Protrusive Dental Podcast

Dr. Mahrukh Khwaja, a positive psychologist and Dentist, discusses mental health in dentistry, including strategies to avoid burnout and stress. Topics include seeking professional help, reducing suicidal and burnout rates, cognitive reframing, toxic work cultures, and signs to look out for. Emphasizes the importance of daily resilience training and creating a positive team culture.

THIS is the most impactful interview podcast I have published in almost 6 years of podcasting. Do you resent bringing your work home with you (treatment plans, letters, CT scans)? Do you struggle with work-life balance? Do you have days where you feel unfulfilled? The honest advice and mindset from Jorge Andre Cardoso might just change your career and YOUR LIFE. This is the real deal, Protruserati! https://youtu.be/GJExz_vEH2w Watch IC048 on Youtube As Stress Awareness Month continues, we’re taking a close look at the challenges dentists encounter, from making clinical choices to achieving work-life harmony.  Protrusive Dental Pearl: Explore Jorge Andre Cardoso’s Cementation Guide. This resource allows you to access specific protocols tailored to your needs by simply selecting the type of abutment, retention type, and the cement restorative material you plan to use. Need to Read it? Check out the Full Episode Transcript below! Highlights of this episode: 02:39 Protrusive Dental Pearl 03:41 Catching Up with Jorge Andre Cardoso 05:50 Jorge Andre Cardoso’s Introduction 08:32 Practice Ownership: From Stress to Success in Dentistry 13:17 Balancing Clinical Work and Life 19:38 Education and Work-Life Balance 22:34  Embracing Diversity in Dental Practices 24:19 The Importance of Foundational Knowledge in Dentistry 30:27 Maximizing Practice Efficiency and Personal Fulfillment 37:44 Learning More with Jorge Andre Cardoso For those interested in attending the Conscious Leadership Course this October or November, please act quickly. Visit Soft Bites online to learn more from Andre and Manuela and secure your spot. If you are interested in joining a Protruserati cohort – please indicate your interest in Protrusive Guidance.  Got stress management tips of your own? Share them in the comments! just tell us about what was the most impactful thing that you gained from Andre in this episode. Access the CPD quiz through our app on https://www.protrusive.app, either on your browser or by downloading our mobile app. For the full educational experience, our Ultimate Education Plan gives you access to all our courses, webinars, and exclusive monthly content. Join us on Protrusive Guidance, our own platform for dental professionals. No need for Facebook anymore! 😉 If you love this episode, be sure to watch Dentistry is STRESSFUL with Manuela Rodrigues Click below for full episode transcript: Jaz's Introduction: Protruserati, this might be the most important episode I've ever, ever, ever made. I'm not exaggerating. It is Stress Awareness Month and what me and my guest, Jorge Andre Cardoso, what we cover is just amazing. Mostly him, his brilliance just exudes. And we cover such hard hitting themes that if there was one episode this year of Protrusive that you listen to or watch, make it this one. [Jaz]And please, please, please share it with everyone you care for in dentistry. Because the themes that we cover are things like bringing your work home with you. Do you suffer with that? I have for many years, I still do, out of choice. But for some people, they don’t want that. They don’t want that to be a feature of them as a dentist. They don’t want to have to spend their time treatment planning while their children are waiting. We also talk about the frustrations of there being so many different ways to do things in dentistry. Like you ask one colleague and they give you some advice and then when you ask the second colleague, that’s when you’ve shot yourself in the foot because now you’re getting conflicting advice. You are confused and that’s stressful. We also cover themes like how much holiday should we be taking and how many days per week should an ideal dentist, how should a day look like, actually choreographing your day to minimize stress. And in my opinion, stress is a funny thing. Like, we know we need it. Stress is important for us to function properly and to respond properly to the challenges that we face. But at the same time, we know that stress is not good for us. Chronic stress is not good for your health. That is fairly ubiquitous in terms of advice that’s given. But at the same time, I’ve seen a TED talk whereby they say that actually, the stress is not as important as your perception of stress. So if you think that stress is bad for you and that stress will cause you to have a heart attack, then you might do. But if you think of this stress as a good thing, and actually I need this stress, stress is a good thing, then some studies will suggest that actually you don’t suffer with those perceived negative consequences of stress. Isn’t that fascinating? The other fascinating thing about stress, when we’re talking to non dentists, I got lots of friends in the business world, in my little Afghani Sikh community, lots of people into business, wholesale, retail, that kind of stuff. And when I mention stress to them, when we talk about stress, they always perceive it as financial stress. So when I say stress, what they’re hearing is, I’ve got a lot of bills to pay this month. I mean, the financial stress is a big one. And for some dentists, it could happen. And it can be an issue, especially when you have a young family, new house, new practice, and that can add to our troubles as well. But the real stress is like patient complaints, and how you run the practice, and your procedural things, things not working, like those daily things which really do eat at us. And a lot of non dentists just don’t get that. Anyway, I just can’t wait to share this episode with you now, unusually for an interference cast. This is the interference cast arm of the podcast, whereby we talk non clinical things. Lots of clinical goodness here as well. Now, usually I reserve my Protrusive Dental Pearls for PDP episodes, but I’m going to do a repeat. I’m going to give this as a PDP, but I really want to highlight it here now for you as well, because our guest, Jorge Andre Cardoso, he set up this amazing thing. Now, I’ll talk about it in the podcast as well, but basically, if you’ve ever been thinking which cement or which cement family should I choose for my restoration? Like if you’re doing a specific type of crown overlay and what type of cements are best, what should I be using? So what Andre has made is on brainhands. net, there’s a cementation guide. I’ll put the link in the show notes, but you literally select your type of abutment, your type of retention, like, is it adhesion or is it mechanical? And which restorative material you’re going to be using. Could be feldspathic porcelain or zirconia or lithium disilicate. You just choose through all these. And then you click the button, get the protocol, and you watch the magic unfold in front of your eyes. It’s just a fantastic guide for any restorative dentist. It’s evidence based, and I just applaud Andre for what he set up with his colleague. I’m always here to shine a light on the good people and the good stuff in dentistry. So, Protrusive Dental Pearl, check out the Brain Hands Cementation Guide. It’s free. I’ll also put a link to it in Protrusive Guidance, our app, and this episode will be eligible for CPD. More about that at the end, but I’ll catch you in the outro. Andre Cardoso, my good friend from Portugal, Porto. I miss you so much, man. It was great to just catch up a little bit before I hit the record button. How are you, my friend? [Jorge]I’m very well. I miss you too. I was asking before we start, when are you coming back to Portugal? We had a great time last time. [Jaz]I miss you. I miss the Francesinha. I miss all the great other food that I tried in Portugal. There’s so many reasons to come back, but I appreciate you coming on the podcast again, my friend. Talk about a really important topic. It’s Stress Awareness Month. Did you know it’s Stress Awareness Month in April? [Jorge]Yes, I’m aware of that. Yeah. [Jaz]And I wanted to pick your brains because you are such a great comprehensive dentist. I respect you so much in so many ways. [Jorge]Thank you. [Jaz]And actually, a lot of episodes. I have a Protrusive Dental Pearl. And this one, although it’s going to be an interference cast, I never usually give a Protrusive Dental Pearl, but I actually want to give one today because I really want to highlight something epic that you’ve created. I don’t think I’ve highlighted this on the pearl before. But the on brain hand, you have that cement selection thing. Absolutely mind blowing. So if anyone’s listening, watching this right now, the protrusive pearl of this episode basically is I’ll put it on on the link. Everyone, any doubt you ever had about which cement should I use? You literally choose the type of restoration you have and then conditions and it will tell you which cement and also give you the clinical evidence. So I mean, that must have taken a lot of hard work to set up. [Jorge]And sorry to interrupt you, something very important. We also give a very small selection of dental materials that you can use and all of them, we want to do like a very small amount of materials and none, there is no commercial interest. All of that is only based on what we believe to be reasonable and evidence based and there is no commercial interest and it’s free to use. [Jaz]Yeah. I mean, I’m just blown away. So every time I see some colleagues and I referenced your work and I say, look, check out Andre, check out this website. It’s up. And then they love it. They all log in. So I want to just share it to the wider audience as well. But I want to talk about stress awareness. And then before we dive into all these questions I have for you to really help us to share our stories and overcoming different points of stress in our careers and giving tangible advice for everyone. Just for those people who haven’t come across your work before. Tell us about yourself, Andre. [Jorge]Okay. So basically I graduated in 2002. I worked as an associate for three years. And after that, in 2005, I opened my own practice. That was a very stressful year, very stressful year from the opening my practice, because at the same time I was doing a master’s degree in London. I think I eat depression, maybe not clinically detected, but I was really, really anxious at that time. And it was very difficult for me because I opened the practice because I wanted to do international publications. That was the reason. So I wanted to have control of the environment to be able to photograph and have all the materials. But I forgot that you have to pay the bills as well. That’s not a game, you know, you have to pay the bills. So when you have to pay the bills, if you open a practice, that might not be the best strategy. It was very stressful, but then I learned, basically I learned how to manage a team. I just read, I just went to courses. There was a big influence from a friend of mine called Aalok Shukla from the UK. And he basically brought me out of a black hole, which was, I was completely unaware of how you should manage people because my father has a restaurant and he micromanages everything basically, which is not a good idea in these days and because things have changed dramatically. And we’ll talk about that. The way that you manage a person today cannot be the same as the way that you manage a nurse 10 years ago, or even five years ago, things are completely different. So I meet to a lot of education. I do a lot of education of courses and stuff. We did together a course in Portugal, and I really hope to collaborate with you in the future. But in order to do that, I had to get my practice in order in terms of protocol systems, management, philosophies, culture. So basically, my goal is to do a lot of education and in the future, I want to have six months of vacation a year. That’s what I want. That is my goal. So that’s not easy. [Jaz]I love everything you said. I love that you shared that goal. And I also admire Andre the honesty that you’re very honest to say that your reason for opening a clinic, I think it’s very nice that you shared that with us and your honesty and then the challenge that brought you. And actually, Andre, you need to join Protrusive Guidance. I want you to join Protrusive Guidance on our app and just start engaging in our community because you just have so much experience and background, like Marie recently is one of our colleagues, Protruserati Marie. She posted on the app recently that she’s thinking of acquiring a practice and she asked about like red flags and what are the questions to ask and stuff. And there’s so many, we’ll consider at some point, opening clinics. So before we move on to top attacking this topic of stress, as you said, opening a clinic, starting in the clinic is a very, very stressful thing. What’s the number one advice you would give to someone who’s acquired a practice and is really feeling that stress? Cause it’s like your baby. You have to give it all your attention. Every waking breathing moment is someone who’s in that very dark place because of the practice ownership. What advice would you give to them? [Jorge]Well, a couple of things. So first of all, before all that, before even you buy a practice. If you haven’t bought it yet, ideally, you should ask this question. What is it that you want to do in 5, 10 or 15 years? And really take time to think about that. That can be through meditation, time alone. Just take a couple of weeks, maybe sometimes a month to think about that deeply. What do I want? And what you want now may eventually change in the future. But what is more or less your idea? My idea was to open the practice to do publications. So that would be a goal. So now after, so you have the practice. So a couple of things, very important. Number one, do your math, be very accurately with numbers. You have to really know what you are spending, not on a year, not on a month, every single day. You have to know the fixed costs that, so per day that passes by, what is the amount of money coming out of your pocket? Because there is, in my opinion, there is no more important decision that you can make because if you know that number, it will create the cascade of events and thoughts that will force you to be responsible with finances, which I was not. Why? Because I just want to have the best material spent two hours with a patient to take photographs. It was very difficult because there was a point in time where I had to borrow money from my parents. Parents to pay part for the master. It was extremely, extremely stressful for me because my parents, they basically provide me the course, they provide the education. So they started from nothing. No, I had everything. Why did I have to borrow money from them to pay part of the master? Why? Because I was not completely money aware and that’s really, really important. So you can do whatever you want in your practice, as long as you are financially aware of what’s going on on the daily basis. Okay. That’s number one. Number two, have written systems for every little thing. Everything phone answering sterilization, composite feelings, endodontics. So imagine that you want to write a book about your practice with every single detail, the same thing that’s happened, like say in McDonald’s or the Ritz hotel. So basically everything is written down. Okay. And number three, the final one, I would go for. Emotionally intelligent for dealing with other people. I would learn as much as possible about emotional intelligence, leadership, emotional regulation, communication, all of these, let’s say soft skills. So I think those four things would be really, really important. So know what you want, do the math, have system written down and learn about emotional intelligence, soft skills, and whatever you want to learn. So you have to do these four things simultaneously while pursuing your goal. Because my goal is to write in publications. Your goal may be, okay, I want to buy a practice because I want to sell it in the future. My goal would be, I want to buy a practice because I want to control my schedule, that’s a reasonable goal as well. My goal is I want to buy a practice because I want to make a lot of money. Whatever the goal is, these four components, they need to be present. This is my opinion. Yeah. [Jaz]I’m so glad I asked you this off script because this wasn’t part of our script. I’m so glad because that is just an absolute gem. I’m going to make that into a reel and share with everyone because that was just absolutely fantastic. And so just a couple of reflections on that. You mentioned day rate. A lot of people talk about the hourly rate as well. When you start thinking about how much it costs per hour to run per surgery, it’s really, and one of my friends, Koray Feran, great, great, great dentist in the UK. You might know him actually. He talks about how practice owners, they have the fear inside them and perhaps sometimes as associates, I can speak as from associate that we don’t have that fit. And it’s not that we lack ambition. It’s just that we’re completely seeing it from a different frame of mind. And so sometimes it’s good for associates to put ourselves in the principal’s shoe, but also the vice versa. So that’s an important thing there. The other thing you mentioned about systems protocols. I love that you said about, McDonald’s, Ritz, everything is standardizing excellence. How can you ensure that when one of your associates does something, it is just as brilliant as when the other associate does it or how things are sterilized for everything. I love that the whole thing about protocols, including how you do composites, how you manage perio in the practice so you can really scale excellence, right? It’s about scaling excellence. And the last thing you mentioned. It’s about emotional intelligence that all relates to staffing because the number one stress. All my principal friends tell me is staffing and people. So I’m just blown away that you said all those things to actually tackle the questions I had for you today, Andre. The first thing I want to talk about is you may remember a while ago, we talked about comprehensive dentistry and making comprehensive plans and using make me clear. Fantastic. Another wonderful thing that you set up in terms of treatment plan presentation. You said this thing to me. You said, the worst thing that can happen to you is that you become successful in comprehensive dentistry, because when that happens, like, it brings so many challenges and problems, but it’s a beautiful thing. It’s a beauty. It’s quality problem. As Anthony Robbins says, it’s a quality problem to have, but it made me laugh at the time. It’s like you’re so true. The worst. What’s the worst that can happen? The worst that happens, you actually become successful in comprehensive dentistry. Now I’ve been thinking when I started to become more comprehensive, one thing that I had to sacrifice, which a lot of dentists may not be willing to sacrifice would be the following. The fact that I had to bring my dentistry home with me. I had to look and stare at photos and think about people’s cases at home in front of laptop. When I could be at that time, I didn’t have kids when I was starting stuff, but like doing all the things that you could do. And some people are just not prepared to do that. I feel as though in this day and age with the way that we work in dentistry at the moment, and maybe you’re going to offer some suggestions of how we can overcome this, but to be comprehensive, to do the kind of work we want to do. We have to bring our cases home. We have to do a lot of thinking at home. We have to do a lot of posting of our cases, emailing patients, treatment plan, stuff doing at home. And this is a big source of stress. I feel as though my colleagues who have partners who are dentists, spouses who have dentists, they get it, but then there’s a lot of friction and problems who are dentists, who have spouses who are not dentists. They’re like, why are you constantly bringing this home with you? So I guess my question to you, Andre is, do you think there is a way that we can still be