that stuff, so it's, They kinda get used to me. but um, uh, and that's, uh, had one lady joined us as a operation manager. She did phenomenal. but then she had to quit for a personal reason. She's still helping us here and there, but she was the only one that I felt By the way, when we talked about the podcast, she was the one who jumped on board and really made it happen. Oh, that's beautiful. Because I'm busy. She, so she said, "Okay, what do we need?" She called up marketing guys, get the material, all that stuff. And we started with one that I was talking, uh, And it was like a good test. Oh, good. Yeah. So, um, yeah, I love my team. I think they're great. I love that And I love the way that you're able to,

Aliyah Dastour 43:39

like Well, here's the thing. When you graduated school they didn't teach you how to run a business, open a practice, design your practice, hire people, fire people, train people. They don't teach you any of these things.

Dr Ammar 43:52

Nope. The vision, and I, like I was saying earlier, a lot of orthodontists especially, they're very

Aliyah Dastour 43:57

creative people. Yeah. I mean, I work with a lot of orthodontists, and they will They have visions. and so you've gotta, like, get on board and help bring that vision to life. Even when they say, "I trust you," they still have a, their own vision as well. So being able to, like, take all of those things that you have to be able to, do, even though you only graduated with the art and the technical side- Yeah of orthodontics, it's a lot. And I'm sure it's overwhelming 'cause you're only how old? you are? 40-something? Early 40s? 44. Oh, you're nice by saying "oldie." And you have six Yeah practice. I mean, no, but that's young. You have six practices. You have all of this. You have a k- team of 65 people. Yep. I mean, that's a lot. No wonder you were having

Dr Ammar 44:43

Well, now I'm on the chill side, but uh- Good I think could I be less staff? Sure, but I like to always have people for every angle of the practice, and I think that makes a difference. 'Cause the experience is important to you. Yeah. But back to your point that you're mentioning is, yes, I think orthodontists, even marketing wise, orthodontists are the highest, uh, creativity and art And presentation mode specialty in dentistry. I mean, a general dentist could be fine living just off insurance and Google ads. Mm-hmm. But most orthodontists, they are very good at marketing images. So I feel like they're the the most marketing characters in in or- in, in the dentist, dental field.

Aliyah Dastour 45:25

What

Competition And The Future Of Orthodontics

Aliyah Dastour 45:26

do you hope the future state of orthodontics looks like? I know you do a lot with airway, but- Yep ...including that, but just

Dr Ammar 45:34

overall, like, what are you hoping that things change within your industry? There have been inflation of how many dentists are graduating every year. Um, some have a good quality, some don't. And I feel like with that happening is one benefit of social media and presenting what you do, it makes people able to stand out. So now to become good, you have to build up bigger character, better work, better details to become the one who stands out. Okay? So with high competition, sometimes you get the best out of the specialty. Uh, I, think orthodontics in general on the contrast is being benefited and hurt. So it's been hurt because of so many companies now encouraging the non-orthodontists to do the work, so it makes the professional practices at a struggle to survive. So you might have a good orthodontist as we speak, struggling to survive as a practice owner because of the market, which is unfair. That we know. And orthodontists will hide that talk because they wanna make sure that nobody from the other dental practitioners uh, feel unhappy about it, but I'm not ashamed of saying this. I would say, uh, the general dentistry being pulling from the orthodontics in a way that is hurting the ones who are good, but they're not presenting themselves in a good marketing st- strategy. But that push the other orthodontists to be more into marketing, more into refine your skills, 'cause their skills been a little low. It's been on autopilot for a lot, Like people don't bend wires, they don't do tricky stuff, complex cases. That era is not gonna work anymore. So if you wanna become an orthodontist, and if you wanna become an orthodontist, you have to know that you'll be ready to be artist, uh, uh, in your work, you need to be very artistic, you need to be of a vision, and you need to work hard. So I think this part will make the pro- profession better. The one side that I wish, and again, that's biased because I'm into airway. Uh, do you mind if I talk a little bit about airway? No, I would love for you to. Okay.

