Protrusive Dental Podcast

Learn about managing patient expectations in dentistry and facial aesthetics, focusing on communication and consent. Dr. Katherine Bell shares insights on personalized consent, patient education, and minimizing risks. Explore the importance of building trust through communication, balancing natural aesthetics, and addressing patient concerns. Navigate patient expectations by understanding motivations, timing of treatments, and the subjective nature of beauty.

In this episode, we’re launching Protrusive Students, a segment dedicated to dental students while offering valuable insights for young and seasoned dentists. This section provides various resources including exam prep materials, clinical videos, and networking opportunities. A key highlight of this episode is the introduction of Emma Hutchison, a dental student hailing from Glasgow. Emma shares her revision notes and resources aimed at helping students excel in their exams. Together, we’re bridging the gap between academic dentistry and clinical practice, fostering a collaborative learning community among dental professionals. https://youtu.be/Dx6xz1RAnSM Watch PS001 on Youtube Need to Read it? Check out the Full Episode Transcript below! Highlights of this episode: 3:32  Introduction of Emma Hutchison 5:49 Emma Hutchison’s Dental Journey and Background 10:54 Collaboration and Protrusive Student Notes 14:19 Protrusive Guidance Alright, Protrusive Students, listen up! Here’s how you can get involved and access exclusive student spaces, including the coveted ‘Protrusive Vault’, typically a paid feature within our network. Head over to the protrusive.app on your web browser. Select the community plan, which is completely free. Fill out the screening questions to ensure authenticity. We’re serious about keeping our community genuine – no bots or impersonators allowed! When completing the information, simply indicate that you’re a dental student. Now, here’s the crucial step:  5. After filling out the form, shoot an email to student@protrusive.co.uk. Attach proof of your student status, such as your student ID card or a university letter. Also, let us know your expected qualification date. Once we verify your student status, you’ll gain access to a wealth of resources and opportunities tailored to support your dental journey. Don’t miss out – join the Protrusive Guidance Community today! If you loved this episode, be sure to check out another episode for students! Occlusion Questions from Students – AJ005 Click below for full episode transcript: Jaz's Introduction: This is the launch of Protrusive Students. Now, the intended audience is students, but it's also suitable for young dentists, and even experienced dentists looking to reconnect with the foundations and the basics. Look, I've been doing this podcasting for a little while now, and the focus is always dentists. Jaz’s Introduction:And when I speak to students, you guys are so keen for the content, you guys love it, but you guys do admit to me that sometimes the level that we’re speaking at just goes above your head. So I really wanted to create a space just for students. So it’s going to be the PS episodes, the Protrusive Student Episodes. Now as part of Protrusive Students, I’ve also created a brand new zone within our network, Protrusive Guidance, just for students. But again, anyone can join if they wish. It’s going to have a crush your exam section, student clinical videos, and an opportunity to network and liaise with students all over the world. As per the values of Protrusive, you probably are the nicest and geekiest students in the world, so we deserve our own little place. Hello Protruserati, I’m Jaz Gulati, and this episode I have the great pleasure of introducing you to THE Protrusive student, Emma Hutchison. Emma’s a dental student in Glasgow, and her chief mission is to provide you with revision notes and resources so you can truly crush your exams. You see, what I’ve arranged with Emma is for episodes where she gets to ask questions from a student’s perspective. When you’ve been experiencing and practicing for a while, you kind of forget the struggles of when you’re learning something for the first time. I think part of the success of Protrusive is that I’m such an avid learner and learning is one of my highest values, so I always try to reconnect with that. But I’d like to have this opportunity for Emma, our Protrusive student, to ask me questions, which probably most dentists are too afraid to ask because it perhaps seems too basic, but that is what’s going to be the most valuable. So I don’t know where it’s going to go. Like people ask me all the time, like, Jaz, what’s your goal with Protrusive? To be honest with you, I’m just really enjoying the journey. As long as I’m learning and sharing, as long as you guys are learning and sharing through Protrusivez Guidance, I’m in a happy place. So I’m not so much outcome centered at the moment, I’m very much process centered. And there’s a magic of that when you’re a learner. So listen up, this is how you get involved if you’re a dental student and you want to get access to all the student spaces, but also if you verify that you’re a dental student, you will get access to the Protrusive Vault, which is