Sit down and listen to our latest podcast, a conversation with Dr. Chris Hart, a dentist, businessman, and product inventor. He’s also known as the mind behind Oventus. In this podcast, Dr. Hart goes on to explain about: - Health issues that can adversely affect dental health
- The importance of continual education
- The path to trying out new things in dentistry (and other places)
Enjoy!

Transcript

Dr. Luke Heazlewood: Cool. So, if you just want to tell us a little bit about yourself. Where you grew up? Where you went to university? Why did you choose to do dentistry? And how on earth did you end up product invention?

Dr. Chris Hart: No worries. So, I grew up in Rocky *indistinct* in central Queensland. Went to boarding school down here. And ended up in university at *UOQ*. When I was at school, it was 80% unemployment in school leavers. So I just wanted to be able to find my way and was interested in healthcare. So I threw down chiropractic, studied science, biochemistry, physiology for a bit. I threw down physio and dentistry. Dentistry came up so, I thought I better finish one of these degrees and start the rest. It was kind of a, you know, a bit of a fluke really. But then, you know, I was probably...I’ve always had an equal interest between the clinical side and the business side. So when I first graduated, I actually went and did some research at Cambridge University and then came back and had a couple of subjects left in the science degree in biochemistry and physiology. So I mugged up the rest of the studies. Pretty much told myself into coming back. Started buying practices. So I bought three. *indistinct* went to the bank and borrowed a heap of money.

Dr. Luke Heazlewood: (Chuckle)

Dr. Chris Hart: And my first business was really practices and I started Smiles Group. So we ended up, I think at the most, all up we had fifteen that we either bought or managed. And the most we had at one time was about twelve. I then started exiting that *indistinct* practices after the GST and the *indistinct* and everything else. And it was about 10 years since I started. So I set myself a ten year timeline to sort of get in and out of that side of the industry. So I started exiting and sold my last half a dozen or so to private equity investors three years ago.

Dr. Luke Heazlewood: Wow.

Dr. Chris Hart: In terms of how I ended up in product invention, it was just patient need. You know, to be honest with you. I myself was a severe *indistinct* suffering from over congestion. Steroids and other constrictor treatments weren't that good long-term. Surgery hadn't worked. and I was desperate for some air, so I got a couple of saliva injector tube and I bend them down the back of my throat one night and secured it with some *indistinct* material.

Dr. Luke Heazlewood: (Laughter). That’s awesome.

Dr. Chris Hart: And that was the first *indistinct* device.

Dr. Chris Hart: Because at the time, I had a dozen practices, we had about 250,000 patients under my care. And I started actually delivering them to my patients who had *indistinct* congestion *indistinct*, otherwise intolerant to other oral appliances. Cuz the reason being, if you've got a blocked nose, you can't shove a big bit plastic in your mouth, you can't breathe through either. So...

Dr. Chris Hart: For those particular patients, I was delivering them and working with my lab technicians, *Michael Slater*. And we did about 50 or 100 I think all up. And they were working quite well. And I’d taken out patents, so got to spend some more money on patent protection--over $150,000 or something. And I thought I wasn't sure whether it had legs, so...

Dr. Chris Hart: ...I had to check with a patent attorney and he referred me to the fellow who's currently the CEO--*indistinct* Technology. He felt that initially it would be about $3 million to bring it to market so I thought, "Forget it. I'm not doing it."

Dr. Luke Heazlewood: (Laughter)

Dr. Chris Hart: Eventually what we did is, we went to different people and we *indistinct* equity arrangements and so I funded the business. I put in about $1 million in the lot, but then also gave equity away to Neil, the CEO; to *Michael Slater* who developed the original prototype; to Mobius Medical, who helped us run the clinical trials. And the money I put in went to the CSR. I would pay them to develop the software development and the 3D titanium printing technology. So...

Dr. Luke Heazlewood: Wow.

Dr. Chris Hart: ...necessity of the moment invention. We invented it for me, gave it to my patients, and then we commercialized it. We actually went from an idea in 2012 to...you know, prototype through a product registered with the *indistinct* and go into patients’ mouth by November 2014. And then listed on the stock market last month.

Dr. Luke Heazlewood: Wow.

Dr. Chris Hart: So you know, we sort of...within 2 years or 3 years...it's pretty rapid progression.