Airway Orthodontics And Expansion Debate

Dr Ammar 47:40

So the standard orthodontics being all about aligning teeth, functional bite, not much into joint relationship and all that stuff. And, uh, the pendulum being going for years between expansion and expansion, extraction. If you're too crowded, and then extraction which mean pulling teeth out or not. So we went to school, and we studied with, uh... I went to Ohio State, amazing research-based program. So when people talk to me and they say, "Can you cite some research?" Uh, we, we breathe research in my program. We used to review articles daily Some programs are more hospital-based, they barely did that. We have so much cases. Um, I had to do at least 200 to 300 cases between transfers and my actual patients and what we teach dental students and then surgical cases, education, craniofacial people, kids with deformities and all that stuff. So when it comes to experience, knowledge, research, we were loaded, and then we had to teach so much to dental students. I know some programs are a little bit on the lower level, like it's just hospital-based, less didactic, less research But what we learned is a standardized, like, you know, ABC of orthodontics, which most people practice. Unfortunately, airway is not being recognized by that. And I'm gonna simplify this. Now we'll talk about airway for children, and there's airway problems for adults. For children, we can modify their faces, their bones, and that's something we do. That's why th- we are the specialty of orthodontics and facial orthopedic. means we're moving bones as well. We have appliances to make the lower jaw stronger forward if the lower jaw is small. We have appliances to bring the upper jaw forward if the upper jaw is small, patient with an underbite. we have appliances that expand the arch. So all of this has cosmetic thing, but it has an aspect of it that belongs to the nasal cavity, oral cavity volume and size So by common sense, when you make those volumes bigger, means you get more intake windows for breathing. Now, how much breathing improvements? We've seen some studies that shows there's more nasal flow, more tongue space. Now, and more-- less AHI, which means that, they... if they have a sleep apnea, their wake-up sessions are less. But We don't have long-term studies being conducted to show, clinical trials, shows that sleep apnea gets better in children when you expand the arches and do all of that. The problem is, even if we compare this, expand it how much? 'Cause people say, "I put an expander," but for how much? Two millimeters, 10 millimeters, 50? So when you do those studies, it's gonna become even more complex 'cause you have to really get to the details. Mm-hmm. You know, there was a little reel, I forgot it was John Travolta I think, and he's shown like he's an extra smart kinda guy. and he was telling him, "Tell me a guy born whatever, how old is he now?" He said, "Well, tell me specific." "Where?" He said, "What? It makes a difference." He said, "No. If he's born in 1942, whatever, in California, at this time, at to the second." What I'm trying to say is, when we trying to put that research together, then we fail to get unified powerful research. Then, all of a sudden, we jump from the scientific, um, explanation of research to the legal terminology. So people comes in it's like, "Well, we don't have enough studies," and all of a sudden, that becomes, "This is not science-based." Mm. So the argument is when people are receiving this information, like doctors and prof- practitioners, "Well, I wanna follow studies 100% to, to to standardize the care," which I don't blame them. You want standard of care so nobody goes crazy, out of what the standards are. But then we are cutting off the facts, and we make them sound like there is no airway relationship, even though we have ton of data and studies shows that. They just happen to be not enough to make it the standard of care because we need more research that we're not doing, so it's our responsibility. Research start with a question, and then question need to be answered, and that's what we need to do. So I think it's a matter of time to make this as a standard of care. My problem in this is expanders exist years, decades before even airway specialty exist, before even sleep specialty exist. So we've been using expanders to fix th- things. Now, what standards we use to expand is people have a crossbite and we wanna expand a little bit to jump it. But then who set those standards? Practitioners. And then we use them to do research, and we stuck by them So that vicious cycle that people are stuck in, what if I expand more? What, b- what problem's gonna happen? That's always like, "Well, we don't have enough studies." Then what do we do? We shoot ourself in the foot and we say we cannot do it? I'm gonna tell you one example that's very related to this. Well, before I jump to that example, so basically to your audience there, airway problems is we orthodontists who are believe in airway, we like to expand the arches, we like to make them bigger, and then once we do that, nasal cavity get bigger and air volume is more. We are wanting that this to help breathing to get better. Now, if I tell you every single patient of mine's telling me that but that's not in the eye of science, that's not enough. So I'll tell you, the studies already proven that the air nasal flow, air flow is better, snoring decrease, and that's a big sign sometimes with airway issues. But the studies that we want, we don't have them yet to say it's a classic treatment for sleep apnea. Guess what? The standard of care send them to the ENT to shave the tonsils and adenoids to make the room more clear. So technically you have one room, you take the furnitures out or you make the room bigger. Mm. That's the common sense, correct? But that doesn't work this way when it comes to science. So I'm gonna take you to another example, cars industry. They've been doing electrical cars I think for almost 100 years ago. In 1905 or '6, there was an, e- a a, electrical car being manufactured and tested. Guess what? we kept designing those beautiful cars and using the same technology almost for a whole century. You open the hood and there's million device It took one guy to come out, of that and create electrical car. And now he created it, he built a factory for it, he made it, and now we go on the streets and probably every 10 second you will see one of them. Now we can have a lot of data about how electrical cars works and all that stuff, and then all the other companies start doing them. So let's remember as a humans, when we make all those research, all those studies, those are not biblical, they not just come sacred. We made them. Mm-hmm. We need to be smart about them. We need to be as well value them, and then we use those as a tools to grow. Because if we stuck in that cycle, we're gonna be worship the wrong things that we should be doing. Science is there. it, just need us to ask the question and do it. And the biggest thing I wanna add, at this is if my child need expander, and at age 14 and 15 I cannot expand them anymore unless I do jaw surgery, I'm not gonna sit there waiting for somebody to research this for another 20 to 30 years to prove something that doesn't hurt, actually, as an orthodontic device, that actually been helpful. So That's my in, in like insight about airway. I've been expanding before I even know about airway, and we've been expanding before we know about airway. Now we know it has benefits, what's the shame in this? While we're doing this, if somebody wanna dedicate time to research more, that would be great. I wish I can do that, but I'm very busy treating my patients. Actually Treating But I wanna tell you this. Every day I see 70 to 80 patients, which is almost equal to a full residency program for somebody going to residency- to learn orthodontics. You see that every day? Every day. Yeah. Wow. So residency, you see six, seven patients a day. and the whole year, the whole residence program might finish 100 to 150. Some program 50, 50 res- uh, patients. Mm-hmm. This is something we do every year. we start at 1,000 patient. That's why you only get little sips of, of water in between all of your