comprehensive? But not have to bring our cases home because I think that is a source of stress having to bring work home with us. [Jorge]So I’ll answer but before that I’ll answer another one. Number one is Can you not be comprehensive today? I don’t think so. I think it’s very difficult. Maybe NHS base or public health system base, you can do that. But the thing is that everything is multidisciplinary. Everything is comprehensive because now you have a 50 year old male that understand that before the veneers, you should do Invisalign and you have to do some perio for recession and then some implants. So it’s very difficult that you say, oh, I’m not going to be comprehensive. So the thing is that If you think that comprehensive and this is not for you think twice because it’s coming to get you, number one. Number two is I thought about a lot about this. How can we manage this need, this absolute need of bringing work home? You have to integrate at least partially that in your working hours you have to integrate that. Because the thing is that while it is delegatable you can delegate sometimes lab communication in some aspects you had. You can do some of that. In some aspects you can delegate some lab communication, but for treatment planning, you have to do it yourself. There’s no other way. So I would integrate that. I would integrate that in your clinical hours. My personal take on that would be, and this can be difficult for some people, would be to have a conversation with your family. Say, look, there’s part of my work that I have to do at home. I’m trying to either start later, at the practice or come early and I will do some work at home. Or ideally, you should leave the last couple of hours, at least one hour at the end of the day to take care of that while you are still in the office, it depends on what works best for you. But I thought a lot about that. There is no other way except integrating these, which are working hours within your working hours at home or in the practice. Now this might be scary. Why can it be scary? Because, well, but I’m not making that much money. The thing that comprehensive dentistry can eventually scare you is because it seems that you are not seeing as many patients per day. As you were with single tooth dentistry, but that will eventually catch up and you have to realize there’s no other way of running away from it. Yes, you may have a lot of your work that is single tooth dentistry, but like I was telling you, you have to face the fact that comprehensive dentistry is here to stay and you have to adapt yourself. And one thing very important, which is that the price of comprehensive dentistry is not proportional to single tooth dentistry, which means like, for example, six crowns, six individual crowns could be six times plus the price of crown. When you are doing full mouth rehabilitation, you cannot say like, oh, it’s 10 or 20 crowns, 20 times the price of a single crown. You have to integrate a lot of things. You have to add that to the cost of provisionals, sometimes one or two sets of provisionals. And also, reflecting time or treatment planning time. So the price of comprehensive dentistry is exponential. It’s not proportional as it is single tooth dentistry. So sooner or later you will have to charge more. You may initially charge less because you don’t feel very confident, but sooner or later you have to see that you have to charge more because the price will skyrocket in terms of provisionals, breaking of provisionals. Time that you spent in front of the computer. So you have to accommodate all that. [Jaz]Thank you, Andre, for that. I’m just putting myself in the shoes of, I’m an associate, but I’m just thinking if you are in the wrong environment for comprehensive dentistry, then it’s a total loss already. You’re really in an uphill battle, but I’m just trying to think like, sometimes you as an associate want to be comprehensive, but the environment is not quite there. And so we need to really mold our environment. And so the advice I would give is imagine you’re an associate. It’s very difficult to have that conversation with the principal and say, hey, actually, between 11 and one, I’m going to block my diary and not see patients and not generate an income for the clinic for you, because I am thinking about cases. I’m doing some lab work. I’m doing that kind of stuff. As an associate, you don’t really have enough bargaining power when, like we said before, the principal knows their numbers. We have an hourly rate. So I think the advice we can give is if you’re in the kind of environment where that’s difficult to achieve to do what you said before, which is come in an hour earlier, stay in an hour later if your goal truly is not to bring it at home because you can’t overcome that. And the other thing about it actually is education because when we qualify for dental school, we are nowhere near being comprehensive. And so we have to do courses and reading and learning. And you know what? I think there’s no shortcut for that. I think the first five years, first 10 years and forever really, we always need to dedicate that time to do it. So again, where do you find that time from? So my next question that leads into this is Andre, how many hours per day and how many hours per week and how many days per week kind of thing you think is a good mix between actually being in someone’s mouth. And doing the education, the treatment plans, the non clinical, without losing our sanity. [Jorge]I think that the percentage of that, in my personal opinion, would be between 10 and 20% depending on how deep you are in your story into comprehensive dent. For example, I do a lot of comprehensive dentistry. Mine can be about 20% of my working time. In the beginning it can be like 10%. [Jaz]So what you’re saying is 10% of your time goes towards comprehensive dentistry? Is that what you mean? Sorry. [Jorge]No. 10% of my time works is for outside of the share work, which is education and treatment planning and everything between 10% and 20%. [Jaz]Got it. And then therefore, how many days per week should you be clinical? [Jorge]So I would say that I think that four days would be maximum for your own sanity. And the final day of just education and treatment planning. I think that’s a good relation, four to one. [Jaz]Yeah. I think that’s good. And I think a lot of people say, three and a half and whatever works for you in your phase of life, right? There’s different phases of life and it’s a conversation that you need to have your family as well. And sometimes you tell the family that, okay, I’m going to go in an hour early and come back an hour later so I can do the treatment plan stuff. But then also, these courses and some education time that you need, if you have this knowledge gap that you’ve identified, this skill gap, and sometimes it involves dialogue and emotional intelligence and conversation with your loved ones, who, especially if they’re not in dentistry, to understand what you’re trying to achieve here. [Jorge]Okay, so one advice would be tell the practice owner. Look, I am starting to this comprehensive dentistry journey. Just give me give me some time to do proper initial examinations and let’s see the return of that financially within one or two to the old way. But let me just give some proper initial examination and proper treatment plan presentation. Give me space and time for that and in the beginning, I am learning. I don’t want to be paid over that. Just give me some time and if results happen, we’ll go this path. If not, we’ll go backwards. This way, you will be offering, you’ll be doing like a, a irre fusible offer to the practice owner. [Jaz]I think the lesson here and what we’ve shared in the last couple minutes is there needs to be a dialogue with lots of people, your family, your principal, and you can’t just expect to change something about how you practice and your goals without sharing with the universe what it is you’re trying to achieve. When you start to let people know your intentions, then you can actually break down the barriers and actually work in a common goal. So I think that the main tip there is okay. It’s great to have these aspirations, but don’t just keep it in your mind. Speak out loud and discuss this. Try and seek a win win with family. Try and seek a win win with loved ones. Try and seek a win win with your practice principal and your practice and your nurse, even your nurse. Everyone needs to be in on it. You can’t just do it alone. Now, speaking of doing things alone and then collaborating. One source of stress that I always had when I speak to our colleagues, a constant source of stress is the following, whereby there are so many different ways to do anything like I thought in restorative dentistry, we have so many different collisions and different viewpoints and techniques and ways to do things. I thought restorative dentistry and occlusion. I thought that was very controversial. Then I did a diploma in orthodontics and I was like, oh my goodness. Orthodontists can hardly agree on anything, right? Like there’s so many different school of thoughts in orthodontics. And that really opened my eyes. Like, wow, there really is so many ways to do things. I remember when my educational supervisor, Raj Ratan, many, many years ago, he asked us a question. He said, what would you prefer? Would you prefer that everything was a rigid system, and if you want to do a composite, there’s always this steps, and that’s how you do it, and there’s nothing else, and that’s how you do it? Or, do you prefer a system whereby, actually, you can pick and choose, and there’s a bit of ambiguity, and most of us, and we were like one year qualified, most of us, put our hands up for the rigid one, because when you’re a newly qualified and you don’t even know the foundations so well as well as you want to, you kind of want a recipe book. We actually crave a recipe book. When you don’t have experience, when you don’t have enough knowledge, you want a recipe book. But when I started to change my mindset and my perception, actually the beauty of dentistry is that we can do things in so many different ways. And if we take that away from us. Then our proficient actually suffers. And I actually started to enjoy my dentistry more when I started to see the beauty in this, but the problem happens. Andre and something I saw on your instagram page is when we seek advice from a colleague, a mentor, and then we seek advice for that same case from a different mentor. We get different opinions and that can be a source of stress. So my question to you, Andre, is how have you managed this in your mindset, in your career, in your stages of learning that actually sometimes there are too many chefs and too many chefs spoil the broth? How do you think about this? [Jorge]So I think this is really tough one because I think that dentistry starts with a lot of complexity and then you just start to funnel it, funnel it, funnel it to create your own ideas and your own protocols. So I’m sure it in the beginning for occlusion for you was completely different and now because you teach about it, you have in your mind the paths, the guidelines, and it’s much easier now. My recommendation for that would be to resist social media education in bits. I would go and read the classics. I would go and read Dawson. I would go and read Magne. I would go and read Lindhe. I would choose three or four big books where you would start. Perio, I started with Lindhe. You don’t have to read the whole book, but just try to see whatever you have. Now just go and read that chapter. So Lindhe is for Perio. I would go for Dawson or eventually Okeson for occlusion, and then you can eventually disagree from Dawson in the future, but I would start with Lindhe for Perio, Dawson and Okeson occlusion. Maybe read some, I would say, Fradeani to see the opposite situation in terms of occlusion. I will also read Pascal Magne in terms of biomimetic dentistry. And I will stick with the classics. In the first years of my career, this is what I did myself, because I am with you as well as you, you are probably, you remember the world before the internet and we had to use books. So I would read the classics, but really the classics. I will read the classic of Perio, which is Lindhe and the classic of occlusion. And I will start from that. Then once I had those foundations, then I would go for bits of information and start doing some of the courses, because I think that for Instagram, there’s just so much things out there. And I think this younger generation is used to learning by bits, by its soundbites. And this can be very addictive as we know. But for you and I, because we provide education and we had to read the classics, I’m sure you read the classics of occlusions, right? [Jaz]Absolutely. [Jorge]That is not very confusing. But if you haven’t passed by the classics, it’s completely confusing because you hear this and you hear that. And also there’s a lot of issues in pre-grad school because of lack of funding. And sometimes the preparation is really, really basic. So I would really go for the classics in the first years of my careers and then expand from there. It doesn’t mean that you should always stick with the classics, but then you have the foundation where you can start to create and to filter your own ideas and where you are going to come go and find for the knowledge. Another thing, I think that even if you go online, I would go for structural online education, like what you do, like you have a structured online program. It doesn’t have to be present, but there’s a structure for the person that created education, thought about the directly, the pedagogy. So there’s A, B, C, and D because I’m sure that when you create a course, you think about what will be the student experience and it’s a stair. So I’m not going to talk about the third step before going to the first. So we’re going to first step, then the second model. Because that really is important today, because otherwise you’ll get confused, so you have to resist. Once, unless that you are in the position that you have very confident in your knowledge, then you can hear the soundbites and the small pieces on Instagram, which are important, of course. And remember, for example, Marcus Vlatic does an amazing job with spreading education, but it’s small bits. It’s not structured. It’s heads and soles place, but I think that you should focus on the basics, the classics, and then go for structured education. And then eventually you’ll feel more comfortable learning from small bits of social media and sort of education, which is also important. Of course. [Jaz]I think your main point there is really make sure we nail the foundations and with the point you made about the structure and having structured learning where just like you said, when me and you make education, we think very hardly about, okay, first we need to walk before we can run. In fact, me and two colleagues are writing a book called Problem Solving and Occlusion. Very basic one for the young dentist. And we’re thinking very hard about chapters. So before we talk about checking the occlusion, we’re actually talking a little chapter on articulating papers before we then the use of it on conforming with a basic composite before we then talk about a simple crown and how and then we talk about the onlay where things a little bit difficult to check the occlusion. So there’s a stepping stone. And again, it’s the foundations and it’s right. End this question with the following quote. My friend Alan Matthews from Scotland, I don’t know if it’s his quote or not, but I quote it a lot, which is basically listen to everyone, but do what feels right to you. Any one stage in your career, you are a, as Zak says, a patchwork quilt of all your mentors and teachers and books that you’ve read at that moment in time. And you’ll never have all the answers and you’re always a constant evolving clinician. But at that moment in time, just respect that. Okay, with the best information that you have at that one moment in time, make the best decision you can, and maybe that decision will be different five years later. And just be at peace with that. But with the moment that you have, with the best available knowledge, whichever one feels right with you for your patient, go with that piece of information. When things get a bit confusing, when you’re not really sure which path to take, listen to everything, but whichever one feels right to you at that moment in time, and don’t stress too much. If you get stuck on that decision, then you cannot move forward. And that itself is not a nice place to be. Before I ask the final question, any reflections on that, Andre? [Jorge]Well, yes. And I will add to that the fact that do the best with your current knowledge and with the current tools of the practice. Sometimes you only have this composite. Sometimes you only have this adhesive. Sometimes you only have this limited amount of time. So don’t stress about that. It’s always good also to work on depression the first year. So sometimes you may want to do like a layering composite restoration, but it’s just not within the budget of the patient. It’s just not within the time limitations of the practice. It’s just not within the composite existing on the practice. So do whatever you have with the knowledge that you have and with the tools that you have at this point in time and just get over that. It’s fine. Just do the best that you can. [Jaz]I love it. Fantastic. Well, the last question I have is respecting stress awareness month and the real point of this podcast is just whatever different questions that we’ve asked and different things that you’ve given so much value today, different people will hear it differently depending on what stage of career they’re in. [Jorge]Absolutely. [Jaz]Any part of that where they think, you know what, this is a good strategy or good mindset process to come from to help reduce my stress. What do you think, Andre, of the themes that we haven’t yet explored? What is the number one thing that you want to now touch on as a final thing about, okay, this is a big stress issue in our profession and what tangible advice, actionable advice that you can give our colleagues listening and watching right now so that we can improve their lives in some way? [Jorge]I would say that if you are a practice solder, I think that you should surely considering think working in that practice. More, but improve the part that you work, that practice more than you work in the practice. So think about that. Think about how you can improve the practice and not spend so much time working in the practice. So one thing is work the business and not work in the business. If you are an associate, right? When I mean working on the practice, it means the culture, the systems, the financial awareness. And also the emotional, so cultivate yourself as a person. Now if you are an associate, it’s the same thing. Do try to work nonclinical stuff. Try to see how you can improve your education, how you can improve your communicating skills, how you can improve your treatment plans, how you can improve your comprehensive dentistry. And also work very seriously on your emotional intelligence. So I think that today we need to think more and more about that. Now regarding the emotional intelligence and the mental health, I mean, there’s something that I think that it’s really important to say in this podcast, which is, and we are all different, but I see one very common thing, which is I see a lot of exhausted colleagues because they work in excessive amounts of hours. I think that taking time out of work, either for family, for vacation, and very specially for exercise and for do some sort of activity that you like. It might not be exercise, but just do something that you like. Most often than not, it involves exercise like outdoors activities. I think this is really important. I think that we are forgetting the importance that being outdoors gives to you, even if you are not aware of that. I mean, go for a walk in the park, stay more time with your son. We believe that is just something that is okay, I’m not working. I’m just spending time with that person. I’m just spending time outside. I’m just surfing. I’m just traveling. But the fact that it’s in your brain and your soul is unpayable. There’s nothing that can pay that. And I think