usually a paid space within the network. The way to do it is you go to protrusive. app on your web browser. You then select the community plan, which is free. Now, when you fill out the screening questions to make sure everyone is legit, I don’t want any bots, I don’t want anyone who’s pretending to be a dentist or a dentist student. When you fill in all the information, just say that I’m a dentist student. But the next step is, once you fill that in, you need to email student@protrusive.co.uk. That’s student@protrusive.co.Uk and you need to prove to us that you’re a student. I want to see your student ID card or some sort of letter from university and also tell us which date you’re expecting to qualify. The team will go ahead and match up the application on Protrusive Guidance to your proof, and then you’ll be allowed in the network. And that will also trigger us to add you to the Protrusive Vault space. Now I know what you’re thinking. Why so many steps, Jaz? Because I want to see, I want to see really how badly do you want to be in this. Well, I think it’s going to be an awesome space. I wish we had this when I was a student. Sometimes to get the best people, you have to make things a little bit difficult because people who really want to be part of it, they’re going to self select themselves. So let me remind you one last time, apply for the community plan, which is free. And then also email student@protrusive.co.Uk. That’s student, not a plural, singular, student@protrusive.co. uk. Make sure you spell protrusive correctly and give us the proof and also your expected year of qualification. And when you’re using your email, use your personal email. Try not to use your uni email because if you lose access to that, you might lose access to the network. So without further ado, let me introduce you to Emma and I’ll catch you in the outro. Introduction of Emma HutchisonIt is with great pleasure that I introduce to you all. Emma Hutchison. Emma, welcome for the first time and one of many times to come to the Protrusive Dental Podcast. How are you? [Emma]Thank you. I’m good. I’m good, Jaz. How are you? I’m excited to be here. [Jaz]I know. I know. Right. And so we’ve got some really, really great stuff in store for dentists and for students. So it’s quite special. So those of you who don’t know yet, we’re going to talk about Emma today. She is a dental student, but we’re going to learn a little bit about her journey because I find it really inspirational, the whole journey element, how someone gets into dentistry. And your background with nursing. I’m so excited to unpack more about that. But basically, I found Emma because you guys might remember on the Facebook group a little while ago, I posted that Protrusive is growing, it’s expanding, there’s so many ideas and stuff. And I feel is that I wanted to get some students on board a to help them instead of them. You’re working as a locum nurse. I said, okay, how can we help you in terms of having some sort of income and stuff, but at the same time, how can we work together to help it make it easier for young dentists and students? And so what has come to fruition, which we didn’t know at the time, I didn’t know it would go in this direction at the time, Emma, is Emma’s notes. Because I feel like I hit the jackpot with you, Emma, when you show me some of your notes, they’re absolutely impeccable. Right. They’re so, so good. So well done. But before we delve deeper into that, Emma, just tell listeners and watchers a little bit about yourself. [Emma]Yes. So firstly, I’d just like to say thank you so much for this opportunity, Jaz. I’m glad to be here. So my name’s Emma Hutchison. I’m 24 years old and I live in Glasgow in Scotland. I’m currently in the middle of BDS3 in my third year at Glasgow University in Dentistry. But I’ll say this is actually my fourth year due to COVID, we all had to repeat a year. So I was unfortunately the 2020 baby of dental school. So we all had to repeat our first year. [Jaz]But that’s not too bad Emma, because if you think about it, there’s a lot of dental students, right, who were in the peak of their, like, clinical third, fourth year. So I feel as though they had it quite bad. I feel as though if I could do first year again, Emma, don’t get me wrong. I’d have to do first year again. [Emma]Absolutely. Absolutely. And to have first year online, that was good, but no, I felt so bad for especially the fourth and the fifth years. Yeah, definitely. I would choose first year again. [Jaz] Emma Hutchison’s Dental Journey and BackgroundBut what got you into dentistry? Like you’re here at Glasgow. What attracted you to dentistry? And when did you actually do your nursing? [Emma]I’m going to go out on a whim here and say, I think a lot of dentists at one point thought they wanted to be doctors. I was one of those. You’re 14 at the time, you don’t really have a clue of what you want to do. [Jaz]One thing I’ll say, Emma, is just because it’s the first time recording, is with the international audience that we have, your beautiful Scottish accent, okay, I want you to talk a little bit. I want, it’s beautiful. I just want a little bit slower because the first time we had a Scottish guest, the girls just could not transcribe it at all. They