Aliyah Dastour 55:50

um, so I, I So you were talking a lot about the airway. Yeah. You are kind of leading this whole charge, right?

Dr Ammar 55:57

Like, you're setting the example for other orthodontists- that's definitely something- dentists I wanna do. Yeah. Yeah. And there's a lot of- other practices- And I'm doing it already, Yeah too, like, that help with, um, like children for speech therapy.

Avoiding Over-Treatment And Selling Fear

Dr Ammar 56:09

There's a lot of different- So I'm interacting with a lot of therapists, speech therapy, my functional therapy. So technically it's a multi-aspect treatments. Um, do I believe every aspect is necessary for everyone? I... don't think so. I don't think every kid need expansion. I don't do that in my practice. By the way, I talk about airway, there are kids come for a consult and it's like "They, they're fine. They don't have a problem-" Uh, so as myofunctional therapy, I think some need it, some don't. So I, I feel like that is the problem is the non-airway is seen the-- Some people talks about airway, but they take it to the extreme, especially where finance is a, is a problem. Like you see some doctors who do l- airway, they overcharge, over-treat. They make us look bad, and that's the problem that I'm having. I'm sorry I clicked her microphone. I'm sure it's gonna be knocking. But the ones who are using that as a niche to push so much, over-treating almost every child, and they're doing e- extremely expensive stuff, that not even functional. Like, I've seen even a pediatric dentist using non-expanders to do that, or adult, uh, dentists trying to talk about device they think that they can expand the upper arch with it, which you, at that point you need surgery. So I've seen the other side of it, and it's so difficult position. That's why I decided to talk about it. By the way, it takes a lot of courage to go on social media talk about it in the world of orthodontics because- Why? Oh, because 99% is not into the airway. Why? So you really get on the cross, because that's what they educated us. It's not in the airway. We're not... I mean, in my residency, if you mention the word airway, probably people think it's an airlines. This... You see how funny it is? Yeah. So when you imagine yourself living in a society, just close your eye and think whatever that you don't need to share, it, and you come up with something in you opposite of the whole culture, what that socie- society gonna do to you? Yeah, they've got their pitchforks ready to So that's what happened with airway. Yeah. So a lot of people who talks about airway, they don't talk about it on social medias. They just wait until somebody show up at their practice and do it. And this is funny, but I feel like my personality is not... that type. I always like to do what I say and say what I do, and this is my, my stance. My wife tells me sometimes I lose people This, way, and I don't care. But I wanna talk about what I believe in, and sure I'll be attacked, but so many people around me are doing it. They just don't

Aliyah Dastour 58:30

talk about it. Well, I mean, and you're doing, you said how many? 80 to 100 people, patients a day? 70 to 90. So I'm saying, Yeah ...so you're actually seeing the results.