that today we finally start to see, especially after the pandemic, this shift, which is people are realizing that life is not about work. The most important things in life are not only work. Work is an important part of life for your self expression, for creativity. But if you don’t balance with the most important thing of all, which is human connection. With others and with yourself. If you don’t focus on that human connection with others and with yourself, because if you are not well connected with yourself, it’s very difficult to do human connection with others because the life as people used to say, which is it’s not about the goal, it’s not about the journey. But the most important thing is about the people that come together with you. Because that’s- [Jaz]I was just going to say this. Cause I was just going to say that, Andre, you taught me two years ago. You said this quote. I was literally just going to say, you stole it from our mouth. I was going to say that you’re the one who said that life is not about destination. It’s not even about the journey. It’s about the people. And you just said it right there. And I absolutely love that. And actually recently on our Protrusive Guidance app, one of our colleagues, she sent a message, if you have a chat function and she sent a message, do you guys sometimes feel like giving up? That’s all she said, right? And you could just tell she had a tough day at the clinic, right? You could just tell right? Yeah, and the outpour of support and resonating with that and advice that’s been pouring in the chat. It’s just been so heartwarming and and one thing that I offered it’s been absolutely brilliant and then having physical exercise and physical walking and that kind of stuff is mentioned a lot one thing that I use a lot which mean my wife both use a lot actually this technique is we always need to have our holidays booked a year in advance. So I know exactly what I’m doing in June. I know what I’m doing in October. I know what I’m doing in December and I’ve got these booked out. And it is so nice for the mind to know that, okay, you know what? Sometimes things get tough, but you know what? We’re almost there. We’re going to have a nice break and just rather than when things get so stressed and you burst and you don’t have anything booked, you don’t have something booked, it’s not a nice scenario to be in. So regular breaks that are purposeful are for me as an important technique for me. [Jorge]Yes, absolutely. Because it’s something that you look forward to on a regular basis, on a regular basis, and let’s be honest here, dentistry, it’s one of the most stressful situations for a variety of reasons, but basically you are dealing with, my friend Aalok Shukla says this dentistry is a bunch of it’s one scared person inside four walls, together with a group of people with sharp instruments. So, this is as stressful as it can be. Doctors, they treat patients, they do delicate procedures while patients are asleep. We do delicate procedures in a very sensitive part while they are awake and they have expectations, they have pain, they have insecurities, they have I mean, it’s really difficult. So dentistry is you have, it’s like a high performance athlete. You have to see yourself as a high performance athlete and performance athletes, they have time for sleep. They have time for eating. They have time for exercise. I mean, you have to understand that there’s a lot of time outside the practice that you should really used for recovering and human connection. And even in the practice, I mean, what’s the point of treating a patient if you don’t have a human connection with a patient? What’s the point of opening a practice if you don’t like yourself? So work towards liking yourself, work towards connecting to your self, because at the end of the day, nothing of this makes sense if you don’t connect with patients, if you don’t connect with family, if you don’t connect with staff, if you don’t connect with other colleagues. It’s all about connection. That is the ultimate goal. So let’s never forget that. The ultimate goal. Yes, you can make money, you can have a family, everything, but you should connect with these people. That’s the main goal of life. It’s about human connection. It’s not about anything else. So use your success, use your creativity, use your business, use whatever you are doing. Use your education to make better human connections, to help other people so that they can help you. Because at the end of the day, that’s all that there is. [Jaz]For those listening on Apple and Spotify, you’re not seeing that I’m smiling. Everything you’re saying, I’m just smiling away, because despite the fact that my son has walked in and he’s sitting there, despite the fact that my mum has walked in a few times, right? This is probably, I’m going to say, the most fun I’ve had at a podcast. This is the most impactful podcast. I think I’m probably a pleasure to be involved in Andre. Honestly, I’m so happy. Thank you. We’re covering this topic. And I’m making notes on the back of this, this card that was given because I couldn’t find my paper. I’m congratulating us about a son one year ago. So just past the mishmash and me being in my PJs recording this, this has been a great podcast. One of the best podcasts, one of my biggest contributions, thanks to you, to dentistry. Thank you so much for this. I am just, I can’t wait to get this out for Stress Awareness Month. Andre, how can we learn more? Because you need to tell us about the Soft Bites podcast that you and Manuela, unfortunately Manuela couldn’t join us today, she’s absolutely brilliant. But also, tell us about the retreats and the courses, because the retreats are exactly this topic. Please tell Protruserati, I really wanted to learn more from you. [Jorge]Okay, so basically, once a year, sometimes twice a year, we do a retreat in the south of Portugal, in Sagres. It’s called Conscious Leadership Course, and it has these two components. I’m much more of a rational person, and Manuel is much more of an emotional person. So, basically, I teach a lot of systems and protocols and tips, and Manuela in mindfulness. So, it’s four days that we have in an amazing environment. It’s very informal, so we help each other, we give the lectures, we do some meditation, some other activities, and we think about the struggles in dentistry, and we provide some mechanisms and tools that you can implement in your practice right away, and we give all the templates, all the formats that you can eventually use right away. So the next one in Sagres will be on the 3, 4, and 5 of October, that weekend of October, in the South of Portugal, this year, And we also have one upcoming in November in Amsterdam that we were invited to give, but you can go to softbites. online and stay tuned for more information, softbites. online. It will be lovely to have you there. And it’s basically about at the end of the day, using dentistry to fulfill, like you were saying the most important thing in life, which is being good with other people around you and being good to other people and use dentistry as a means for that. Okay? And of course, that for all that you need to have the financial success. You need to have the time offs. You need to have the exercise, but at the end of the day, lose all those things as a creative way to give more and more of yourself to other people. [Jaz]How many people do you typically plan to have in the retreat? [Jorge]We don’t, usually don’t accept more than 12 people. That would be maximum. But usually what we have is about nine because we want to, basically, we go to dinner. We have some drinks at night. We go to the beach. [Jaz]I can tell you guys now that Andre looks after you, looked us after. What was that drink that you got for us? What was that drink that you introduced me to? It was like a, was it lemon flavored? What was it? [Jorge]Oh, limoncello. [Jaz]Limoncello, but no, but it was Limoncello, but it was a Limoncello, Mohit Sangria. Yeah, yeah, yeah, yeah, yeah. I mean, I can vouch for your hospitality for sure. But you know how last time we talked about digital VertiPreps, right? And so my team will put a thumbnail up for that. And we’ll put a link for SoftBites. online, but also that VertiPreps episode we did. But based on that episode, we kind of were just chatting like, hey, we’re going to come to Porto, right? And so in the same style, I would love to organize 12, 15, whatever people, basically, Protrusive community to come and do the retreat with you. I would, I think it would be great. I’m always looking to like host a conference, something like that. But I think to do a small numbers and something so meaningful and so, so big. So maybe this will be the birth of that. So I’m going to put something in the show notes, a link to register interest, to go and learn from Andre and Manuela about this retreat, because I think it’s just much needed in dentistry. But for those of you who are looking to go in October, November, please don’t delay. Check out SoftBites online, learn from Andre and Manuela, for sure, great people. And honestly, I’m just so grateful for you giving your time to talk about these kind of things with us. [Jorge]Well, thank you so much. It’s always a pleasure to talk to you. And now go and play with your son. [Jaz]I’m going to Easter holidays. You should see him. He’s just looking, he’s just climbing the window there. Look, look, look. So anyway, it’s close. Thank you so much, my friend. God bless. And I can’t wait. And hopefully I’ll be there with the Protruserati on this retreat with you learning mindfulness with Manuela and learning efficient systems with you, my friend. [Jorge]Yes. Thank you so much. Take care. [Jaz]Well, there we have it, guys. I told you that that was a good one, right? I hope those themes that we covered really resonate and they help you to make some decisions, have some important dialogue, have some important conversations, get you to think about how you choreograph your day with intention, have some sort of goal in mind. I’d love for those of you on the app, Protrusive Guidance, under this episode, just tell us about what was the most impactful thing that you gained from Andre in this episode. I want to thank you guys, part of the Protrusive Guidance community, just for being the nicest and geekiest dentist ever and making our magical little community what it is. Do check out Manuela and Andre’s podcast, Soft Bites, for more of this kind of stuff. And if you are interested in going on a retreat with Andre and Manuela as part of like a Protrusive cohort, then probably in 2025, I think this could happen. Haven’t asked my wife yet. So I haven’t got level one permission, but I’ve been true to my word in the past. Every time I’ve said on the podcast, okay, hmm, I’m going to go here. Be it AES or be it the Porto. We went to see Andre for Verti Preps. I made it happen. So I’m earmarking 2025 sometime when the weather’s good in Portugal. Let’s go on a retreat with Andre and Manuela. And the way that you can signal to me your interest is by DMing me on Protrusive Guidance. Don’t do it on Instagram because it won’t get I mean, yes, we look at Instagram, but it’s managed by the team. Please DM me on the app Protrusive Guidance. Head to protrusive. app. If you’re not on there already, please get on there. It is the nicest and geekiest community of dentists in the world. So I want you to DM me on there and tell me, Jaz, put me on this wait list or this interest list for this four day retreat in Portugal with Andre and Manuela. And of course, if you want to go sooner than that, then just go. I think they’re doing later this year, 2024, they’re doing some retreats. Go to it. But if you want to go as a protrusive cohort, maybe this year is not a good year for you, then signal your interest to me and I’ll put you in our little list. Please don’t forget to share this with a colleague. If you think that it’s profound and it’s helped you, it’s likely going to help your colleagues as well. As part of Stress Awareness Month, please do share it with a colleague. Thank you so much for listening all the end. Once again, this is Jaz Gulati signing off. See you same time, same place next week. Bye for now.

In this podcast, Jaz and Emma dissect a routine oral health exam, including dentures, dental composite knowledge, and details of success in dentistry. They discuss what a check-up looks like, personal touch in exams, defining a healthy mouth, and various muscle assessments. Topics include patient history, soft tissue evaluation, periodontal exam, magnification importance, and building confidence in dentistry.

Discussing the struggles of perfectionism in dentistry and the importance of embracing failures for growth. Dr. Marco Maiolino shares insights on setting daily standards rather than perfection. Highlights include the impact of imposter syndrome, lessons from aviation, and bouncing back from failures

Dental Student in THREE different countries?! This is a story of grit and determination. I hope that it will allow us all to reconnect with that burning desire we once had to enter our profession. In this episode, we meet Nav, AKA the_stu_Dent who has had the craziest journey as a Dental Student. Not only defined as a mature student, but as a British born overseas one now working his way to qualifying in Slovakia, with hopes of eventually returning to the UK where he wants to practice full time in the near future. https://youtu.be/wK1INeI_gdQ Watch IC047 on Youtube Check out this entertaining episode, where we uncover what makes the_stu_Dent tick and why he ended up pursuing Dentistry with such determination, the highs and lows, and how he ended up trying at 3 different Universities in 3 different countries, just to fulfill his dreams. Need to Read it? Check out the Full Episode Transcript below! Highlights01:35 – Nav, the-stu-dent Introduction 04:25 – Why Ukraine and what year did The-stu-dent enter?09:18 – How did Egypt come about?14:16 – Failure was not an option16:24 – What happened when The-stu-dent visited Egypt first-time around?19:14 – 3rd STOP – Slovakia.21:54 – What are the fees like in Slovakia?25:13 – What was the decision behind choosing Slovakia over alternative countries in the EU?27:15 – What has The-Students experience of Slovakia been like, and how much clinical exposure do you get?30:58 – Are you working part-time to fund your dentistry?35:17 – What are The-Stu-dents final words of Wisdom? Access the CPD quiz through our app on https://www.protrusive.app, either on your browser or by downloading our mobile app. For the full educational experience, our Ultimate Education Plan gives you access to all our courses, webinars, and exclusive monthly content. Join us on Protrusive Guidance, our own platform for dental professionals. No need for Facebook anymore! 😉 If you liked this episode, you will also like PS002 – Adhesive Dentistry for Beginners Click below for full episode transcript: Jaz's Introduction: Imagine being a mature dental student who has to go to study in Ukraine. And then you realize actually the course you're on actually was potentially a fake course, and then you had to go to Egypt. Jaz’s Introduction:And then for one reason or another, which we will reveal on this podcast, you end up then moving, transferring to Slovakia, and it’s now been something like seven years, but you’re only still in your third year. Sounds crazy. I know, but trust me, this guy, Nav Bhatti. His desire and his hunger to get into dentistry is amazing. It’s really admirable and I think he’s got a really funny story if he doesn’t mind me saying this. It’s funny because, like, he’s the type of guy who’s very happy go lucky. He’s very straight talking. He’s humble and someone who you can look back and laugh about it. But he’s been through a real tough time with all these countries. And I have so much respect for, again, once again, for his desire and his hunger. And so now he’s in a good place in Slovakia, but it makes for a fantastic episode. I think guy’s in for a real treat, something a little bit different. This is the kind of episode that you listen to once you’ve had a really hard day at work. And maybe you’re not ready for like, immediate dentine sealing and deep margin elevation and air particle abrasion. You actually just want to just listen to a protrusive podcast that’s a bit more light and you’re just curious. You’re curious as to what leads a dental student from country to country to country in the pursuit of their dental degree. So I hope you enjoy this interview with Nav Bhatti and I’ll catch you in the outro. Main Episode:Nav Bhatti, aka The Student, the most international dental student ever, which there must be a record and you must have broken every single record. So where this stems from, let’s dive right into it. Okay. What is your story, man? How do you even begin to tell your treacherous journey through dentistry? And God bless you, a couple of years away from qualifying. But how have you come? You’re in Slovakia. You’ve been in Egypt. You’ve been in Ukraine. God, you know, God bless Ukraine. What’s happening, man? [Nav]I’ll tell you what, it’s been a crazy, crazy story. I mean, I’m 37. So it goes to show that there’s a lot that’s happened beforehand. That’s kind of given its hand as to why dentistry and then the journey in itself. But if I was to quickly sum it up for you, I was doing a completely different life before this. So I was a national account manager. I qualified from Brunel university in West London. I was doing economics and business finance. I came out there, worked for Heinz, for example, worked for Unilever. My account managed grocery stores as big as Morrisons online, such as Domestos and Cif, which everyone has in their household. Dentistry was never like, no one would ever piece that together. But I actually have a brother in law of mine, who’s a big fan of the Protrusive Dental Podcast as well. So shout out to Dr. Nasser as well. He would always turn up in the nicest cars. And as a youngster, when I used to see that, I was like, hey, do you know what? I want a piece of that action. So dentistry was kind of always there. And I’d always taken an interest in sort of with the Asian background of be a doctor or a dentist as you grow up, missing the mark in my A levels. After going through account management for a few years, I kind of realized I was contracting quite a lot. So I was in for six months, out for three months, in for six months, out for three months, and it became a bit stagnant. [Jaz]And when you were out for three months, there was no income. Is that how it worked? [Nav]Essentially. Yeah. I mean, the six months that were paying on contracted work was decent. Don’t get me wrong, but it was never enough to make you feel as though you were comfortable. You didn’t have anything that you need to a pension long term. It does kind of weigh you thin a bit. And then it was my mum, my saving grace, who turned around and said, look, why don’t you look into pursuing medicine or dentistry? Cause you wanted to do it when you were younger anyway. So I did what anybody else does in the world and jumped online, looked at anywhere that would take somebody like myself to study dentistry. And I found unfortunately an agency, which many other people would probably say the same thing that essentially sold us a dream and said, come along to Ukraine, of all places, the fees aren’t too bad, very affordable, and do it in five years. Not only that, but if you have a certain degree, we can even skip a couple of years, put you into like the second or third year. [Jaz]Now this agency, was it targeting British nationals who wanted dentistry? Like what was the angle? [Nav]Pretty much, pretty much. I mean, the company itself is registered in the UK itself. So the key demographic are the guys that didn’t quite make it into medicine dentistry. And obviously, as you know, now, with the UCAT and then the competition, the limited places in medicine and dentistry, UK students are dying to get into medicine dentistry. So they are very desperate to do that. And I feel they do prey on that. I wouldn’t really say they use that as a target audience. They kind of see it as that’s their food really. So it’s sad. [Jaz]And what year was this Nav? Because obviously with what’s happening with Ukraine, Russia, I mean, what year was that? And also you must’ve considered