just, for them it was Japanese. All right. You’re doing great. I’m loving it. Just maybe just for the international audience to slow down a bit. [Emma]Okay. So I definitely think I was one of those people who saw they wanted to do medicine, but for, at the time, I was 14 at the time, I didn’t really know what I wanted to do. There wasn’t much work experience for me to do, and I went and did a day’s shadowing in an oncology ward down at the hospital in Livingston, and I did not like it. I really didn’t like it. Looking at it more and more, it really just wasn’t for me. And my mum’s a dental nurse. She’s worked in the NHS as a dental nurse for a long time over 40 years now. And she said, what about dentistry? So I thought about it and then work experience with her for a week. And she got me seeing all sorts of things. I was in GA sessions. I was doing sedation and things like that. I was watching everything and it was amazing. And I loved it. [Jaz]And it didn’t gross you out? [Emma]No, no, it didn’t. It was really, really interesting. Really interesting. And that sort of, I don’t know, fueled the fire, I suppose. [Jaz]And you worked a lot with the implant clinicians as well, right? [Emma]Yeah, so that was a wee bit later on, doing implants. I worked at an implant practice when we had our sort of year out due to COVID and things. I worked at a private practice, does a lot of implants and things in Glasgow. So that was really, really interesting. [Jaz]Which was amazing for us as a protrusive listeners and watchers because when we had Devang Patel on, about restoring the single implant. Like, you know more about implants than me, Emma, right? And so it was amazing to have you just to finesse those notes. They were absolutely brilliant. And so that came in so much handy. I started to see, wow, Emma’s got a lot of broad experience. That was a stroke of luck, I thought. [Emma]Yeah, no, it was really, really good. It’s really interesting, but had a bit of an unconventional route into dental school, I suppose. I think at school in what’s our sixth year or final year, you apply to dentistry before you get your results from what I was sitting at the time, which was my advanced hires, which I think is the equivalent to your A levels, I think. So I was applying with my results that I got from my hires which was the year before and I think I got three A’s and two B’s. But it just didn’t really cut it for dental school I think they were asking for four A’s at the time So it was a bit of a bummer, but I said, you know what? I’m going to go ahead and I’m going to do really well in my advanced hires especially in chemistry because that was one of the ones that I got a B in, so kind of a biggie. So I don’t know how some miracle managed to get an A in my advanced higher chemistry. And I thought, right, I’m definitely going to apply again. I take a year out, I’m working at Costa Coffee, and I try again, and the same thing, I just, I didn’t even get a sniff from any dental schools, didn’t get a sniff at all, no interviews, anything. I think my UCAT was also maybe a little bit poor. [Jaz]So you had the grades but no interviews? [Emma]No interviews, no. I think they were still quite hung up that I got that be in higher chemistry even though I had got my A in advanced higher and also it’s just so competitive to get in. So, so competitive. So fair enough, but I was so disheartened and that’s when my mum said to me, she’s a dental nurse, she said, if you really want to do this, go and do your dental nurse and see if you even like it. I think a lot of people get to dental school and they’re like, not for me, which is fine. I managed to get a trainee job as an apprentice, where I went to college one day a week, was in the practice, the rest, and I absolutely loved it. I worked in such a good practice, well organized, fully staffed. It was great. And I applied again. I went on a course this time to help with my UCAT test. And here I am really, so yeah, that’s pretty much me. [Jaz]Perseverance, resilience, that can do attitude, you display all those. So, so well done. And I’m so glad you did that when you look back, life doesn’t make sense, but whether you believe in destiny or God’s plan or whatever you believe in, right? Like you had those extra experiences. And I think honestly, Emma, like I know we’re still early, I think, the world’s your oyster, and I think as a dentist, like you’ve already shown me qualities that you’re going to be amazing, honestly, like the foundations that you have and the experience that you had as a dental nursing, that’s really going to set you up, I think. Collaboration and Protrusive Student NotesI think it definitely, definitely gives you an edge. So well done for persevering. And so it’s great to share that story with everyone. And when I see what we’re going to be, what we’re going to be sharing with the Protruserati and the students, it’s is your notes. And they’re so detailed and methodological. And I think it’s wonderful that you, we had this thing that Emma, are you sure you’re happy to share in a world where students are hoarding their stuff? I said, Emma, I’m going to put your name on it. I’m going to say Emma’s notes, but how do you feel about sharing it we’re dental students all over the