Dr Ammar 58:39

You're not just trying it here and there. You can- You're actually- I wish I have the time to have ask every mom to talk about their cases and all that stuff. Yeah. Need to hire another person just to film the Well, we've been... I've been doing it. Some people don't like to share this. Of course. But I had the lady, if you go to my Instagram, and, um, actually, she's wearing a scarf, so you will, you will... It's a very distinctive case. Um, her kid came to me like dark under the eye, sitting on the chair like keep moving around like he didn't sleep. So restless as a kid. Mom says, "Look, I've researched everything, and I've been told orthodontics and airway has nothing to do with it, But I've been with my ENT for three years, and I'm done. So I'm here

Aliyah Dastour 59:22

understanding

Dr Ammar 59:23

from a science background, because I'm into science, that I shouldn't be with you today. But my child, um, suffering, and I'm seeing all your videos. I wanna see what we can do." Do you understand this? Like, I was sitting there. I don't need to pitch that because she's anti-it. She said, "Based on my respect to how science being translated, I should not be here." And, uh, and I said, "But let me tell you though, there's no- nothing unscientific about it." We just, when we talk about a standard of care, sometimes we get stuck into the, ex- the translation, almost like lawyers. We're doctors, we're not lawyers. So we do have evidence, we just don't have enough evidence to make it standard of care. But we do have evidence that airway improve. Now, I cannot tell you I'm treating sleep apnea, 'cause that's the one that we're not standardized yet. But sure, you can go to the ENT and let him shave the tonsils and... She said, We did all of this. No results. He still have tubes in his ear, infection all the time, hearing is not great." Sure, we start expansion. Three months later, I was jumping between my chairs and seeing my patients, didn't pay attention to, I wanna check on her signs and symptoms. I worked on him, expanded nicely. So from a clinical orthodontics, I was pretty happy. And then I saw, uh, saw the mom, I was like, "Oh, whoop," Now I recognize her. I was like, "Hey, how is it going with him?" She said, I just wanna talk to you and at some point she actually start tearing a little bit, so we had to stop "We actually did a video, so had to stop it and do it again. But long story short, hearing test is pass, No more ear infection, no more ear tubes needed. Sleeps much better, no snoring. And she said, "When I told the ENT," which is not on the wagon of orthodontics effect it, he said, "I don't know, but he might just outgrow it." She's told him- ..."You've been with him for three years, and you know everything, and you think in three months he outgrow it?" He said, "Yep, there's no data to support that." Now, there are some ENTs who believe orthodontics have insight. So it's, it's a... I think people personality and people comprehension comes into the game. Yeah. and again, just like I said, sometimes there's a bias. There's something called academic bias. If I'm writing books and I'm spending 20 years of my life teaching against this philosophy, you think it's gonna be easy even when I have a published books and articles under my name, to come and say, "This was difficult," or, "This is actually not something that I believe in but actually I should"? How many people we saw in our life, in society, in history, came against the flow? We just talked about it. It's not an easy thing. When you go against the flow, it's not an easy thing. And I, I

Aliyah Dastour 1:01:59

could use so many examples. I will let it ponder there. Yeah, Yeah. And just let's talk about airway.

Airway Symptoms Parents Can Spot

Aliyah Dastour 1:02:04

What are some of the Symptoms that you named a couple of them in terms of- Yeah but for a mom, if she's looking at her kid, and she's like, what are some of the things that her child is dealing with- Yep ...that might be a good evaluation?

Dr Ammar 1:02:20

Well, good thing. I, by the way, I interviewed a sleep physician, triple board certified, so we get a lot of info there. But I'll give you some simple information. If a child is snoring, grinding at night, uh, wake up tired, move in bed, sweat in bed, wet the bed, um, not hereditary-wise, but having always like a very dark, under the- eye, very tired during the day, hyper during the day or hypo, sometimes related to even ADHDs, and I'll tell you why. When somebody is tired chronically, they either become very hypo during the day or they become super hyper, so they can get over it, Hmm. and then they crash. All of those, and a mouth breather, by the way. So he sleeps, mouth open. All of those are very high red flags for possible sleep apnea for children. Now, when I talked to the sleep physician, um, Dr. Melody Hawkins, she works at INOVA,