like Valencia and what’s your Debrecen is another one in Hungary, right? [Nav]Yeah. [Jaz]That’s a quite popular one. So why did you choose Ukraine again? What year was it? [Nav]Okay. So this was 2018. And the reason why it was very simple with the places like Spain, Hungary, et cetera, you’re not going to get anything for less than 14 grand up. Right. I know, for example, annually, that’s correct. Yeah. So tuition fees are high in the other UK. And then obviously if you don’t have a student loan paying for that, you really do have to depend on either your own savings or maybe the bank of mom and dad, which unfortunately I don’t have access to at such great lengths. So they were happy to help me. But, the only thing that was accommodating of that was Ukraine. And that’s the reason why I, and so many other people ended up in Ukraine because their fees were around, I think, three grand a year. So really and truly it should have been alarm bells for me at that point. You know, it’s a five year course. You can skip a couple of years if you want. It’s only three grand a year. I should have started thinking, hey, something dodgy going on. But I think when you’re like- [Jaz]How does the company get money from this? So, as an introducer, that company who connected you to this pathway into Ukraine. I’m just fascinated. What’s their business model? How did they get money from this? [Nav]I’ll be honest with you. I think from what I’ve kind of uncovered, I don’t want to say too much and then put too many people under the bus here. But I’m pretty sure they’re in cahoots with the university because it’s a private uni. So probably is a case of they just set the uni up themselves, signed a couple of things off with some people on the inside with the government and essentially being able to run an educational institute that quote unquote teaches dentistry and medicine. So I think the bulk of that tuition fee goes to the agency and then a bit of it goes off to paying the staff. Listen, I’m just spit balling here by feel as though that’s probably how he’s the way it was run. So that’s how it went. [Jaz]Okay. So how did it go in Ukraine from 2018 to what year? Like 2020? [Nav]Yeah, yeah, yeah, 2020. So it was a bit of a weird one. I mean, I kind of went in there knowing what dentistry kind of should be, again, lucky to have exposure with my brother in law. So when I went in there and realized that we were studying very weird subjects, sometimes in university, which was a high school, essentially, that was shared with high schoolers. Well, we just took some of the private classrooms. Then also I’d ask questions like, when are we going to start working on phantom heads? When are we going to the simulator rooms, et cetera. And because I’d never got any answers for that. And it was kind of like, oh, next year or next semester. I kept on digging. I’m quite tenacious when it comes to that. I quickly realized this isn’t a real university, so to speak. So how it went- [Jaz]Oh my goodness. [Nav]Yeah. How it went in Ukraine was terrible. Best way to describe it. We were doing online classes before Covid, for example, which was like a thing for them. And then when, obviously when Covid hit, everybody just went home and it was just a shambles really. I kind of stayed there in- [Jaz]Weren’t there any students in your senior years, like you were in your first year of that dental school, quote unquote, wasn’t there any fourth years, fifth years to see the clinic? Weren’t there any clinics? [Nav]This is the thing. I genuinely feel, and again, not like going to name anyone here. I genuinely feel. [Jaz]You haven’t named any company. [Nav]Yeah, I mean, I can name the company. I don’t mind doing that. But the people per se in the fifth year. I feel as though one, the cohort wasn’t very big. I think our cohort was probably the biggest one. So we kind of entered in that year. The guys beforehand, I feel as though we’re almost sworn to secrecy about the whole thing. It was kind of like, if we stay quiet. We ended up getting a degree and then we can just leave with it. And then, either take the ORE or start with medicine. And here’s the kicker. If you now Google through the GMC’s website, so the general medical council. And if you look at this university, which was Dnipro medical institute, it’s now actually officially blacklisted. So that’s how bad that uni is. So these people, I feel as though they got out at the right time and they stayed quiet because they didn’t want to bring too much to it. But that’s how bad it was. So nobody in the fifth year was going to tell us that this is dodgy. Something wrong is going on here because it’s self preservation. [Jaz]So close to getting their degree and just finding some sort of work for themselves. But wow, how scary is this for the world of medicine, dentistry and patient care and all the ethical things that we think of? [Nav]Exactly. Exactly. It’s really shouldn’t be sold in the way that they were selling it. And to be honest with you, that’s the quickest piece of advice I can give anybody who is even trying to start on that journey. Don’t do what I did. Don’t just take someone’s word for it, but go out to the country. It might be a bit of a headache, but it’s worth it. It really is because I didn’t do that and I regret it really. [Jaz]I think this will help someone like loads of people, as you know, want to do dentistry, as you said, and then they’re kind of looking at their options. And then so just if it sounds too good to be true, it probably is like with everything in life. But you know, in your position, I totally feel for you, man. Like, you wanted to save some bucks, which I totally understand. I totally understand because of the position you were in and what a disappointment that ended up being. And then COVID came. So what then happened, what was Egypt the next step and how did that happen? [Nav]So this is the thing. I mean, I feel as though, thank God, God’s always watching. And I feel as though I really was put on a path. So there was myself, one other guy out of our entire year group. And in fact, in our entire university, that kind of was taking dentistry a little bit seriously. So we ended up getting a private tutor who’s from Syria. So Dr. Khaled was a big mentor of mine. And we would essentially we pay out of our own pocket to get work with him. He was the only guy that had a simulator-esque lab within his own clinic. And he was teaching us- [Jaz]In Syria? [Nav]Uh, he’s from Syria. No, he had it in Ukraine. So he’d moved over to Ukraine and he was kind of like teaching there. And I think it was a lab tech slash dentist at the same time. So it’s Ukraine, anything goes. So he kind of became quite close. We became good friends, I’d say. And then I sort of said to him, look, this is the situation. I’m worried. I then understood, by the way, you have to also realize something in my naivety, completely. Didn’t have a clue about the ORE. So all I saw was just, okay, dentistry. Finish and become a dentist. That was it. As you stay in places like Ukraine, you start realizing, okay, I actually have to do an ORE. Okay. The ORE is not actually that easy. So I need my education to be good. So these are the reasons why I was trying to find answers. So anyway, Dr. Khaled was the guy that turned around to me and said, look, if you’re really looking to take it serious. There’s only two countries in the world I recommend that you go to. And one was Egypt and the other one was Lebanon. So of all places, I was thinking, right, well, yeah, I’m not going to do Lebanon. They’re just with all the situation that’s going on over there. Research- [Jaz]Lebanese food culture and- [Nav]And allegedly the women, but I can’t say much about that. So, but yeah, no, I was told that Egypt was the place to go. So I researched heavily into that. And the issue that then becomes quite a bit of a trend later on with Egypt. They’re terrible with emails. They’re terrible with phone calls. So I had very limited information and then kind of got to a point where I was like, right, I need to just go out there and see it for myself. So we skipped down to, I think the end of 2019 out of my entire cohort and everyone from year one to year five at the time, bear in mind, I think I was going to be at three then. I was basically the heretic of university going around telling everyone like we’ve got to leave and we’ve got to find somewhere else. I had the agents threatening me, we’ll give you your money back, leave. We’ll give you a transcript, but get out of it. We don’t want you here because basically you’re bad for business. There were only two other people that turned around and said, we’re going to join your journey, your crazy journey. And they actually ended up coming with me to Egypt to check it all out. Looked great. [Jaz]You were like some sort of Messiah. Like you were the enlightened one, right? And they’re like, this guy’s onto something. And then all these naysayers are there like, Oh, well, who is this crazy guy? And were you all right? [Nav]Yeah. And the thing is? I’m quite an arrogant individual. So even now I kind of low key sit there and go, told you so. Like, I’m not sitting there like, yeah, I hope the best for [inaudible], I actually am like, cause we went through so much. I have to tell you Jaz, it wasn’t fun. It wasn’t easy. There was a lot of traveling. There was a lot of expenses. When I went out there and found the uni was great. When we came back, it was a nightmare getting our documents, getting them signed, notarized, etc. Like, it was almost impossible. We eventually got to Egypt. I had to take two cats over with me as well. I had all my suitcases. The journey itself was crazy. We didn’t know about the COVID travel situation. So we ended up having to sleep at the airport. [Jaz]Was COVID a legit thing yet? Like- [Nav]Yeah. [Jaz]There was no lockdowns and that right at this point. [Nav]It was the end of 2020, right? So COVID had really taken its toll, but because I’d not traveled yet, I didn’t know what to expect. I was basically just stuck in Ukraine. I hadn’t gone home for two and a half years bearing in mind. Right. [Jaz]Whoa, whoa, whoa, whoa. So all throughout lockdown, you were in Ukraine? [Nav]Yeah. And prior to this- [Jaz]Everything was locked down. You weren’t even learning because uni was shut. [Nav]Pretty much. I mean, they had online classes, I said, but it was a joke. And just a little kicker as all for you. My parents sent me to Ukraine with this secret, it was kind of like a, look, mate, you’re in your thirties, if your balls this up, we can’t like, take the flat for it. So go there for a couple of years and make sure you’re good enough to become a dentist. Then we’ll tell the family. So for two and a half years, I hadn’t seen my siblings. And like there were all sorts of rumors. Like, is he dead? Is he married off to someone and not told the family? Is he in prison? Is he this? Is he that? And I had to just keep it quiet with everyone. So it was just really awkward getting- [Jaz]With the respect. It’s getting hilarious. [Nav]The story is wild. I’m telling you, like, I’m giving you the top line of it, but it was insanity in his finest, and I couldn’t really communicate with anyone, but my parents in the UK. So I was playing in a football team before I went to Ukraine and I’m AWOL from there. So they were like, where the hell is this guy gone? Obviously I was working before that. Where’s he gone? Friends, all the rest of it. All of a sudden I’m just nonexistent. So I’m out. [Jaz]Why can you tell people that, Hey, you know what? I’m just going to take like a kind of sabbatical and do like this educational journey. What was that like a taboo thing? Or was it like you want to come back and surprise them? Like, hey, look at me. Sonic three has come kind of thing. [Nav]I guess that would have been really nice, but the honest, honest truth was just, I think my parents fear factor and mine as well, collectively. I think what we didn’t want to do because obviously dentistry is a completely different beast. What I didn’t want to do is kind of go there, spend a year or two and tell the whole world, yeah, I’m doing this. And then God forbid fail and come back. And with all due respect, in the way that our culture is set up, unfortunately, it can be quite judgy. The last thing that you want is kind of like, 30 years and then, you got nowhere with it. As I said- [Jaz]What were you thinking? Whatever that kind of stuff, that kind of mentality, bad duas and stuff. And Nazar and all that kind of stuff, evil eye, that kind of stuff. For those who know, who know. [Nav]Exactly that. Not even going to try to like sugarcoat it, but that’s basically what it was. So, I mean, if anything, it kind of forged me into the resilient person I am today. And I thank my parents for that. Thank God for that as well. But, again, we were taking it to the end of 2020. I remember we got to Kyiv airport to leave, to go to Egypt for our first trek there to see what it was like. And we got to the front of the queue and they were like, right, where’s your COVID papers? And we were like, I can still remember, and my friend would vouch for this. I kind of tried to be the big man. And I was like we’re from the UK. We have a British passport. Surely we’re fine. And they were like, it doesn’t work like that, mate. Like get in line. We can reschedule your flight for tomorrow. You need a 24 hour COVID test. So. We had to sleep in the airport that night, get a COVID test, go the next day, missed our hotel, had to rebook, crazy, crazy, crazy stuff. But we saw what Egypt for what it was. [Jaz]But at this point you’d agreed with the Egyptian university that you’re going to enroll and it’s going to happen kind of thing. [Nav]No. This is what I meant earlier. They’re terrible with emails. So communication, they’re rubbish. [Jaz]So you legit thought, okay, Ukraine’s not working. You need to take massive action. I love people who take massive action and you decided, okay, me and the only two guys who believe me, I’m going to go. Everything’s on you now because these guys are like, okay, I’m just following Nav, right? So you’re there with the two cats and two suitcases, whatever, and with two guys. Everything’s in twos, like Noah’s ark, except everything like in cats and suitcases and stuff, right? And you’re trying to get to Egypt and be like, hey, just knock on the door. Be like, hey, I’m getting a couple of dental students here, like, was that the plan? [Nav]Essentially, I think we were so desperate. When you get this desperate, you just end up doing crazy stuff. So I remember we went there. They’ve got like a foreign students office. We met with the president of the office and she was like, yeah, you guys, no problem. Just bring these documents. We’ll get you in. So we were like super happy. We ended up kind of going back. As I said, it was a headache getting our documents. We eventually got everything and then we flew out and then we went there. That’s when he just turned to rubbish. So I think we got there in. I want to say around January. No, it was new year. Sorry. It was new years, 2021, we landed like a week later at the office and unfortunately there was a new person who was the president of the office. So our luck just started going the other way and they were like, no, we can’t get you in and this problem and this problem. And eventually it was, I think, I want to say March or April that they took us in and they said, unfortunately, you have to sit one of the first year subjects again. And then from September, you’ll be in the second year. So you’ve got to bear in mind, we’re essentially third year students going back into first year and doing it all over. So that’s kind of the Egypt leg of things. And there’s a lot more, but I’m not going to go into it, but we started doing, doing that in Egypt and in all fairness to Egypt, I think it was out of the three, because obviously I’m here in Slovakia, it was probably the best in terms of education and their hands on approach and working with patients and exposure, but in terms of having their stuff together and making it easy for students. I would say for any international student, unless you know, Arabic, stay clear of it. And unless you’re comfortable with the culture, stay clear of it as well. But, we were out there for a couple of years. We ended up in the third year there as well. [Jaz]And then you actually went through, I mean, this is wow. So you do three years in Ukraine, you figure it out and then you go to Egypt on the whim, just hoping, and then you do first year again and then you do second year and then you enter third year in Egypt. [Nav]Yes. And the reason behind this, is it was a bit-, Brexit was going on around that time before we went from Ukraine to Egypt. And there was a lot of whispers in the wind that they’re going to get rid of the EU recognition of degrees. So people would have to do the ORE regardless where they went. So that’s why we ended up with Egypt because we said, well, if we have to do it anyway, we might as well go somewhere. We’re going to get the best education. Probably our fault because we didn’t really read between the lines. It was more whispers, but it wasn’t anything official. And obviously then we found out that extended it for another five years and EU recognition was still on the table. So that’s why when we were in the third year, we thought, right, we can do fourth year, fifth year, sixth year in Egypt still. Cause you need to do six years there. [Jaz]So it’s a six year course in Egypt. [Nav]Yeah, it’s officially a five, but you have to do your sixth as an internship, which is just basically working with patients all day, just to receive the degree. So that was the thing in our head. We were like, we can do the extra three years in Egypt. Sorry, between two and three years for the ORE on average. So it’s anything between five or six years to work completely UK. And there’s a risk of failing. And then there’s the fees and the GDC, and then you’re not working with any patients in that time. So there was lot of advantages and disadvantages of it, or we can skip town, start again with the EU. That’s why we’re now here in Slovakia. [Jaz]Was this your idea again, Nav? [Nav]Unfortunately, yeah. So they probably hate me for this. All right. [Jaz]Because those two guys followed, yeah? [Nav]Yeah. Again, I think the group’s growing, to be honest with you. So people are like slowly, slowly coming along. But I think now we’ve kind of figured it out. We’re here now. And unfortunately, although we should have been going into the fourth year, we started getting the third year. So I feel like we’re like the Kings of the third year. So we’re in the third year now. [Jaz]So now you went to Slovakia, but this time you are allowed to enter the third year? [Nav]Yes. Yes. So, and that was our push. [Jaz]There’s a good part of this. Okay. Fine. [Nav]Yeah. So I mean, it would be nice to go into the fourth year, but it is what it is. I mean, we’re in the third year now and that kind of brings us to where we are. And, currently sitting in Kosice. So Slovakia is second city. And, we’re into our second semester of third year. And yeah, we’re still alive. So, that’s the journey. [Jaz]Well, shout out to Slovakia. Slovakia is the ninth biggest cohort of Protruserati. Would you believe it? I work at one stage, it’s probably slipped down to like 12th or something, but like it was up there. Like you wouldn’t think like Slovakia, I would have put it, 20 something, 30 something, but these are Slovakians keep coming back to Protrusive, which is awesome. So great to have you on. [Nav]Yeah. I’m going to try to get more of those guys from my uni onto the channel as well. So for sure, man. We need that family to grow. So, yeah, Slovakia. [Jaz]Thanks for coming on the show, genuinely, but there’s still so much I want to know. So we know about why dentistry. We know about a little bit about your journey so far, how you ended up from Ukraine to Egypt to Slovakia and Slovakia is a five year course? [Nav]Six years here. Here it’s a dental medicine course, so it’s an MDDr I believe is the title of the degree itself. [Jaz]So you basically got three and a half years left? [Nav]Essentially. Yeah. So it’s painful. Okay. It’s painful. [Jaz]It’s okay. Look, you live once, right? You live once and you are doing something and the desire and the hunger you have, it’s all about that. And I can see that, that fire in your belly when you came to visit me at the practice, man, more power to you. How many people just live their life? Just doing the same old thing every day and not feeling like they’re living life on their terms. You, my friend, are living life on your terms. Now, whether you’re right or wrong or whatever, it doesn’t matter. You’re living it by your terms and you’re not going to have regrets because whatever you do, you’re just going to give it your shot. So I highly admire and I respect that. So don’t feel as though, oh, no, I know you don’t, but I know you’re just saying it to everyone. But some people thinking, oh my God, what a crazy journeys. That is not for me. But people have to appreciate that. Dentists have to appreciate that. If you manage to get in first time and you’re in a nice European dental school, fine, good for us. Right? And American Dental School, but, but sometimes you have to take an alternative path and that’s what you’re doing. And so, massive respect to you. [Nav]Humble. Humble. [Jaz]What are the fees like in Slovakia? That’s thing you wanna cover. [Nav]Okay, so when we started, they were at 11 and half thousand euros per year. First you can pay that in into installments first. I think it’s 11,000 actually. 