world, and I was just amazed that you said, you know what? We’re here to look out for each other. Let’s do it. And so we’re embarking on this journey together to make dentistry tangible for students as well. I’m so, so glad to have you part of that. What do you think about that? [Emma]Yeah, I’m just, I’m so excited for it. So like, I understand the overwhelm and again, maybe that wee bit of a background in dentistry, it can be a wee bit easier to pick out. I suppose what’s relevant to the real world and what happens in real life, so, we learn about multiple different bonding systems and file sequences, like what do we actually need to know to pass our exams, and then what do we need to know moving forward in our career at dental school and beyond. So just sort of making that a wee bit more tangible and a wee bit more easier to understand, like that’s what I’m excited for. So it’s good. It’s good. I’m excited. [Jaz]Well, the way we’re joining forces is like your notes, which I’ll probably just bring up on the screen for those watching, for those listening, just take my word for it because that’s just beautiful. Like the dental material one is like amazing depth and detail, but not overpowering. It’s not too much. It’s just the right bullet point amount of stuff, which I love, but I agree what you’re missing. And I mean that with respect. And we all saw the students do is that real world aspect to it, which is why the theme we’re going for is monthly. We’re going to record something that’s going to benefit all dentists. Right. But it will be a focus on how can we make your dental notes? How can we add that real world clinical attribute to it to make it more understandable for dentists and students? And be that bridge between dental students and the real world dentistry. And I think that’s how we’re going to best join forces to benefit everyone. So for example, the episode after this, the one we’re doing is about adhesive dentistry. And so you have some top questions. So we’re going to be sharing your notes on composite, dental composite and amalgam and adhesive dentistry. So those notes will be out there for all dental students, but you’ve got these real world questions to ask me, which we’re then hopefully we’re going to add that missing element that you hadn’t done school because you just don’t get enough experience at dental school and that’s okay. It’s not dental school’s fault. So I think that’s how I think we’re going to best merge our unique positions. You as a dental student, who’s so detailed and thorough with her notes, me with my enough experience, real world and making things tangible to bring it together. And I think that’s what’s going to make your notes even more special. [Emma]Yeah, absolutely. Absolutely. And like I was saying, I know the overwhelm and dental school, especially the first two, three years. It’s just, what do I need to know to get me through the exams? And then you can sort of, you sort of lose the whole, you know, you don’t even think about it, the whole, what does this actually mean for me as a clinician? And what does it mean for my career? So I think, especially third year, that’s where it sort of start starts to shift a bit from just theory, theory, theory. And then you’re thinking, wait, how do I actually put that into practice? That’s what I’m finding difficult at the moment anyway, so we’ll navigate it. [Jaz]That’s where we’re going to help together. And that’s where the Protruserati, we’re all going to come together on the new platform called Protrusive Guidance. There’s a whole section we have on there called Crush Your Exams. This is where you’re going to shine, Emma. Your notes can be there. We have example questions and stuff, but mostly just the depth and the beauty of your notes. And then we have student clinical videos that we’re going to have to help students see there’s little things that, when you’re starting out in clinic, how to give local anesthetic, basic things, which I think we’ve really beneficial students have that clinical element to it. And that’s where I think the whole section run by me and you will, I think we’ll do really well to help students everywhere. And dentists, actually, I think dentists will also be able to back to basics is a nice thing to have. But the other element which I’m really excited about is the community aspect. I think dentists can be an isolating profession. I’m sure you’ve seen it in your time as a nurse. It can be between those four walls. This is the dentist, the patient and you and it can get a little bit lonely, especially if you don’t interact with anyone getting that mentorship. So what we’ve trying to set up is a safe space for dentists and students. How important do you think it is to have that kind of a safe space as a student? Is this something that you think is demand for out there? [Emma]Yeah. I think it’s hugely important for students to have a space to interact, to have that bit of an outlet. Sometimes sticking your hand up in a lecture theatre can feel, it can feel embarrassing. I don’t know, everyone else wants to leave or sticking into a message, into a group chat, asking your peers. It can actually be quite scary because you don’t want to feel silly and you don’t want to feel like you’re lagging behind