Aliyah Dastour 1:03:16

Inova,

Dr Ammar 1:03:17

she told me, technically, if a child is a snoring, that's already-- like we already put him in a category that he has a sleep apnea. So they bring him in, and they do sleep studies and all that stuff. And even sleep study will give you-- They will patch so many things on you and they trying to figure out your rhythms, your heart rates, and all that stuff. And at the end, they give you num- numbers, and we do that for kids and adults. The issue is, is their most recent studies when they talk about sleep apnea, they don't just use the sleep studies because there's other factors that we don't know. What we don't know, again, can affect the sleep. So now we use a lot of the ter- like the terms I gave you, like the signs and symptoms, quality of life measures as part of the diagnosis. Now, let me put this clear. I am not a diagnosis body for sleep apnea. I'm not a sleep physician. I did not diagnose it. I never promised my patients that I'm diagnosing sleep apnea or I'm treating sleep apnea. Mm-hmm. I tell them what's the status. Every single patient walks in. I tell them exactly what I told you about science and what's going on. And I tell them that I expanded my two kids, and I tell them, "It doesn't hurt if I'm doing it, so do you wanna do that?" And most people wanna do it. Mm-hmm. now every single patient that I ask in my practice, "How did you feel about it after?" They always give me positive, uh, responses. They're not snoring, they're sleeping better, uh, whatever other factors. So again, grinding, lack of sleep. Lack sleep could be not just compartment, could be mental, It could be stress and you cannot sleep. So all of this we need to know. By the way, this is the same for adults. I'm gonna tell you just like a scenario what I want you to envision. I have two consult rooms, and I have three TCs, three coordinators, So they kind of circulate. But sometimes I walk into one room and I find a mom with a child. She's shopping around online, need an orthodontist. I talk to her about airway expansion, and she's completely not paying attention to what I'm talking about, and she's like, "Well, my dentist didn't tell me anything about that." I was like, uh, again, I have to explain to her like, I know you love your dentist. I know she's nice. She's whatever. She's not into this, that doesn't mean it's not there, okay?" And then I walk out of this room, I walk to another room, now I have an adult, my age, your age, older, severe moderate sleep apnea, big problem, researching around, sent by other specialists, "Hey, go, you need an expander or maybe you need a jaw surgery." And now we're talking a much more intense, much more expensive treatment plan that involve a surgeon. Now, not me, like the surgeon, bill and all that stuff. And I feel like, can I just bring you please to the next room so this mom knows what you're going through? This happened to me daily, to the level sometimes I get a little, like, annoyed, And the patient-- And my TC tell me "Dr. Ammar, "Please, like, the patient sense your anger a little bit about it." And I was like, "I know, but I want her to really-- I want her to know- It's important, yeah what she's not looking at." And I even tell them, "Look, your head gonna got bigger. Your mouth actually doesn't get bigger, like your arch is not. Um, we have a studies," now let's talk about what proven by science, "that at three years old, your arch width is the same, you just add to the back of it. It gets longer you add more molars to the back. So if your, if your child body gonna be tripled or, you know, quadrupled, and his head gonna go up by 10 to 20% more, but the arch and the nasal cavity is not getting bigger, that's important for you to know, just so, you know, you kinda get the vision of what sleep apnea." but again, some people wanna listen, some people don't. So my job is to make sure I inform patients about what's going on. I do not tell them that I'm diagnosing sleep apnea. at all. I always give them a referral to a sleep physician, and ENTs as well. Mm-hmm. by the way, one thing to mention, and I'm gonna talk about that on a separate video, um, there was a study done by Audrey Yoon, she's pretty good, uh, researcher on airway and orthodontics. We found out that when you expand in children, the tonsils and adenoids actually shrinks naturally- Mm. Why? instead of you go there and shave them. Now, to a certain level, the, like- Why, why do they shrink? So here's the theories. Now I'm gonna g- tell you a theory. I don't know for sure, like everybody has their own story. But if I am breathing through my nose normally, means more air flow into there. One of the theories we have in orthodontics, that will develop my sinuses and nasal cavity bigger And then the flow cleans up the area much nicely. So my adenoids doesn't need to go blow up because adenoids is a immunity tissue trying to protect me from bacteria and all that stuff. So air goes through the nose, mucus makes it warmer, and it takes all the particles away so that your lung gets that air pretty clean. But if my nasal cavity is so narrow, my turbinates are are pretty tree style, my mucus instead of being cleaning the air now it's becoming a stagnant area and bacteria start accumulating. It's warm, it's a humid, it's dark. Beautiful for bacteria. Mm-hmm. So then my adenoids get larger to protect my nose. Nice. While they're getting larger, they block my breathing. So when we go there and shave them- not... I don't know if we are solving the real problem. But anyhow, then we start breathing through the mouth. Now my mouth has the tonsils. Tonsils are designed to filter my eating, drinking, I don't know, two or three hours a day. M- maybe me three hours, I eat a lot But what it... when you start mouth breathing, now you're making them breathing filters 24/7. And then you're drying your mouth, which where your saliva have all the immunoglobulin to actually protect your bo- your body and your mouth. So then guess who's taking all that load is the tonsils, so they get larger. So when you expand the nasal cavity, all of a sudden you make the air flow better. And from the air flow getting better, now your adenoids doesn't need to get this effect. They shrinks a little bit naturally, and so as the Tonsils because you're not mouth breathing anymore. That is the theory. Mm-hmm. I don't know if this is 100% accurate or not. makes sense. from a- ...But you always put a theory. It- y- Well, common sense Biological ...and science sometimes- Yeah, I know. doesn't add up. But at least I have to have a story of, of That's in every study we do, we have to pull up some story. At the end, doesn't matter what I think it is or somebody else thinks. The f- fact is those tonsils and adenoids are shrinking naturally. So if I can avoid those surgeries and maybe keeping one of those immunity, uh, tissues are still there in my mouth, that will be great, in my nose. So, uh, that study actually helps a lot into making that understanding for people- Yeah patients, and even physicians. That's awesome. Before we wrap this up-