11 or 11, 000. So that’s for dentistry for medicine, I think is 10 or nine and a half roughly. But this year, because of the influx of international students, they’ve actually increased the price. So from this September onwards, it’s going up to 13, 000 euros per year for dentistry. And I believe 12, 000 euros per year for medicine. So I would say it’s just in the fringe of accessible now for UK based students, because it’s close enough to tuition fees in the UK. But I feel as though uni is getting aware of the amount of students that are coming over. And I think this is going to be a common theme around the EU now, where so many people are traveling out of the UK into the EU to study. Because of the lack of seats, it’s just one of those things that people just going to cotton on to it and realize it can just bump the prices up and up and up. And then I feel as though people probably need to get into it ASAP rather than delay it. But obviously you don’t want to rush a decision as big as this either. [Jaz]And you have to do the course in English, Slovakian, how does that work? [Nav]Yeah. So quite fortunate. So Egypt was officially an English taught subject or taught course even, but because of the majority being Arab students, the teachers would naturally just speak Arabic. Whereas here in Slovakia, there is a year group for Slovak students, the year group for English speaking. So this is completely dedicated to English speaking students. So it’s quite fortunate in that sense. So anybody who is looking to come over and is worried a bit about the language, nothing to worry about there. However, you do need to learn Slovak as a language over the course of two years. And that’s basically infused into the core of your subjects that you have to ask before you get your degree, but it’s pretty easy. [Jaz]I mean, why not? If you’re living in a country for that many years, why not learn the beauty of the language and appreciate the culture? I mean, how many languages do you speak? [Nav]So Urdu and Punjabi, they’re interchangeable, but I would say those two roughly, and I speak English, of course. I was getting better at Arabic, my Egyptian friends are probably watching this would probably say, no, I wasn’t, but for sure I was picking things up and play football out there as well. So I got in with the locals, which was quite helpful. I would say those are kind of the four or three and a half that I can speak. And then obviously now I’m learning Slovak, but I’ll be completely honest with you, it is insanely hard. I think Russian was easier because we were learning Russian when we were in Dnipro in Ukraine. That was easier than Slovak. Slovak is crazy difficult. So, anybody who is trying to come here, be warned. But as for me, yeah, those are the subjects that I can speak. [Jaz]No, good. More power to you. Learn Slovak, my friend. Why not? Well, if not now, then when? So, but based on those, like recently I was in Valencia. I was at the European Alliance Society conference. We’re doing an IPR workshop and I love how they say Valencia. They say Valentia, which is pretty cool. So, I was in Valencia. It was pretty cool. And then I remember that lots of dentists were DMing me saying, Hey, I went to uni here. Hey, I went to uni here. So lots of people end up going to Valencia or Debrecen. Maybe I’m saying it wrong. Maybe it’s in Hungary. I know you touched on it already, but the fees, are they that much different to the Slovakian fees? And so what I’m trying to get to is before you consider Slovakia, what was the sort of decision matrix that you made to choose Slovakia rather than potentially Valencia, Hungary, some of these, Czech, I don’t know, some of these other places? [Nav]Yeah. Yeah. I think most of it is budget wise. So Czech, I think was around 15 K in euros, that is per year. Don’t quote me on these figures. Spain for a fact was, it was either Madrid or Valencia. I can’t remember which one I called. And they said 21 grand a year. Poland was about 15, 14 to 15 grand as well. And then the other thing is as well. My decision was kind of driven by the uni’s accepting transfers as well. So this is like the big filter, if anything, if I was a fresh student going in. Yeah. I think it’d be a bit more easy for me to kind of find a country that works for me. And then, I’ll just take it from there and start from fresh because of me coming from Egypt. So they’re not on the ECTS system, the European credit transfer or something, whatever it is. I had to go in with their credits, which may not be recognized. So it was really narrowing down the filter. So I worked with an agency called Europe studies. So they were very helpful as a lady. They’re called Evie. I think she’s based out of Greece and she kind of did all the legwork and said this is the unit that’s really going to work. Other than that, I can’t guarantee you a transfer anywhere else. And I thought, I’ve done this for years now. The last thing I want to do is have the hope of going somewhere great, like Spain, for example, but then they say, you’ve got to start from the first year, which it would have just killed all of us. So that’s kind of the driving factors. One is the budget and two, just to make sure that they would take the transfer. And that was the reason why we ended up where we are now. [Jaz]So two of you went from Ukraine to Egypt. How many of you went from Egypt to Slovakia in your year? [Nav]So in total, there was three. So there was three in the first instance. So myself, two others from Ukraine to Egypt, and then they ended up, yeah, being four from Egypt to Slovakia. So now there’s four. So God forbid there’s any more moves, but if there were, it would probably be five and then so on and so forth. [Jaz]Wow. Okay. So what is your advice then in terms of, I mean, Ukraine is pretty much, in such a sorry state, God bless it. Obviously it’s not something that you can really consider. They’re probably not even running unis there at the moment with the war and stuff. So that’s not an option anymore. What has your experience of Slovakian dental school been like and how much clinical exposure do you get? And it sounds like, from your instance stuff that you’re fairly happy actually. [Nav]Yeah, I would say that I’m overall, I’m very happy with the university in itself. The experience I’m getting is great. It’s again, because they teach dentistry, not essentially as a BDS, but as a Doctor of Dental Medicine. They’ve really, really incorporated a lot of medical subjects into our degree. For example, I’ve studied neurology, not just neurology with the trigeminal nerve as the main focus point, and that’s it, but more so neurology as a whole, where we’ve been looking at gynecology, for example, which you’d almost argue, you could teach that as part of maybe internal med, but not entirely its own subject. We’re doing ophthalmology, for example, the list goes on. So there’s a lot of medical related subjects. So for those that are looking to come over, you just got to bear in mind. The first three to four years is you’re almost a medic, if that makes sense, but then kind of into the fourth year, they’d introduce you to the patients. So as of next year, officially, I’ll be working with patients. And I’ve validated that myself. I’ve gone to classes where fourth years are sitting in there. Working on patients. The classes are a lot more smaller in comparison to maybe Egypt, where there were 20, 25 of us, two professors walking around and then about, a hundred patients waiting outside the door here, it’s a lot more, I would say intimate, it might be you and two others, and then your professor, your teacher working on a patient taking turns and working the way through it again. I would find it very hard to compare any country thus far with the practical experience that we had in Egypt, but I do believe that what they teach in Slovakia in terms of that hands on practical experience is enough to get you going for your first year as a trainee dentist in the UK, eventually when that time comes. And also I’ve heard from friends that you can actually sign up with the local dental hospitals that the university has affiliations with and work there in emergency hours. You won’t get paid for it. But you’ll get the exposure to loads of extractions, emergency, temporary fillings, all the rest of it. So, in that sense, there is enough here to provide you with what you need if you seek it. And I think that’s a common theme as well with universities generally. They don’t spoon feed you everything, but if you ask for it, they usually do help. So this is no exception. [Jaz]So when you finished the sixth year in Slovakia, your plan is to come back to UK? [Nav]Finally, finally. Yes. That is the plan. [Jaz]I mean, I hope you get to taste that moment that day. And then does that involve an ORE for us, for us lacking trained? [Nav]Yeah. Thank God. It’s one of the exceptions. So on the GDC website, there’s an annex. So there’s a PDF that you can download. I pretty much know back to front now. I’ve seen this so many times where it gives you the list of exceptions or the list of universities and their degree titles from the EU that are exempt from doing the RE and this would be one of those that may change the subject to change. I highly doubt it. I think the way that dentistry is in the UK and the NHS crisis and just generally me personally, I would say, I don’t think that it would change. I’ve kind of spoken to the likes of Eddie Crouch on Twitter, for example, we’ve had like informal to and fros. I think he is of the same thinking as all that. Although they can talk about it, whether they’ll get rid of that exemption list, it was highly unlikely. So yeah, fortunately for us, we’d be able to come back and skip the ORA and just get straight into what is now the PLVE, I believe the name of it, which is our, vocational training equivalents. Hopefully between six and 12 months and then from there, shoo up and be the next occlusal hype man out there in the world. So let’s see how it goes. [Jaz]Why not? So last couple of questions, actually, it’s obviously expensive. Everything you’re doing and you have some savings, et cetera. Maybe you’ve burned through, maybe you’re not, let’s not get into that. But are you working part time to fund your dentistry? [Nav]Okay. So I had a part time job, which was sort of online calls like surveys. So I could do that from where I am on the laptop. It was very mundane and it was very time consuming. And I found that I kind of spoke to my parents about it. And they said, look, just live like a hermit. Stay at home and basically eat at home, which is good. You learn how to cook, to be a bit more savvy with your money as well. And they said, look, we’ll fund you a little bit extra per week to get you by. Oh, I’ll be honest with my budget. It’s about 50 quid a week. So, you can live off of that. This is not including rent that I can tell you sort of the rent that I’m paying at the moment is about sort of 300, 250 quid, 250 euros, roughly per month. Taking the bills into account and stuff. So anybody who’s looking to do this kind of journey, that’s the kind of budget you need and you can live off quite comfortably about 50 pound a week. If you know how to cook, can you do part time work? Yes. Could you do it locally? If you know the language, otherwise just find maybe something that you can do on a laptop or remotely, so long as it’s not eating into your education. And I think that’s my parents biggest worry was, we don’t want you to be distracted so much, just trying to earn a living. We’d rather take the sacrifice and that, you succeed here and then later on, you can just pay it back. So that’s kind of the agreement we’ve had, but anybody who is looking to do it, the options are there. [Jaz]Very nice. And I wish you all the best for that. Now, one thing we’re all dying to know is which is the best night out. Slovakia, easy up to Ukraine. [Nav]Here’s the thing, right? So I’m not like an outdoors kind of guy. You could ask anyone that knows me. The most exciting thing that I would do is I maybe hit a burger joint or like a pizza restaurant or something along those lines. So I hate being out too late, I’m basically an old man even when I was young I used to hate it as well. But from what I’m hearing Egypt, for example is a very because it’s culturally different men stick with men, women stick with women. There’s curfews, people don’t go out too late. It’s like cafes, like small cafes. [Jaz]Yeah. I can imagine a good night out in Egypt is like being in a cafe, doing shisha and some dates and just watching the sunrise in the early morning. That’s what I think people do there. They drink their green tea or whatever. [Nav]Pretty much, pretty much is. That’s pretty much how it is. And they love their football. So that that’s kind of their culture. Ukraine, I would say that the students that were there used to speak quite highly of it. But again, it was the cities that we went to, or bear in mind is all like Dnipro is not Kyiv because [inaudible] is not Bratislava, for example. So we’re kind of like away from all the fun stuff, but I guess it really, really comes down to your cohort. So if you are alongside other people that you can get along with. So internationally, and they speak English for English speaking. You probably have a good time here as well. I know a lot of people go out to the local town center here and have crazy nights out and they say it’s very safe. So if you ask the guys and the girls, they’ll all say it’s very safe here. I’ve had people say that they feel safer here than the UK. So, which I don’t think is very hard nowadays anyway. So I’d say in terms of the night out, I think Slovakia at the moment probably takes it. Just because of what I’m hearing from everyone, but for me, a good night out is, as I say, pick up a slice of pizza somewhere and just go for a walk. So I’m a bit boring. [Jaz]Let’s answer this one. In terms of food, where was the best? [Nav]Egypt. Have you not seen that? Oh man, you got to see this. I’ve done a video of this, right? And there’s a picture of me in Ukraine and I’m like in shape. I look great. And then there’s a bit of cutaway to me in Egypt. And I don’t know. I think I put on something around 15 kg in that time in Egypt. The food’s insanely good. The problem is everything’s cheap as well and accessible. So food wise, Egypt’s nice. [Jaz]All that shawarma and everything. [Nav]Yeah, for sure. I was like getting in there with all the like restaurant owners as well. So everything was discounted. So the place called Chickenworks out there with Farooq, he’s giving me 20 percent off. I love that guy, but if I have any heart related issues, it’s his fault. So I’m just saying that now. [Jaz]Amazing. Well, now you’ve answered these big questions I had for you. Thanks for sharing. Thanks for being, make yourself vulnerable to share your journey. Thanks for inspiring so many people. Thanks for just telling us the truth. And one of the reasons I was happy to connect with you is I’ve watched so many videos, your real talk. I love it. I feel like you’re at this point now you’ve been through so much. So you know what? You’re just going to enjoy it. You’re going to speak your heart. You’re going to get out this the other side and you’re going to be, okay, I gave it my best shot. So what are the final words or reflections that you have for the Protruserati listening and watching who thoroughly enjoyed, I’m sure, learning about your very fascinating journey. And we all wish you the very best in getting your dental degree. [Nav]I just say to everyone that is listening, first and foremost, just that was very lovely of you. I mean, that’s, I’m going to keep that, save that. I’ll probably play it over whenever I’m feeling down. So thanks very much. I would say to anyone listening and whoever’s kind of in your family of things, which I relate to massively, I would say it’s just never too late to follow anything you’re doing. Be a dentistry, be outside of that. If there’s any decisions that you have in life, just don’t let the naysayers dictate as to what decisions you make in life and rather kind of just own it. Sometimes it works, sometimes it doesn’t, but if we don’t try, we never get. And then in all honesty, I think you don’t look at these big people such as yourself, even you’re a massive inspiration to so many people out there. You could even say you were just, you’re just a dentist. And no one would have ever known you, but then you took that step to go out there and do what you’re doing now. And you know, 17, 18, 000 subscribers on YouTube and so many following you on social media, you took that step. So everyone can do it, and it’s just one of those things that I feel as though don’t let people make you feel as though you shouldn’t be doing it. Go out there, prove them wrong. And then, and above all else, just have fun doing it. So, fingers crossed to everybody out there. My prayers are with you as well. And let’s all achieve our dreams together. And I hope the Protruserati can do that as a group. So that’s my final message. [Jaz]Amazing. You’ve inspired a generation, my friend. Thank you so much. [Nav]Humbled, humbled. Thank you for having me on my friend. Jaz’s Outro:Well, there we have it guys. I’m not sure how many of you will make it to this part, the ending, but I’ll tell you something funny. I love this guy so much. I offered him a job in Protrusive because I’m always looking to support dental students. I want dental students to learn from Protrusive so they get to write the premium notes stuff, but I pay them. I pay them very well. And it’s really a win win to find a dedicated dental student and also to enhance the podcast experience as well. So after I hit the stop recording button, I said, now do Protrusive maybe for one or two years, see how you find it. I think it’d be great for you in terms of helping you out in terms of his situation. So let’s see how this goes. This is early days. Maybe I shouldn’t even be revealing this on the podcast, but I am. I’m happy to be straight with you guys that maybe Nav is going to be helping us out to actually enhance or to maintain the premium notes that we’re used to and the CPD quizzes and helping out to make sure that Protrusive remains at the forefront of your dental journey. As always, I want to thank the team, Erika for being the producer, and the quality control from Mari, Krissel, Gian, Emma, and maybe even Nav, who knows. Thank you once again for joining, and don’t forget, if you’re not already on Protrusive Guidance, remember it’s a free, it’s our free community, it’s the Protrusive Tribe. It’s the Protruserati it’s the home of the nicest and geekiest dentists in the world. So head over to protrusive. app, request to join. We are quite strict about who joins, make sure that you are definitely who you say you are. So it takes a little while to get in, but once you’re in, it’s a nice, warm and fuzzy community of dentists learning and sharing and connecting from all over the world. Thank you so much for listening again to this interference class and I’ll catch you same time, same place next week. Bye for now.