Dr. Luke Heazlewood: Yeah, mate, you must be exhausted. That’s insane.

Dr. Chris Hart: Oh, no. it's all good fun. And...

Dr. Luke Heazlewood: It’s all good fun! (Laughter)

Dr. Chris Hart: I had a bit of time off when I sold the last business. Had about 6 weeks there where I was sitting around twiddling my thumb.

Dr. Luke Heazlewood: (Laughter)

Dr. Chris Hart: And I thought, well, this thing could have some legs and I might have a bit of a luck with it. So I did and it turned out to be a very good treatment for patients. But also a good business and a good investment for people as well. I think that share prices are up about 50% or so at the moment.

Dr. Luke Heazlewood: Awesome.

Dr. Chris Hart: So investors are happy. Yeah, and we're taking it to US, Europe, and Asia now. So...

Dr. Luke Heazlewood: Wow. So, most young dentists, they don't tend to graduate with significant knowledge when it comes to, I’d say, just first, definitions, simplicity, what is OSA and what's its importance and how it relates to us as dentists.

Dr. Chris Hart: Right, so I always say it's Obstructive Sleep Apnea, which is obviously different from Central Sleep Apnea. It’s an obstruction of the airway where it'll either be a complete blockage or resistance to flow, reduced airflow over time. So complete blockage is an apnea. And then reduced flow is a *hypopnea*. So a reduction of nasal airflow of 30% or more combined either 3% oxygen desaturation or an arousal, or both. So that's how we say it. That’s the definition of the AHI or the Apnea Hypopnea Index. A number of events should have *indistinct*.

Dr. Chris Hart: In terms of dentistry, look, AYE, in my opinion, is front and center to a lot of things we see in dentistry. So, if you look in *indistinct*. For instance, in juvenile, *nasolabial obstructions, tonsilid, adenoid hypertrophia infection, asthma, hay fever, rhinitis*, all these things lead to *indistinct* combined with a *indistinct* you know, dummy, thumb sucking, bottle feeding *indistinct* and so forth. So, in the juvenile years, there is a well-documented relationship between airway issues and arch form development. what happens in adults is...well also then on top of that itself, if a child at say before eleven, is a mouth breather, they'll generally develop with reduced inner molar distance, *indistinct*, often with a deviated septum, often a class 2 malocclusion, could have an anterior thumb thrust as well. So...

Dr. Luke Heazlewood: Hmm.

Dr. Chris Hart: ...those particular patients, and bear in mind, you know, the data will show or the literature will show that 57% of juvenile still have one of these airway issues.

Dr. Chris Hart: If those aren't dealt with, either through treating the allergy, the signs for hay fever, thumb sucking, or adenoid tonsillectomy, and arch expansion mouth therapy, these types of things, those patients will go on to have restricted arch form development as adults.

Dr. Chris Hart: And the literature will also show that patients that are over *indistinct*, class 2 malocclusion, high tonsil degrading, high pharyngeal grading, high *indistinct* scores, high BMI, there's a 95% chance that those patients will suffer from sleep apnea.

Dr. Chris Hart: And so, in adults then, not only is upper airway resistance caused developmentally, it also is implicated in the severity in the number of episodes that a sleep apnea patient will have. And it's also one of the main reasons non-response and non-compliance to current treatment modalities *indistinct* and just mandibular dents in the line. And interestingly, with the advanced technology, because we have incorporated an airway into the device that bypass to the upper airway, resistance *indistinct* very similar data to combination therapy or mandibular *indistinct* and multi-level nasal surgery--as was presented at the American Academy of Dental-Sleep Medicine just last month in Denver. No, sorry in June in Denver. so, there's a very well documented relationship between, I would say, in upper airway issues and dentally, we can prevent it by treating those kids early on and not letting them develop into those adult mouth breathers.

Dr. Luke Heazlewood: Yup.

Dr. Chris Hart: And the effect in on dentistry, the flip side of it is that, if you've seen lots of acid erosion for instance, there's a very high correlation between gastroesophageal reflux disease and sleep apnea. As the airway blocks, a reverse pump setup *indistinct* the struggle for breath leads to gastric acid being brought up into the oral environment. They'll generally then grind and throw back their head back to open the airway up. So they're basically pouring acid over their teeth and then grinding and so you see very rapid tooth destruction. So if you see that *indistinct* gastroesophageal reflux disease, *indistinct*, rapid tooth loss, staining of restorations or margins, and uncontrolled bruxing, then they're all signs there's an airway issue as well.