Life Beyond Dentistry

Dr Ammar 1:09:55

Yep

Aliyah Dastour 1:09:55

up- Okay So I can tell that you are very, very passionate about what you do. Yeah ...As an orthodontist, as a business owner, as a leader, I would just love to know briefly a little bit about who you are outside of all of that.

Dr Ammar 1:10:13

Okay. Yep, that's a good question. Well, I'm very simple person. Um, I'm married to Nour. she's wonderful. I'm from Iraq, she's from Syria. And, uh, we have two kids, Judy and Zara. Judy's on the spectrum, she's lovely. She's always like fun. Sometimes she has her own demands. Zara, you probably watched her, she's going through some personality building right now. But as a family, I think we're very simple. As a person, I think me and my wife, even though we're a little bit different, but we have one thing in common, that we're very I could be very kind and nice, but I'm very straightforward. I like to say what I believe in. Sometimes that might rub people the wrong way. But, uh, I love sports. Um, I love working out. I love to go to the gym. If I'm able to go for three hours a day, I would do it. Uh, work life makes it a little bit difficult, but that's why we open at 10:00. So that's one of the things I'm very passionate about. Um, I go daily. I do weights even though I'm getting older, I get injuries, but weights is something I really enjoy. If I can grab the whole gym's, like, weights, I can put them in, I would love to do that I think your husband is the same I met him. Um, I like hobbies. Um, like flying, um, small RC planes. Not drones, it's RC planes. so You have to really work hard on landing and takeoff. Nice. I used to do it a lot in Ashburn area. Um, love to spend time sometimes with the family, not too much on vacations unless they force me to do it. Uh, but when I go vacation, I kinda enjoy it. I don't know, like- What's your favorite place you've been vacation-wise? Uh, well, there's... Turkey was very nice. I like, I like history if it's up to me, but when you go with the family, you have to do like a lot of family stuff. Uh, we went to North Italy. That was nice. Mm-hmm. Um, recently Marbella, Spain, I liked it. Uh, one thing I felt about it, I don't know if it's because it's vacation or is it just the people there, you just feel everything is on easy. Like, I feel we're in the US here, everything is on steroid, like business, work. It's just go to the max. There, people are a little bit more chill. But again, I don't know if that's just because we're on a vacation mode. But I felt like we went to pharmacy, it's a private, small phar- uh, pharmacy owned by a family, Uh, you could feel like there's a real engagement. Um, doctors are making well, but not crazy like how it is in the US, so they're living their life. It's not too much into like business and all that stuff, and I felt that in every angle of the area. Again, I don't know if that's something I would enjoy. I wish we could live that style in this area, But I feel like Northern Virginia, New York, whatever, like we're pretty intense. Like, we're competing with ourself. We're running so

Aliyah Dastour 1:13:06

hustle.