your peers, which isn’t the case. And I think that’s just in itself very human nature, you don’t want to feel vulnerable and all the rest of it. Especially in a room with a bunch of other people in their late teens, in their early twenties. So I think providing a space where it is open for students to talk to other students, different universities, different continents, like, it’s such a great idea. [Jaz]But Emma, I’d ask your thoughts on actually bringing dentists, like, I was debating whether it should be just for students, like a little space, or is it okay if dentists can also interact on there? I think we decided actually, it’s a really nice bridge between students and dentists. And the way that we’re going to make sure that it’s a nice, safe environment is very simple. The entire ethos or what I’m trying to set up with Protrusive Guidance is, I want the community and the collection of the nicest and geekiest dentists in the world. I don’t want all dentists. Okay. I just want the nicest and geekiest ones. And I think when you combine that together, that’s why I think that even our Facebook group, which we’re going to phase out, sorry to say people on Facebook, we’re going to phase it out because I want to go all in on the Protrusive Guidance platform. And I want this to be the place to go to when you want some advice, but you also might need a hug. [Emma]Absolutely, you might need a bit of a hug, and even from a student’s perspective, I’ve worked with probably over a hundred dentists, I’ll say, I’ve done a lot of locum nursing, sorry, but you just learn so many tips and tricks from everyone you meet, every new dentist that I work with. There’s something something else that I’ll pick up and even being on the main clinic and university, I’ll speak to everyone and they’ll say, oh, clinician said to do this and different clinicians said to do this, you just so many opinions and tips and tricks out there. Why not share them especially to the to the younger dentist as well? [Jaz]I think of all things I think whoever’s going to be nursing for you in the future when you qualified stuff, they’re going to be so lucky. They’re going to be so lucky because you’ve been in their shoes. You walked a mile, you walked a hundred miles in their shoes, right? So I think whoever your future nurse is going to be is going to be very lucky and knowing that you also worked at Costa, I know you make a really good coffee as well. So your nurse will be well treated. [Emma]Yeah, that’s that. [Jaz]Emma, thanks so much for introducing yourself to the Protruserati. I’m so excited to go on this journey with you and see where it takes us to make dentistry tangible for young dentist students and dentists in general to try and make that bridge. I think that’s where the magic and the beauty will happen. Connecting all of dentistry together, not just established dentists, but getting the students on board so that we’re all have this space to connect and thrive. [Emma]Yep, perfect. I’m just so excited for it. I can’t wait to see what it evolves into and just for people to take advantage of this and put it to good use. Jaz’s Outro:Amazing. Thank you. Well, there we have it guys, the introductory episode to Introduce Emma is completed and the next episode is Adhesive Months. We’ve got some adhesive questions about the longevity of composites that’s coming with Emma and every month we’ll release another episode, another revision notes in the Crush Your Exam section and I’m actually really excited to see where this leads. So if you’re not a dental student and you know a dental student, please send this to them. And if you’re a student, don’t hoard this. Don’t keep it to yourself. Everyone’s going to find out about it anyway. Go and share, share the love. Let’s all learn and grow together. So I’ll catch you in Protrusive Guidance on protrusive. app.

Join the dynamic exploration of occlusion and comprehensive dentistry at the AES 2024 Conference in Chicago. Dive into topics like diagnostic records, TMJ imaging, lip aesthetics, occlusion from different perspectives, and insights from dental giants. Get a peek into the challenges and innovations in digital dentistry and stay tuned for engaging interviews and reflections from the event.

The podcast discusses managing black triangles with composite resin in periodontal patients and bonding to root dentine. They explore the debate between ceramic and composite materials, informed decision-making, heated composite restoration protocols, and Bioclear composite guidelines. They also highlight the importance of proper setup in dentistry procedures.

Discover the innovative Bioclear system challenging traditional norms in dentistry. Explore the principles of cavity preparation and adhesion with insights from Dr. David Carroll and Diana McKenna. Learn about the unconventional techniques, advantages of the Bioclear approach, and the clinical protocol for posterior teeth.

Discover the innovative 'Espresso' technique for efficient posterior composites with Dr. Ahmed Tadfi. Learn about proper cavity design, matrixing, and composite handling tips. Follow Ahmed's journey and join the mission to save a life. Explore efficient techniques for successful and aesthetic composite restorations in dentistry.