Dr. Luke Heazlewood: Well.

Dr. Chris Hart: Moreover, we should be screening our patients for excessive daytime somnolence, through an *indistinct* scale, or through a snoring outcome survey, or *indistinct*, or something...

Dr. Chris Hart: ...routinely, because if we don't manage that airway issue, we're putting our dentistry in harm's way.

Dr. Chris Hart: So when I first got into this area, I’d come from, basically, looking at craniofacial *indistinct*, looking at airway issues, and trying to have the dentistry that we deliver to last longer.

Dr. Chris Hart: So that was the genesis of my getting into it.

Dr. Luke Heazlewood: Awesome.

Dr. Chris Hart: And without the managing of that airway, we're gonna get ourselves into all sorts of strifes.

Dr. Luke Heazlewood: So, say we start to notice some of these signs or diagnose some of these signs in young patients, from that place, what would you recommend as a process for someone who's not as experienced in terms of them being able to go a bit out, helping their patients who might suffer from it.

Dr. Chris Hart: Well, you know, education is everything isn't it?

Dr. Luke Heazlewood: Yup.

Dr. Chris Hart: And I spend hours and hours and hundreds of thousands of dollars on training and education, post graduation. So, I couldn't tell you the number of courses I attended, like in terms of...on all fronts. Whether it's orthodontics, invisalign, arch form development, implants, full mouth reconstruction, aesthetic dentistry, TMD, sleep apnea. So, the key is to go and get more information. and if ever you see a clinical situation where the dentistry has failed, but you do the best job you possibly could, or if you see a problem that you don't have an answer to, that's the trigger, to go off and do some more training.

Dr. Chris Hart: So that's the first thing. But it's very easy to implement, just within your comprehensive exam checklist...

Dr. Luke Heazlewood: Yup.

Dr. Chris Hart: ...and things to look for, you know, as well as the things just discussed, the looking at the back of the throat, look at the tonsils, look at the *indistinct* of the tongue, look pharyngeal pillars, check the BMI, look at *indistinct*, look at the malocclusion, look at the nasal airway, look under their eyes--have they got dark *indistinct* under their eyes?

Dr. Luke Heazlewood: Hmm.

Dr. Chris Hart: If you see these things happening, it's very easy to ask some questions like, "Do you feel tired at the end of the day? Do you go for a nap in the afternoon? Have you ever fallen asleep at the wheel of your car? Do you yawn constantly?" And in effect, what you're doing there is you're screening that patient for sleep apnea or sleep disordered breathing. Do you snore? Does your partner sleep in the next room?

Dr. Chris Hart: So there's all these signs and symptoms and I’ve actually...you know, we have the lectures that we're happy to share with dentists who are interested, on how to recognize and screen for that. So, once you see these signs and symptoms then it's time to start screening. If you find a patient that does have...that you suspect has sleep disordered breathing, then you need to give your diagnosis. And then that requires for the patient to go and see their GP and get a referral to a sleep physician.

Dr. Luke Heazlewood: Yup. So then...*Oventus?* is like...how...like what would you say is the big differences between Oventus and other oral appliances for treating OSA?

Dr. Chris Hart: Yeah, that is the inclusion of the airway.

Dr. Luke Heazlewood: Yup.

Dr. Chris Hart: I mean, mandibular advancement's been around for decades. It’s well documented. We know that it works in some patients and it's reasonably effective. But what we also know is that it doesn't always work with patients with increased nasal resistance and that increased nasal resistance or throat congestions or obstruction is one of the main reasons for nonresponse, noncompliance to existing treatments. So, the incorporation of the airway allows us to bypass the upper level resistance. So ordinarily, what would happen is patients breathing with their mouth closed as they should and the nasal resistance builds up. So there'll be a switch there, where the resistance increases and the oxygen level starts to fall, the patient will have an arousal and they'll switch to oral or nasal breathing. And what happens then is you get a very unstable upper airway. With the Oventus devices, instead of switching to an oral or nasal breathing, the device maintains an oral seal, maintains the forward mandibular position, but provides a second enclosed airway to allow the air to get to the back of the throat. So it prevents mouth breathing, it prevents nasal breathing, it maintains an oral seal, and the size of the airway just happens to be 50 square millimeters, which is the same size as a healthy nose.