Dr Ammar 1:13:06

much. Yeah, the hustle. Hustle, yeah. That's- The hustle, life culture. Yeah. Yeah, for sure. Trying to get out of it, but it's not the easiest part. Um- Yeah ...there are hobbies I wish I am able to do them. What are, what are those? I mean, riding horses, that would be nice. Riding horses? I wish I do it. but I- Really? Yeah. I'm not, I've never been an animal pretty close friendly. Like, I'm still anxious around dogs. Yeah. So Like little dogs? Big dogs? I don't know. Sometimes Small? ...could be little, could be... I mean, German Shepherd scares me no matter what. okay? Oh, I love German Shepherds. Yeah. I I just, again, this was culture. I was raised in a way where, where we didn't have animals around. Horses, even a horse, like I get closer to them, they're ginormous. I, I feel more related to them. I think I can train myself into this. If I'm forced around animals, I can work around it. I always liked to fly planes, and I did couple hours, but then I I did some flying, but not, a lot. It's just... It, it takes a lot of time and energy, so that's one of the parts I wish I can watch movies with my wife every night, but we don't do that. Why not? I don't know. I get just- Just life gets in the way- Just, yeah and you're passed out sleeping before you realize it? Uh, I think I go home and it's not watch... I watch a lot of documentaries on YouTube, news. I kind of like that. She probably doesn't like that, right? Well, Noor- How does she sit with you? Noor likes to chill. She doesn't like to watch, she likes to sit and talk. Mm-hmm. And more productive stuff. And I, I tell her, look, I'm tired of my own drama- I want to see somebody's else drama."

Aliyah Dastour 1:14:34

somebody else's

Dr Ammar 1:14:35

So I think that's a part I, uh- That's so funny like to, you know, maybe change. Yeah. Yeah. I'm not into fancy cars or anything. Anything you give me, I do it. Yeah. Uh, tend to eat the same meal at the same restaurant for the next 20 years, fine for me. Are you, like, somebody who once you find what you want, just- Yeah, I'm very

Aliyah Dastour 1:14:52

easy leave it you're cool? Like y- y- you throw me a bone, I eat it. Like, you know, it's, it's- What's your favorite dish?

Dr Ammar 1:14:57

Um, kebab. That's, like my thing. Persian kebab or Iraqi kebab? I would say Iraqi kebab.

Aliyah Dastour 1:15:03

They're different. Okay. Yeah. And- So you like

Dr Ammar 1:15:04

a little greasy. Yeah, it's a little more greasy. And if you tell me, like, more what I've been eating the most is, like, I would say, uh, apple, Fuji apple salad at Panera. That's my favorite order. What is it called? Fuji apple salad

Aliyah Dastour 1:15:17

at Panera. Bread. Okay. Why do we like that one? I don't know. I've been doing it for the last- It's the fruit and the I don't know, vegetables? 15 years.

Dr Ammar 1:15:23

I've been eating that same... Every time I go there, it's the same meal. Mm-hmm. That's it. And then lemonade or a, or a Diet Coke. There we go. That's... And I would do it the same. Like, every time I go to Woodbridge, I go to Panera for my lunch. That's So funny. Another thing, I don't like to be in the same place daily, So I think that's one of the reasons I open multiple offices. So that you can keep- I just have to, yeah keep going around. Keep keep feeling different. And then one time I was gonna come and see you at one office. You're like, "Oh, oh, wait, no, I'm not at that office today." I get it. Yeah. And sometimes I don't know. Like, my team tells "Hey, we're here today." So I kind of go there. Just kidding. Yeah. That's awesome. Yeah. Um, and then in terms of, like,

Aliyah Dastour 1:15:59

10

The 10-Year Vision And Principles

Aliyah Dastour 1:16:00

years from

Dr Ammar 1:16:00

now,

Aliyah Dastour 1:16:01

now, my last question, Yeah. 10 years from now.

Dr Ammar 1:16:03

10 years

Aliyah Dastour 1:16:04

from now. You'll be 54. Oh, yeah,

Dr Ammar 1:16:06

54. okay What's changed and what's remained the same? So my goal body-wise, I wanna be in the best physique because 20 years I did not care for my body, so that's One thing I hope I will be in a good shape by then. Um, practice-wise, I hope my practices are pretty settled. Um, my-- I call it my practice dignity is still high and, um, I still get 80% of my patients coming from word of mouth. I w- I hope this continue. I hope I get better as an orthodontist, and I have doctors around me that we could work around in this. I wanna practice this until the end, and I hope, um, by that age, maybe I will start giving away a little bit of ownership to the doctors works with me, and I becomes their associate. And maybe from 55 to 65, I'm an associate, enjoying doing what I do without the stress of the business and loving what I do. So when I disengage of my practice eventually, I left an operation to doctors who are family-owned, kinda like me, learning my skills or maybe better and doing much better service. So I'm pretty proud of what I left, and I think from business perspective, that is still better than selling to a corporation. I had a guy who taught me with this, uh, basic numbers. Sometimes people get sold into this big money and all that stuff, I think because they buy your own next 10 years of practice as well. So if you add that in, I think I'll be the same, maybe a little less, but I'll be very proud of what I left. I... this is the way I am. I think my wife will be proud, and I think my dad will be proud. Your dad? Yeah.