Dr. Celine Higton discusses mastering rubber dam isolation, focusing on the last tooth in the arch. Tips include using 'Cow Mode' technique and proper lubrication. She also covers matrixing, cavity preparation, and types of clamps. The episode ties into mental health, emphasizing stress-free practice.

Dr. Michael Melkers and Jaz challenge traditional occlusion teachings by exploring practical approaches. They discuss the complexities of canine guidance, the use of PTFE in dental sulcus, mentorship in dentistry, and the importance of individualized occlusal care. The podcast highlights the evolution of occlusal terminology and the debate between canine guidance and group function in patient care.

Discover the 4 methods for documenting dentistry, including camera choices and portfolio building. Explore the reasons why documentation is vital, from tracking changes to medico-legal aspects. Learn about the power of documentation in dentistry for patient communication and professional fulfillment.

Discover how AI technology is revolutionizing note-taking in dentistry, with tools like Digital TCO that transcribe your spoken notes efficiently. Learn about 'Jaz Mode,' a beta feature that compiles notes as you speak, offering a glimpse into innovative note-taking methods. The podcast explores the impact of AI on dental record-keeping and the benefits of streamlining processes for better patient care.

“How long should I tell my patients their posterior composites will last?” – what a great question from dental student Emma Hutchison! As part of our new Protrusive Students segment we’ll be bringing you monthly episodes packed with valuable insights, tips, and tricks specifically tailored to dental students like Emma. https://youtu.be/PP1XICgI-lg Watch PS002 on Youtube Whether you’re navigating clinical rotations, honing your skills in phantom head, or gearing up for those daunting exams, we’re here to support you every step of the way. And kicking off this segment, we’re diving headfirst into the topic of adhesive dentistry! Link for further reading regarding the longevity of direct restorations – A retrospective clinical study on longevity of posterior composite and amalgam restorations – PubMed (nih.gov) The Art of Treatment Planning – The Art of Treatment Planning: Dental and Medical Approaches to the Face and Smile: Amazon.co.uk: Romano, Rafi: 9781850971979: Books Need to Read it? Check out the Full Episode Transcript below! Highlights of the episode:00:00 Adhesive dentistry03:41 Bonding systems07:00 Self-etch vs. total-etch vs. selective-etch14:38 Post-operative sensitivity16:10 Communicating risk with patients17:42 Polymerisation shrinkage19:38 The snowplow technique21:13 Instruments23:19 Consent25:30 Longevity28:05 Risk factors37:37 The next episode If you liked this episode, you will also like PDP077 I Can’t Believe This Sticks Click below for full episode transcript: Jaz's Introduction: So welcome to Protrusive Students Episode 2. In Episode 1, we introduce you to Emma Hutchison, who's the Protrusive Student. I'll be releasing one episode with her every month to answer questions from a dental student's perspective. And every month, we will release some of her revision notes, which are absolutely epic. Jaz’s Introduction:I’ll check them myself on the Team Brandsim. All of these notes are going to go in the Crush Your Exam section of Protrusive Guidance. Protrusive Guidance, if you’re brand new through a podcast is our little family. It’s our little home on the internet via the web browser, or even it’s native app via Android, iOS. All dentists and students can join it, but if you want to verify yourself as student, you have to email student@protrusive.co uk. So when you apply to join the network, which is on protrusive.App. Once you apply, you fill in some details, you explain that I’m a student, and then you should email student at protrusive. co. uk with some proof that you’re a student. That way we will add you to our secret space called Protrusive Vault. So as part of your benefit of being a student on Protrusive Network. You had access to a paid space. There’s also student clinical videos, which we’ll be adding soon, as well as more episodes, just like this one. Hello, Protruserati. I’m Jaz Gulati. Protrusive Students is part of the Protrusive Dental Podcast. If you are a dental student, don’t hoard this, share it with your colleagues. Eventually they’re going to find out anyway. So you might as well be the person who shared it with them. I’m hoping that on Protrusive Guidance, we can help you on your journey. Look, there’s almost a thousand dentists so far on Protrusive Guidance, and these are the nicest and geekiest dentists in the world. And by being someone who is a keen learner, who listens to this podcast, right? Not everyone does, right? Only those who self select themselves as a keen learner listens to stuff like this. And so it’s time for you to meet your tribe and start learning and growing together. Now in this episode, which was supposed to be released in February, but life got busy with kids. It’s actually Adhesive Dentistry. Questions from Emma Hutchison all around the topic of adhesive dentistry. Like for example, some of the things we’re going to cover is the longevity of composites. This is such a fundamental thing. And actually what I love about doing these series now with Emma is everything she’s asking is so foundational that even the dentist listening and watching, I think will gain from this. So let’s go ahead and join the main interview with Emma, all about adhesive dentistry from a student’s perspective, and I’ll catch you on Protrusive Guidance. So Emma, have you started on the clinics yet? So we’re talking about adhesive dentistry today, you’ve got some questions for me. Have you done your first composite on a patient yet? [Emma]I have, yes, I’ve actually been quite lucky. I’ve had quite quite a few patients. So I’ve done maybe about 10 composites so far. I know some of my friends have had zero, so I’ve actually been very lucky at the start of my third year, had some good patients. [Jaz]Very good. Well, you, you’ve done 10, but you’ve seen thousands, right? From your experience in nursing, which is great. So you get even more from that. So you would have seen different bonding systems being used and whichever one you’re using at the end of school. Just curious thing here, this wasn’t scripted, but when you’re doing your bonding stages, like you’re etching, bonding, everything, what’s going through your mind? What are you thinking about? [Emma]What I’m thinking about is just, I’m a nervous hummer. So you know that I’m concentrating, I’m going to be, I’m just so in the zone. You just need to especially early on, I’m just concentrating so hard. I come out, I’ve got a sore jaw after. But honestly, it’s just etch, prime and bond, etch, prime and bond, just repeating that in my head over and over, but just total concentration mode. I forget it after, I was concentrating so hard. [Jaz] Bonding systemsI remember working on the clinics as a student and this is like our first year in the clinic and the dental student in the bay behind me, I won’t name and shame him, I don’t want to embarrass him, but the patient left, he was like, oh no! I forgot. I forgot to bond. I etched and I put my composite, but I forgot to put the bond. So I’ll never forget that. So I see what you mean. You etch prime bond. Don’t forget the stages because when you’re so new. Exactly. But the reason I asked you that, Emma, is because what goes through my mind is a bit funny. Interesting. I think scientifically, I just wondered, are there any other dentists out there? Maybe if you guys are watching on the new platform, just comment below whether this is you or not. I am imagining, the scanning electron Microsoft images of dentine and stuff, right? I’ve got these tubules on mine. And then as I’m doing the etching, I’m seeing these enamel, like etched enamel, like the sort of scanning electron Microsoft part of it. Then when I’m putting my primer, I’m seeing that hybrid layer being formed. So that’s what I’m visualizing. I don’t know if I’m the only one who does that. [Emma]I’m just trying not to cry at this point, but I cannot, I cannot. [Jaz]I love it. [Emma]I just need to just etch, prime, and bond, etch, prime, and bones, because if you miss that, then, your patient will be back in next week. [Jaz]Look, when you start endo, your head will explode. [Emma]Yeah. No, definitely. Yeah, we’ve been doing endo down on the phantom heads and things and it’s just so I’m dreaded. No, I won’t say I’m dreading it. I’m looking forward to the first endo patient, but it’s a lot. It’s a lot. [Jaz]It is. What this chat reminds me of is I remember being a third year student and I was living with fifth year students at the time. So it’s pretty great. I was like constantly getting advice and stuff. So you finished your morning lectures. I’d come home and I literally lived in a flat, like two minutes walk from the dental school, right in Sheffield. It was amazing. And there we are standard, you get a bit sandwich and you start playing FIFA as you do. So I’m playing FIFA with a fifth year dentist. And I say to him, when do you get to a stage where you don’t have to like do a step by step memory of exactly what you have to do next and endo? Yeah. And he said, I’m still not there yet, but I’m almost there. And then when you speak to, when I used to speak to dentists, when I was a dentist, he would say, hey, endo, yeah, you don’t have to memorize it. It just comes instinctively. It’s like something that just gets etched into your brain and it does happen eventually. And now you can, when I’m doing a composite, you don’t have to think about the different steps. It’s just part of the procedure. You’ve done it thousands of times. So don’t worry. It will normalize. It’s like driving. You get, you don’t think about it anymore. [Emma]Yeah, yeah, no, eventually, eventually it’ll all fall into place. [Jaz]It certainly will. Now, Emma, you’ve got some questions for me, depending on time. You’ve got some questions for me that are going to make this topic tangible. I’m actually excited to cover these because I think this will generally make a really good educational episode in dentistry in general. So, it’ll be nice to serve students and dentists together in this episode. So come at me. [Emma]Okay. So my first question sort of spawns from, it was our first day or our first lecture of second year. And bearing in mind, this was the first time we had been in the dental hospital because in the first year it was COVID. So I didn’t get into the dental school until second year. And then we had a year out. So that was technically my third year of university. And I remember our first ever lecture was on boarding systems. And I’m sitting there in the lecture theater and I’m like, what is going on? I’ve had no introduction to composite. Self-etch vs. total-etch vs. selective-etchNo introduction to anything. And everyone was just sort of like, I remember thinking, it was just a bit, a bit mind boggling. And then, obviously I understand we need to know all these different protocols, etch, prime, bond protocols, but there’s just so many different, different things that we’ve covered. You’ve got like, your total etch, your self etch, selective etching, different steps, two, three steps, etch and rinse bonding systems. So I just wanted to know, would you use different protocols in different situations? Like, what are the basic, what are the most common protocols? What do you do yourself, your day to day? [Jaz]Great question. Really real world questions. And I think where I’m going to start to answer this is in the real world, believe it or not. I mean, it’s really good to know all this stuff, by the way. I think Dental Materials is like that one textbook that you still keep because it’s really nice to connect with it. And we’re using dental materials every day, which are ever improving. And it’s great. But to have the foundational science behind it is good. What you’ll find is that wherever you get a job, when you start practicing, start working as an associate, you’re kind of at the mercy to whoever made a decision at one point in that practice, be it a group of associates or being a principal about which dental bonding system that they’re going to adapt in that practice. So every surgery is stocked up with that same one usually, right? It just for think about stock, like when you were nursing, like if there was five different types of bond, I mean, they’d expire, there’d be a ordering issue. Did you ever work in a practice that had different types of bonds or was it just usually one or two bonds? [Emma]I’ve mostly worked in mixed NHS private practices and usually there’s one for private patients and there’s one for NHS patients. That’s about it really. That’s about it. That’s all that I can remember. [Jaz]So yeah, so there was like one or two basically and generally that’s usually how it is. And so you are at the mercy of whichever supplier had that buy three bonds, get two free offer. And then the practice said, okay, let’s go for it. Let’s buy a year supply of bond. And so the most important thing is, figure out which bond it is you’re using, okay, the actual name of it and download the DFUs, the directions for use, right? The most important thing I think is whichever system you’re using, please use it in the way that the manufacturer intended it to get those bond strengths, okay? The biggest sin you can do is like, for example, we were saying earlier, etch prime bond, etch prime bond, that kind of stuff. But imagine you are using a, what I’m using, like I’m using a G-Premio Bond I think it’s like a sixth or seventh generation, right? It’s like a newer generation. I don’t even know exactly which generation it is, but I know exactly how to use it, right? That’s more important for me. It is a self etch. Okay. And so the worst thing you could do is use your phosphoric acid etch on the dentine. [Emma]Right. [Jaz]Wait 15 seconds, wash it away and then use this bond. You’ve dramatically reduced the bond strength. Big time. [Emma]Okay. [Jaz]Because the directions are, you do not etch the dentine here. That’s specifically the direction, you do not etch the dentine. You actually weaken your bond strengths that way. The self etching primer, it does all that kind of stuff for you with the dentine. And so what I’m using at the moment is G-Premio Bond, because that’s what we decided as a practice that we’d like GC products. Okay. And it served us well. And so what I would do typically is once it’s all clean, what I mean by clean is personally, I’m using air abrasion. Are you familiar with what air abrasion is? [Emma]Yeah, I’ve worked with dentists that use air abrasion a lot, yeah. [Jaz]So I’m using like 27 micron or 50 micron aluminium oxide particles blasted. What that does is it, most important thing, is it gets things clean, right? You get rid of the biofilm. That’s the most important thing. And supposedly gets a nicer structure of dentine to bond to. That’s actually debated, but you definitely remove the biofilm, which I think is the most important thing. So I’ve got a nice clean surface. I’ve got rubber dam isolation. I’m a big believer in rubber dam isolation only because like you look away and if you don’t have rubber dam isolation, that’s when I’m stressed. Like the patient’s tongue goes there. It feels a saliva. The gingiva starts to bleed into the cavity. It’s just a stressful. It’s more about stress. My mental health and stress will benefit from having rubber dam on. So I’ve got my rubber dam on. I’ve got my abrasion on. And so what I would do is I would use my etch first on the enamel only because of system that I’m using. So whichever system using follow that the system I’m using, I will do a selective etch technique. I. e. I’m selecting, I’m choosing to etch the enamel only. Then I will wash it. So I would typically wait 20 seconds to 30 seconds. Okay. I’ll wash it and observe that frosty enamel. Okay. I want to see that frosty enamel. Okay. Not overly frosty, but you just want to see some degree of frost frost there. Then I will get my G-Premio Bond. Post-operative sensitivityOkay. So I don’t, there’s not a separate priming stage in a separate bonding stage. Like a fourth generation one will be OptiBond FL, which is supposedly the gold standard. Have you heard of OptiBond FL? Have you heard of it? [Emma]I’ve heard of Octobond, but not OptiBond. It might be the same thing that I’ve heard of, yeah. [Jaz]Probably. I mean, they have OptiBond Solo, and they have a few different varieties of stuff, but one of the ones that a lot of pedantic dentists like to use is OptiBond FL, because the initial research in the 90s and 2000s was like, wow, this is amazing. And people, once you have a system that you can trust and things work. It’d be silly to deviate away from it. And so the way that one works is that you do a total etch. Total etch is when you etch the enamel and you etch the dentine. And typically what you do is you etch the enamel first. Then by the time you get to etching the dentine and then you wash it, that means the enamel had more time than dentine. Is that what you do at the moment? [Emma]Yes. That’s what we’ve been taught at class school. Yeah. [Jaz]Do you know what bond you’re using at the moment in the [Emma]No. I should, I should, but I know it’s got the pink or purple color. That’s all I know. [Jaz]That’s totally cool. Emma, that’s totally cool. I don’t remember the bond I use at dental school. If you ask me when I’ve done 10 composites in, listen, as long as I remember to use a damn thing, I’m happy. Right? So these are the things whichever one that be in the real world, when you get there, it will be so different to what you use in dental school that you must take a moment to pause and look at the directions for use. So back to the OptiBond FL, you do the total etch, which is the etching, the enamel, then the dentine, then you do the primer stage. Separate. Okay. Get nice and dry. Another coat get nice and dry. Okay. You don’t wash that that way, then you put the separate bond adhesive. So