Dr. Luke Heazlewood: Hmm.

Dr. Chris Hart: That’s the *indistinct* incorporated into 3.5 millimeters of *indistinct*. So we basically put a second nose into the space of the mouth guard.

Dr. Luke Heazlewood: Wow. And for dentists wanting to utilize the Oventus device, do they have to do particular training or is there like...what's that sort of things look like?

Dr. Chris Hart: Well, we run our own training courses to enable dentists to deliver the Oventus device. So that's obviously an important start. And within that course we do full day of training on dental sleep medicine in general and how to diagnose and how to manage it and how to work with sleep physicians and GPs and surgeons for that end to make sure that get optimal patient outcome. So, we can certainly provide training on that basis. But also, I think, dentists who are looking to get into this area should allow themselves all manner in the area. So you know, I know the Australian Sleep Association provides training, the Australian Academy of Craniofacial Pain and *indistinct*. American Academy of Dental Sleep Medicine also provides courses and a myriad of profit making training organizations as well.

Dr. Luke Heazlewood: Hmm.

Dr. Chris Hart: But I think if you look, towards ones that are probably...sort of...agnostic in terms of treatment modalities and run by not-for profits, that's obviously very, very *indistinct*, very good training as well.

Dr. Luke Heazlewood: Yup.

Dr. Chris Hart: And if you need to do a particular type of device or you want to use a particular type of device, then there are specific trainings for different devices as well.

Dr. Luke Heazlewood: Oh, thanks.

Dr. Chris Hart: Including ours.

Dr. Luke Heazlewood: So, not to keep you for much longer, but you've obviously very successfully carved out different paths and a different path in dentistry. What advice would you give to young dentists who are wide similarly and may want to achieve similar things?

Dr. Chris Hart: Oh, look, I remember I sat next to a young bloke on a plane a couple of months ago, and I think he asked me a similar thing. I just sort of said, *indistinct* you know, you got to think outside of the box. And you got to back yourself.

Dr. Luke Heazlewood: Hmm.

Dr. Chris Hart: And the reality is that someone tells you something can't be done, it's not because you can't do it. It’s because they can't.

Dr. Luke Heazlewood: Hmm. that's so good.

Dr. Chris Hart: It’s usually very limited by their own experience. The other thing is you've got to believe in what you're doing. Cuz, you know, when the going gets tough, it's much easier to keep going.

Dr. Luke Heazlewood: Hmm.

Dr. Chris Hart: *indistinct* just sit down. So that's probably the three main things. But whenever, we're talking about *indistinct* that's life in general. But in terms of dentistry, it really is about patient care. If you can see a better way to deliver care or outcomes to a patient, then you should chase down that treatment modality. At the end of the day we're all here for our patients. And anything I’ve ever done, whether it was in the clinical business building the network of dentists and within that business we actually had our own training institute and management consultancy as well. So that we could improve the standards of care delivered to patients. And so the evolution of that continued under this business, where we said, "Alright, if there's a problem, you know, in a patient or within a patient population, and we can solve for that, we should."

Dr. Luke Heazlewood: Yeah, that's...Yup.

Dr. Chris Hart: So, you know, that's what drives innovation in the end.

Dr. Luke Heazlewood: Well, mate, I just...yeah, really want to thank you for what you've done. So good to hear about the success that you guys have been achieving. Not without all the hard yards. But thanks, thanks so much for coming on the podcast. I know we'll...all those young dentists will really appreciate that. So...

Dr. Chris Hart: Yeah, no worries. Listen, thanks for having me, mate. If you guys want to shoot an e-mail or whatever, then feel free. I’ll be happy to give advice where it's appropriate and where it's wanted. you know, I certainly, as a dentist, we tend to work to some extent on our own, so the more that we talk to each other, the more likely it is we're gonna get better at coming through for our patients and enjoy what we're doing.

Dr. Luke Heazlewood: Brilliant. And I thank you very much for that Chris.