Aliyah Dastour 1:17:50

Tell me a little bit about your dad. Tell me a

Dr Ammar 1:17:52

Okay. Well, my dad was the head of education when I was raised. I was the youngest out of his seven kids.

Aliyah Dastour 1:17:57

of seven

Dr Ammar 1:17:58

A very principled guy. He stands out for what he does. Never seek benefits of relationships. He always lead, and he takes, uh... How do I say it? Um- I never seen him b- hiding behind anyone. He hides behind himself, and he always more calm when it comes to confrontation in life, and he's very man of principles. Never, never seen him once, uh, gone around for money. But yes, he goes around for success. Never seen him hiding behind strong people. He's the-- He is hiding behind himself. And until he died, he always kept us in a very dignified, like, status, And I'm very proud that I'm his son Just that's He's the one that you look up to, huh? Yep. He's that leader.

Aliyah Dastour 1:18:55

That's awesome. That's beautiful.

Dr Ammar 1:18:57

I think when I came to US, um, I did not wanna ask my family for help or anything. So went through tough life, me and my wife. And honestly- When did you guys get married? When did you- Uh, married without... Well, we married right at the time we come. Like, we got married and she came. Like, that's how it is. And I was here, so it was, like, a little bit not the most classic. I think she's not forgiving me for this. But, uh, it was a paper issue that I couldn't go. It was so much craziness.

Aliyah Dastour 1:19:22

much craziness.

Dr Ammar 1:19:24

I see people nowadays, like, going seeking image, seeking, um, strong, uh, leaders in the societies to get around them, to benefit from them, to learn from them. Which is okay, I got it. But don't... I think that sometimes we live in that hypocrisy when we're, right or wrong, we just follow the interest that we have. Life is so short and we will leave it not with the money we made, not with what we, uh, success maybe we created. It's really of how we did it. So I would rather fail but with good morals, good integrity and... Which I didn't. Thank you. I mean, thanks God I'm, I'm able to make all that success and I didn't need anyone to use, nobody to deceive, uh, not to hide, uh, not to change my principles, not to, um, exchange them for currencies and all that stuff. You could make success if you stand of what you believe in. I don't think you, people should... A lot of the time I, I see them doing this, like they sell their morals for the benefits. I mean, define benefits. Is it money? Is it being rich or have a nice house or? I mean, I could live in my nice house now and I could live in a basement apartment, I'm fine with that either. Like, I don't think this will change who I am and I don't think I'm gonna enjoy it differently. Probably, I would enjoy it anyway. Like, you know what I mean? And I think for people I want them to be like this, especially doctors because we have a moral and ethical responsibility and we should always hold it. And you, don't hear that often either Yeah. I don't know. I think there are people who still doing it like this way. I agree. Yeah. I agree. Yeah, yeah. That's awesome. There was this, um, movie cut which says, you know, a lady would say, "I don't care about money." He's like, "Because you have it." but I, actually, I, I did have it, I didn't have it. Yeah. I don't think it's great to help you kinda have more luxury in life, you have more- abilities- abilities yeah ...and all that stuff. But I don't think it should shape who we are, who we go around with- Mm-hmm what we do, who do we support, what ideas and, um, flow we are with, you know? Yeah. 'Cause a lot of people who seeks money, es- aesthetics, financials too much. to a level that "I feel like, there's no soul in anything they do. Yeah. And I feel with, with social media, we're going that direction a little bit more in general. Mm-hmm. But I feel like from time to time, and this is kinda seems like it's a God's will is this, there's always those people that comes every decade or whatever, and they reshape that little, uh, turning point- Yeah where they become leaders by examples. Mm-hmm. And then they keep the society from going really off. Mm-hmm. Um, because I feel like that's where the society go off the cliff and then those are, those are the types who makes you proud of something, not just being rich or money or whatever. Make you proud of being honest, make you proud of being, uh, productive, make you proud of being hard worker, make you proud of being a good parent.

Aliyah Dastour 1:22:33

Well, I think that that is such a beautiful story. Yeah. Such a beautiful legacy- that you're gonna leave.

Dr Ammar 1:22:39

Thank you so much. I hope we do it again. Yeah. There's so much we could talk about. I know. Yeah. Part two will be in my studio, so we get both in. Oh, that'd be nice. I would love to.