the primer goes into the tubules, okay? Okay. And then it links to the adhesive that you put next, and then that hybrid layer is formed. Then you put the composite on top. Whereas what I’m doing, back on the newer generation, is everything is in that one bottle. So after I have selective etched the enamel only, we’ve put the G-Premio Bond, which has got the prime and the bond, everything inside there, and it’s got the etching ability to self etch the dentine. [Emma]Okay. Yeah. [Jaz]Then I will dry and it, this stuff goes to like four microns thin. So super thin, we will cure it and then we’ll go proceed with our composite restoration. So the real world lesson here is to make sure whichever system you’re using, you make sure that you follow the directions. And if for those of you who want to really get deeper into this, but in a really tangible episode, there’s an episode that I did with a guy called David Gerdolle. So the episode we call it, I can’t Believe This Sticks Extreme Bonding. It was PDP 077. I would encourage anyone listening to this right now. And you’re interested in learning more about what are the most important things to do? And what Dr. Gerdolle said was that as long as you get the tooth, clean and rough. Out of the six different things that you’re trying to do when you’re bonding something, the two most important is clean, no biofilm. And what you meant by rough is get that nice etch pattern, like optimize your surface to bond to. And if you can do that, things will stick. So we talk about air abrasion, we talk about etching protocols and that kind of stuff. And so the whole bonding thing, whichever one you’re using nowadays, they’re newer, they’re supposedly better. The issue, Emma, with using the more gold standard fourth generation earlier bonding is it’s technique sensitive, right? You have to get the whole what we call wet bonding where you have to make sure you don’t over dry the dentine and the risk of over drying the dentine increases when you’ve etched it. If you’ve etched it and now you have to wash it and then you have to dry it, how do you know you haven’t overdried it and whatnot? That’s why it’s supposedly technique sensitive. So the new ones actually make it a lot easier for me. [Emma]Yeah, okay. That makes total sense. That’s good to know, actually, because I’ve never seen anyone do the separate prime, the separate bonds. I had never even heard of that. And then when they’re talking about it in this, maybe that’s the drawback of doing dental nursing, actually. I’ve never seen that before. So putting that into context for me was really, really difficult, actually. So no, that’s good to know, just follow your manufacturer’s guidance and don’t just take any random bond and use it willy nilly. [Jaz]And if you could do this for me, Emma, for homework for the next monthly episode is, I want you to find out exactly which bond you’re using. Let’s look at the directions for use together for that one. Okay. And let’s evaluate what you were doing well and what you weren’t doing on your first two composites so we can actually learn together. If you don’t mind, that could be a nice reflective thing, right? [Emma]Yeah. Yeah. Perfect. [Jaz]You know what? You asked a good question, which I didn’t answer. Would I use something different in different scenarios? Personally, I don’t, because we just, that’s what we have, right? Like the real world answer. That’s what we have. Communicating risk with patientsThat’s what we use. And some of my biomimetic dentists are like, oh, Jaz, you shouldn’t be using that bond. You don’t get as high as bond strength is like clear fill or that kind of stuff, which I get. But I have heard this thing on some webinars that I went on whereby. If you have got some caries, which is not close to the pulp, which is not close to the pulp, then in those scenarios, you should consider using a gold standard total etch. So we’re etching the enamel and the dentine. If you are in a scenario where you’ve got deep caries close to the pulp, then the theory is perhaps we don’t want to put that 37 percent phosphoric acid etch right next to the pulp, right? So that makes sense to me. And then for those, you might decide to use a self etch, which actually when I heard that, like, five, six years ago, it made a lot of sense to me. But in the real world, do people do that? I’m not sure. [Emma]Yeah. No, I mean, I’ve just never had the conversation. I just sort of pass what I’m supposed to pass. So no, that’s good to know. Very interesting. Very interesting. The next question I had for you, Jaz, was we’ve talked a lot about like post op sensitivity can last for quite a few weeks. Do you think, do you notice that there’s any certain patient populations or specifically situations where post op sensitivity is more likely and how do you address this? [Jaz]Again, fantastic question. The only thing that comes to mind to me is people with cheese molars. M I H. Have you heard of M I H? [Emma]Yeah. [Jaz]So molar incisor hypomineralization, and these molars, which for those dentists who might be not familiar with this, this is when at the point of development, when the enamel is developing on the sixes and the centrals and whatnot, is hypomineralized. Polymerisation shrinkageThere’s not enough mineral content. These teeth are weaker, and there’s different sort of degrees of it. It’s mild, moderate, severe kind of stuff. And if it’s severe, as the tooth erupts, the enamel is just breaking away and that tooth’s got to come out. Whereas if it’s mild, they have like these yellow patches and white patches on it and the yellow patches is why they’re called cheese molars. Typically, these teeth can be a bit more difficult to numb and what I have found and what I’ve read is that they will be a bit more prone to post op sensitivity. So that’s the first thing that comes to mind. The other one that comes to mind for me, I don’t know if this is evidence based or not, is people with pre existing cracks in their teeth. If you’ve got a crack in the tooth, especially if it’s a wide one or deep one, then that nerve is already upset, especially if they’ve already got symptoms of crack tooth syndrome. Every time they chew something hard, they feel like some sensitivity. That pulp might already be upset. Deep caries. Especially if they’re already symptomatic whenever I look at a tooth and I think what risk level should I inform my patient, right? So should I tell my patient that you are low risk of needing a root canal? Are you a high risk of needing root canal? Number one thing I look at is how deep is the caries and if it’s close really close to the nerve, then not only is their risk of root canal treatment going to be higher, pulp necrosis, but also it just makes sense that the settling period might be longer. And I think generally speaking, Emma, my patients don’t thankfully experience post op sensitivity very much. And I think the reason for that is is I got anything just like damage a dollar to us, get everything clean and rough. So I’m using rubber dam isolation. I’m not allowing that saliva or blood to touch my cavity, super, super clean, following my bonding protocols rigidly. I’m doing the air abrasion, so I’m trying to do everything really gold standard here and I’m not rushing it. It easily will take me 45 minutes plus to do these restorations. And so my experience of post op sensitivity, because I do like to ask my patients when they come back has been pretty good over the last 11 years dentistry, especially even more that as I’ve developed as a dentist. The snowplow techniqueBut people with deep caries, I would expect it. This is just a given and perhaps people with cracks, that’s the only ones I can think of. But thankfully, when you follow good bonding principles, it’s not normal. If someone’s saying that, oh, post op sensitivity is normal and every single patient will get it. Then I think I would look at the protocols. Are they using their bonding agent properly? Are they perhaps etching the dentine where they’re using a self etch bonding agent and that would then help lead to the sensitivity problems. The other thing I do, Emma is when you’re placing composite, if you don’t mind me asking, what have you been taught in terms of the exact way to do it? So you don’t remove, but you’ve reduced the impact of that polymerization shrinkage or the polymerization stress. [Emma]Very small increments. Your depth of cure around about two millimeters, definitely not any more than that when you’re not trying to like connect the walls together. [Jaz]Okay. Yeah, yeah. Makes sense. You’re not doing like, for example, you wouldn’t join the buccal in the lingual wall straight off the bat and cause that shrinkage stress. And that’s, that’s correct. I would agree with that. So also depends on how you’re placing it. Anything else? [Emma]Make sure you’re doing your full cures. Don’t ever, I know some people do the 10 seconds and then build up the other cusp. Do that 10 seconds so that your first increment gets 20 seconds. Fine, but sort of just making sure that everything’s fully cured. You don’t want that. I don’t know in Glasgow we call it a soggy bottom. I don’t know where to start. Yeah, there you go. No soggy bottoms, thanks. Yeah, very small increments. Just taking your time with it and building it up nice and slowly. [Jaz] InstrumentsGreat principles there. So yeah, don’t join the walls together. Smaller increments. It all makes sense. What I found is that when you look at radiographs of your work some years later, you find these little air voids and air bubbles in there, right? Because like I imagine as a dental student, you’re not heating your composite, right? You’re just using normal cold composite, right? [Emma]Yeah. [Jaz]If you work on like a tooth model, that’s clear and uses clear bands and you start doing these increments and if you can see the actual composite in place, you’ll notice that when you add one increment and then you add another increment and when you, whatever instrument you use and then you retract it, sometimes the composite gets pulled away a bit or that to two increments, they don’t meet together beautifully, that wettability isn’t there. And so you get little voids, right? Which is not ideal. And if that void happens at that sort of where the hybrid layer area is, you might get more sensitivity, right? It just makes sense if you haven’t been able to do that. So what I’ve been doing for the last seven years is something called Snowplow Technique. Have you heard of this? [Emma]No, I haven’t. No. [Jaz]So, a dentist called David Winkler taught me to do this when I used to work for him in Windsor, and he used to teach a lot on composites and fantastic dentists. And then I started to read the literature behind it. A lot of great dentists do this, whereby before so, you’ve done your whole etch bond, it’s ready to now put your composite in. Before I put my composite in, which, by the way, I am using heated composite. In practice, again, to get more wettability, right? Something that’s hard and stiff and cold compared to something that’s warm. It’s just going to get in all the nooks and crannies, right? So that’s also helping to reduce this void issue. I will put a tiny, tiny, teeny, weeny drop of flowable first. Then I will put my composite increment. Okay. And then I will adapt it and cure. And then before the next increment, again, a tiny little bit of a flowable composite. And so that’s called a snowplow Technique, basically. And so, that’s- [Emma]I think, I’ve seen people doing that. [Jaz]You’ve seen that in practice. Yeah? [Emma]Yeah, I’ve seen people do that, yeah. [Jaz]It just makes sense to me. And so I’ve been doing this for years and I feel as though maybe that may or may not be relevant. I don’t know if the study’s been done where there’s a snow plow technique versus no snow plow where that actually really makes a difference. But in terms of my radiographs, I’ve seen that issue where you used to have these little random voids. That’s definitely been eliminated. [Emma]Okay, cool. So is that something that you would only really use with heated composite? [Jaz] ConsentYou can use that snow plow technique even without heated composite. In fact, I think the need for it probably gets even higher when you don’t have the benefit of the heated composite, right? But I just like this, the way it all seamlessly mixes together so nicely, which actually takes me to my next point. What are you using as a dental student to adapt your composite? So you put increment, what instruments are you using now to actually get the composite where you wanted to go in the cavity? [Emma]So, I am actually, not just saying this, I’m a big fan of a flat plastic. But then also I’ve found just a dry microbrush. I quite like a dry microbrush. One of the dentists I work with he’s a huge Protruserati, actually he was the person who said to me, you should definitely go for this job, you should do it. He’s a huge nerd. [Jaz]Give a shout out, give a name. [Emma]Oh, his name’s Pearse Hannigan. [Jaz]Of course it is, hello Pearse, good to see you. [Emma]He’s a huge Protruserati, so he is just a huge fan of just using a dry microbrush, and I’ve been trying it and it’s just getting into all these wee bits and bobs. I’m still sort of, I’m definitely still in that realm of figuring out what works for me, but a flat plastic and a micro brush are my sort of holy grails at the moment. [Jaz]I’m the same. So I’m using a micro brush. So I knew when you said that you use a micro brush, that I knew that’s not something that you would picked up from dental school. I knew someone in the real world would have taught you that. And so shout out to Pearse for this great advice. Something that Jason Smithson taught me years ago. So yes, when you’re adapting the composite, when you use a micro brush, some of the reported benefits of this is you don’t get that. It doesn’t stick to the micro brush, so it doesn’t sort of pull up. And also if you look at it like you use something like something spiky on the composite and it makes this like a roughness even within the composite ready for the next increment. Now, just so we know a reported disadvantage of using a microbrush is when you look at those scanning electron microscopes, you have these, your composites are a bit hairy, like the microfibers are actually breaking off into the composite. So what we know is try and use a more expensive, higher quality microbrushes rather than the cheap ones, because that might be more of an issue with the cheap ones. So just in case everyone starts to switch, make sure using a nice microbrush that’s going to be strong enough. [Emma]Okay, no, that makes sense. Yeah, I suppose you don’t want hairy composite. [Jaz] LongevityThat’s right. And so I think all these things together are what reduce your post op sensitivity. [Emma]Okay. Okay. Perfect. Is that something that you would ever, I know you’re saying it doesn’t happen to you that much, but is that something that you would put in a consent form? Is it just something you generally mention at the end of an appointment? When do you address that? [Jaz]Every time. So there’s always a pre chat, right? There’s always like a debrief before we start the restoration. So usually I’ve got the photo of their tooth because at the checkup, I would have taken a photo of the tooth, showing the caries, showing the issue. So I’ve got the photo on the big screen already as they walk in and I say, Mr. Smith, do you remember what we’re doing today? And usually my patients are like, I have no idea what you’re doing today. They don’t remember. They’ve got memories like fish. So they come in and say, have a look at his tooth, right? I describe them. Can you see that there’s a bit of discoloration? There’s an issue over here. Oh yes. Yeah. Oh, now I remember. Yes. We’re doing a filling. So yes. And then I showed them the radiograph saying, okay, based on, the fact that you’re not in pain at the moment and you’re not having sensitivity and it’s not super close to the nerve, the chance of your nerve dying after this and needing something called a root canal is thankfully low. It’s not zero, but it’s low. And then obviously I do the reverse and I really exaggerate it in terms of, okay, this decay is really close to your nerve. This is really bad news. We are doing CPR for the tooth here. We’re going to give it the best shot we can, but if the tooth dies, don’t worry. There’s a solution. We can still help you. But here’s the things that we should watch out for afterwards kind of thing. And then I’ll remind him at the end as well that, okay, Mr. Smith is totally normal to have a bit of sensitivity to hot and cold for a couple of weeks. It will settle. The bite will feel a bit funny initially. It will settle. Be careful not to bite your lip when you have food today. The usual stuff that you will always, always, always say. And so there was another podcast we did actually consent is like an onion. Right? Consent is like an onion. I don’t know if you listened to that one. And Sean said this amazing thing in terms of what patients remember from the appointment. And what they remember is peak end. There’s two things that patients remember from any dental appointment is the peak, the highlight of the appointment. Was it a funny joke? Was it something bad that happened? Like they can remember the peak of that appointment and the end. So it’s really important to utilize the end and end on high to make sure that they remember and end with the most important bits. [Emma]Okay. Yeah, that’s helpful. Yeah. Save it all till the end. But that sort of overlaps with my next question talking about how do you assess, suppose predict the longevity of your adhesive restorations in your patients like are there specific maintenance or follow up protocols that you recommend just to make enhance the durability of your restorations over time? [Jaz] Risk factorsThat’s an interesting question in terms of, I think we’re coming to is that, okay, when we see the patients again, checkup after checkup, what should we be watching out for? Is there any way that we can intervene to help these patients get the most? I think there are a few things actually that we can talk about here, but let’s take a step back. How long, when I’m placing a posterior composite, how long do I expect it to last? And I think this figure in my mind has changed a lot over the years as I’ve gained more experience and read more things. In terms of what you’ve been taught, I don’t know if you’ve been taught this or seen this in terms of the research or in terms of what the lecturers have taught you at dental school, how long should these fillings last? [Emma]I still don’t think I could tell you. I don’t think I could tell you to five years. I don’t know. [Jaz]And so let’s start with that. So some of the key literature that I was looking up for in preparation for this episode was a guy called Nick Opdam, who’s done lots of great work on longevity of restorations and composites and whatnot. In fact, funny story, when I was a DCT, like one or two years out of dental school, there was this conference at King’s, and Nick Opdam was there. And I came up with him. And I was like you’re a total celeb. Can I get a selfie with you? And it must have been the first ever selfie a dentist has ever taken with him, right? Because he was completely taken aback. He’s like, what? Someone wants a selfie with me? Like, how do you know who I am? My face is never on all these papers that I write. But I recognized, I saw his name and I saw the lecture. I was like, oh my God, this is Nick Opdam’s a legend, right? So I’ll see if I can dig out that photo. Go to my Google photos from like 2014 and see if I can dig out this photo actually. So anyway, absolute legend. And I think 2007 he did this retrospective study where they looked at almost 3, 000 restorations done by two dentists and they followed it up. And I’m just going to see if I can get numbers. I don’t want to say anything wrong here in terms of their good work. But it was 82 percent longevity. Okay, of composite at 10 years. Okay, so 82 percent at 10 years. And for amalgam, interestingly, it was 79%. Okay. And I think what counts as a failure is, caries, fracture, and sometimes with an amalgam, the tooth fractures rather than the amalgam, right? So that would be a failure. And so 82 percent at 10 years, we can make what we can of it. But what are the things to consider was the annual failure rate of 1 to 3 percent is generally what’s said in the literature. So every year, 1 to 3 percent of composites will fail. But the most important thing I think to come to directly answer what you’re saying is when the restorations perform the worst, is patients with high caries risk and on cases whereby you had to do more than one surface, every additional surface that you had to do. So if it’s just an occlusal, great. If it’s an MO, okay, still okay. If it’s an MOB, okay, that’s stretching If it’s an MOBL, right, it’s an MODBL, like the more surfaces that are involved in a composite, the more complex it becomes. Trying to get a good contact point. I don’t know if you’ve found this on your restorations. Have you done like class twos already? [Emma]We don’t actually, is that black’s classification? We don’t use Black’s classification. [Jaz]Really? My God, what do you use? [Emma]We don’t. Just whatever surfaces it is. [Jaz]MODO. [Emma]Yeah, yeah, yeah. We don’t use Black’s classification anymore. [Jaz]That’s mad. [Emma]I’m always Googling, when I’m editing your episodes, I’m always Googling what’s what. [Jaz]That’s alien to me, that’s crazy, I wouldn’t even expect that. Okay, fine. So, MO or DO, have you done the interproximal on posterior teeth? [Emma]I believe. Yes, yeah, I have, yeah. [Jaz]I think one day we can talk about matrix selection and that kind of stuff. I think that maybe would be really good, connecting the real world. But you probably have one or two matrices available in dental school to use for posterior, right? Do you know which ones and the names of them? [Emma]We’ve only got one, actually. What are they called? It begins with an O. [Jaz]Omni-Matrix. [Emma]Yeah, we’ve got Omni-Matrix, I think. Yeah, just the standard Omni-Matrix. And then your clear cellular strips and that’s about it really. [Jaz]When you’ve done your restorations, have you done some MOs or DOs yet? [Emma]I’ve done one. [Jaz]Okay. [Emma]All the others have actually been anteriors. So, yeah. [Jaz]Nice. [Emma]So no, just one. [Jaz]One thing that I would struggle with, even struggle now, I’m much better now and I’ve got some videos I even recorded yesterday actually, which I’ll upload to the portal of just getting a lovely tight contact and the way you can check for a tight contact, it’s not. Yeah, it helps to floss and see, okay, how tight it is. But even more important is you try and bring the floss out. And does it click on the way out, right? Does the floss hang there? That’s a really good test to see if you’ve got a nice tight contact. And so as a dental student, we were using a siqveland , whatever you want to call it. And we’re doing amalgams back then. And then, yeah, some composites. And I was really saddened by the contact points I was getting like floss was passing right through and I was like, Oh my God, the patient’s going to get food packing, recurrent caries and stuff. But, but what we know is that more important than our skill, more important than how well you do the restoration is the patient’s caries risk. [Emma]Yeah. Okay. [Jaz]So caries risk and the more surfaces involved. So the number one thing we can do for our patients to make sure that they get as long as possible from their restoration is trying to actively work on reducing their caries risk, right? So all the usual things, diet advice, be very meticulous with their oral hygiene, keep giving them the coaching that they need, fluoride application. If you can do this, it will make the restoration last longer. The other thing is making sure the patient takes ownership of it. The patient needs to understand that, okay, I’ve done the restoration, but now the restoration belongs to you and you need to look after it. And I think that’s the most important thing. Just to share some more studies, actually with, with Nick Opdam, he then also did a systematic review meta analysis. They only include studies that had five plus years follow up and there were eight authors, again, about 3000 restorations approximately. And the same thing, they found caries risk and how many surface were the most significant predictors of failure. So once you’ve done the multiple surface composite, The only real way to improve your success rate in the future is upgrading that to an indirect restoration that covers the custom stuff, right? So that’s one way, certainly if you’ve pushed the boundaries, maybe because Emma, you might be at a scenario where you got deep caries and you don’t want to do a crown. Because this tooth might need root canal. And so you might do what we call a posh core, right? You do a giant, ginormous composite and try your best. And we see, okay, at the one year mark, is the nerve still alive? Or is it, has it gone kaput? And if it’s still okay, you might then say, okay, there’s no pain, there’s no issues, but this composite is going to fracture. It’s just too big. It’s not fit for purpose. We should now do an overlay or an onlay and that’ll be a good thing to do to reduce your fracture risk and to reduce your caries risk would be all the things that we talk about prevention back to that study, they found an annual failure rate. This most important thing, annual failure rate of 4.6% on people with high caries risk and 1.6% on patients with low risk. I mean, that is really, really a big, big, huge difference. [Emma]Okay. So there’s loads of different factors, but the main takeaway is I suppose you can do the most beautiful composite or restoration in the world, but if it’s got a higher caries risk then it might not last as long as someone that doesn’t. Okay. That makes sense. [Jaz]And if it’s bigger, you’re more likely to run into fractures and issues. And so the larger a restoration gets, the more the tendency to go towards something like an indirect restoration of crown, although there are other parameters, which I know we will be talking about one day as well. The other thing to consider is. When would a composite fracture? And a composite would fracture is perhaps if it’s been placed quite thin. Thicker the composite is going to have more strength, right? And so maybe if you’ve not added enough thick bulk because you’ve tried being ultra conservative, you might then get that failure of a fracture. Or, here’s an important one which I didn’t learn for a few years after dental school is when you look at your cavity, is everything nice and smooth on that floor, right? If there’s like, sharp, spiky bits of dentine sticking out, perhaps you removed an old amalgam, right? You removed an old amalgam, and there’s spiky bits of dentine. Just get your rugby ball, red bur, and smooth that sharp bit away, right? Because when you’re putting your composite on, it likes this nice, smooth surface. It doesn’t want these sharpnesses, which leads to my final point, which is not evidence based, not evidence based in terms of outcome, but evidence based in terms of process, which is what burs we use on the teeth. Any guidelines that you’ve been shown or decision making in terms of when you’re removing caries, when you’re treating a tooth, what kind of burs are you using? What kind of shape of burs are you using? [Emma]So I’d say upon our main restorative clinic, we’ve got all your usual burs, like your rounds, your fissure burs. I have seen burs out there working as a nurse that I’ve never seen in the dental hospital, which is fair enough, I suppose, but a lot of clinicians will have different opinions on what you should be using in certain situations, like I’ll be using a large round bur to do something and the clinician will come in and say, I really think you should be using a fissure bur. But I don’t think, I really don’t think I’ve had that much experience in terms of using loads of different types of burs. Just your standard ones really. [Jaz]The main takeaway here Emma is like, if you look at the shape of the bur, things that are round in nature, so pear shaped and round, are more favorable before composites than your sort of fissure burs or square, rectangular, tipped. Because, if you imagine cutting tooth structure away with the rectangular one, the corner that it has, it actually causes these micro fractures in the teeth. And you get left with these sharp bits in the cavity. If you’re using a round bur, you’re less likely to have those sharp bits and things are allowed to be smoother. So a little thing like that, basically, which again is more process driven than outcome driven. But these little things, and if you look at all the things that what can we do to make sure at the time of restoration, we reduce the failure rate? Well, I think again, going back to isolation. Nice, clean and rough. So following the bonding protocol, reading the directions for you. So bringing together the entire episode that we’ve discussed so far and making sure you do get a nice contact. And we’ll talk more about contact points in the future. So make sure you get a nice contact so you don’t get food trapping there, right? And you coach the patient so that whatever cause the caries, it doesn’t happen again. You lower the patient’s caries risk and make sure that when you are doing your restoration, it’s thick enough and it’s not on a bed of sharp dentine that everything is nice and smooth. And with these foundational things, we’re hoping to get beyond 80% at 10 years and that would be nice. [Emma]Yeah, yeah, perfect. That’s actually really, really hard for me to hear about the round fissure, because I’m a fissure bur kind of gal, so that’s hard for me to hear. [Jaz]Maybe higher up for, if you use a fissure bur on a fissure, it makes sense. If you’re using a fissure bur down with the contour area, it doesn’t make sense to me. [Emma]Yeah. Okay. No, that’s perfect. That’s fine. Lots of good tips and tricks in there, Jaz. [Jaz]What’s the number one thing, Emma, that you think you’re going to change about and the change is harsh because you’re so new to it all, right? I would just love to know, what’s your big takeaway from our chat today on the really good questions that you come up with? What’s your big takeaway? [Emma]I suppose to take away today is just know what you’re using, what prime and bond am I using? I don’t know. So know what you’re using, know how to use it. Look at the manufacturer’s instructions. But yeah, just knowing what you’re using, how to use it, don’t just stick with what you’ve had forever and use the same techniques for everything, because all the materials are different for a different reason. So yeah, know what you’re using and know how to use it. [Jaz]Perfect. And so next recording, we’re going to find out which bond, do you think you’ll find out by then, right? [Emma]Yeah. [Jaz]Which bond you’re using, and then we’ll dig up the DFUs together and we’ll have a look at what does this particular bond say? And so just to whet everyone’s appetite for next month’s episode with Emma, we’re going to be talking about documentation. And so I know photography and videography is not something that you really get to do as much at dental school. But some things that we can talk about, maybe like documentation. What are the things that we’re looking for? How do we do a routine checkup? What do you think that would be useful when you’re actually doing checkups? What are we actually checking for? Would that be helpful? [Emma]Absolutely, like, one of the things that I found very hard at the beginning of third year, how do I do a checkup? And it’s easy enough learning about it in a lecture, you do this, this and this. But what does that actually look like with a patient and, okay, I’ve done this, I’m going to do this now. Like, how do you actually communicate that with a patient? And, yeah, like, just your steps and I know you find your own little way to do it in your own sequence. But how do you do a checkup like that was one of my huge questions and it seems so silly like it’s one of the basic things. [Jaz]It’s not silly. I remember Emma. I remember having this exact same thought like I remember being like a third or fourth year student and the tutor coming and is doing the checkup and I was really trying hard to watch exactly how they hold the mirror, exactly how they’re holding three in one and what they’re trying, what are they actually looking at? How are they so quick? I was like, how are they just so quick and looking around? Like why am I taking like five minutes per tooth? So I’m super excited now to talk about my checkup protocol. And the lesson I can give you now, even before we record that is there’s a book out there and it’s called The Art and Science of Treatment Planning. I haven’t read it. I don’t know if it’s any good, but it is the art. And the science. So what I mean by that is that my checkup will be different to the other hundred of checkups that you’ve seen with a hundred other dentists. And have you ever seen a routine examination that’s exactly identical between two clinicians? [Emma]No, never, never. It’s always a wee bit, it’s always a wee bit different. [Jaz]Well, then I think it’d be really good to, for me to share. So as part of documentation month, we’ll share my checkup, but also I’d like to know about some quirks or some things that you’ve noticed with some dentists that you’ve worked with, and then we’ll get everyone on the comment section to chip in. I think this would make a really educational thing. I might pick up a few things that some colleagues are doing that I’m not doing at the moment and vice versa. So I think spontaneously we’ve decided our next topic quite nicely. [Emma]Yeah, perfect. No, I’m excited. I’m really excited for it and just getting more and more. I’m like a sponge at the minute, just taking in all the time. [Jaz]Never lose that, Emma. Never, ever lose that about you. It’s so, so important to have that enthusiasm and be like a sponge throughout your career. It will serve you well, serve me well so far. I’m still a sponge and I think not to insult the Protruserati, but we are sponges. We’re all sponges. Not spongers, but sponges. All right, Emma, thank you so much. I’ll see you next time. [Emma]Thank you so much. Jaz’s Outro:Well, there we have it, guys. Our first proper Protrusive Students episode. Thank you so much, Emma. You’ve got those revision notes promised in the crush your exam section of the Protrusive Guidance app. Once again, you want to head to protrusive.App, the website, make your account, make a free account. And then email student@protrusive.co.Uk with your proof that you’re a student and try to join with your own personal email address. So even after you’re done with being a student, like I know we’re students forever. I get that. But once you’re no longer at dental school, you want to have an email address so you can continue to engage on Protrusive Guidance. Once you do that, the team will invite you to the protrusive vault. And of course you get access to the crush your exam section and the student clinical videos. And lastly, we will see you on our own student forum. So I’m excited to see the growth of Protrusive students. I’d love to see where everyone’s from, right? All I envisage dental students from all around the world. Remember some years ago when I was still early in podcasting, this German dental student, I bless her, I forgot her name now, but she reached out and she said that yours is my favorite English dental podcast. And I don’t know if she’s qualified or not yet, but those kinds of interactions wherever you’re from in the world. It’d be great to have you on Protrusive Guidance. And I hope you gain from this. I hope you really, really gain from everything we’re doing with Protrusive Students, and I would love for you to hit the like button or comment below if you’re finding this helpful. We’ll catch you same time next month for every monthly episode of Protrusive Student, but of course, there’s so many protrusive episodes you can listen to in the meantime. Bye for now.