‘Tell all my patients I’m running 20 minutes late..’ – sound familiar? If so, this episode is for you! Punctuality goes beyond habit; it reflects our respect for others’ time and professionalism. In this episode, we delve into mastering punctuality in dental practice, exploring the balance between patient care and schedule.  Join Nikhil Kanani as he unveils his five actionable strategies for refining workflows, improving communication, and boosting efficiency in your practice.  https://youtu.be/ixkHjJGKGl0 Watch PDP176 on Youtube Protrusive Dental Pearl: Explore the Greater Curve Matrix Band for your restorations – it’s now my preferred choice for around 70% of my cases. Wherever you are in the world, find a Greater Curve dealer and discover their range of products. Claim £100 voucher towards this matrix system when you sign up to the DRE Composite course – use coupon code PROTRUSIVE on www.drecomposite.com Need to Read it? Check out the Full Episode Transcript below! Highlights of this episode: 05:28 Protrusive Dental Pearl 11:08 Nikhil Kanani Introduction 16:13 Preparation 20:33 Stick to your Time Allocation 25:39 Have a Protocol List 28:39 Work Simultaneously and In Flow with your Nurse 31:33 Use Templates/Pre-written Procedure Protocols 35:58 Learn more from Nikhil Kanani Join the Nicest and Geekiest Community of Dentists in the World: Protrusive Guidance If you loved this episode be sure to check out 10 Habits of Highly Successful (and Most Valued) Dentists – PDP042 Click below for full episode transcript: Jaz's Introduction: I hate running late, like I rarely use that word hate, but I generally hate run late. My wife knows it very well because she sees in me that I am the most anxious. I'm the most worried when I'm running late for something, because for me, when you agree to meet someone or go somewhere for a certain time, it's like a promise that you've made. Jaz’s Introduction:So in my values, not breaking that promise and being punctual is actually really important. Now, interesting thing that I think maybe Jordan Peterson said, or I read somewhere, was that this isn’t like a blanket rule. Like, even with me, if I’m running late, I’m not happy. However, there are some things that I value more than other things. So, for example, going to a party. Like, if I’m late to a party, I’m chill. I’m okay. Because parties aren’t my highest values. Not anymore, they used to be, but that was a long time ago, right? So they’re not my highest value. So if I have to do a few tasks or quick do a few emails before I have to go to a party, for example, and I end up running late for that party, it’s okay with me. That can sit okay with me. But if I’ve agreed to meet a friend at a cafe or some friends at restaurants, then you bet I’ll be there on time, maybe even early. Because I value those kinds of encounters and those relationships. Now bringing about dentistry, a long time ago I made an episode called Six Signs That You’re A Comprehensive Dentist. And one of the signs was that you’re running late a lot because you’re trying to give your patient a lot of value. And you talk to them, and you nurture them and you answer all their questions and give them that little bit extra of yourself. And if that sometimes means you’re a few minutes late. I think that’s worth it. But I have got to terms that in operative dentistry, we can sometimes run late and it’s okay. You’ve got to accept that sometimes you underestimate the situation, especially when we have less experience. For example, that caries cavity, which was way bigger than you anticipated, or that extraction where you didn’t actually notice that that mesial root had a bit of a curve on it. So these little things, sometimes we underestimate it. Sometimes what happens is that the air abrasion sand needs changing, and the water needs changing at the same time, and your ID block didn’t work, and that was the case that you decided to finally pick up your camera again, dust it off, and start taking photos step by step, because Jaz told you to do that. Oh, and of course you found a crack under the amalgam, so you took a photo of that and then you showed the patient and then that led to the discussion of all the different things that can happen for that crack tooth, so you can see how sometimes it’s just Sod’s Law and you’re going to run late. However, what today is about, what this episode is about, is to make sure that it’s not happening consistently. If you’re running consistently late, there’s something systematically wrong. There’s a bigger picture problem, which me and Dr. Nikhil Kanani, my guest today, are going to cover. So it’s the Five Ways to Stop Running Late. The kind of advice he focused on was actionable. I said, Nikhil, please make it very actionable for dentists and their DAs or nurses to be able to implement. So naturally it contains themes of note taking, protocols, and team working to be able to achieve this. It’s a more lighthearted episode of Protrusive, but it’s still eligible for CPD because it still meets the GDC development outcomes of B, which is like the effective management of yourself and working as a team to give your patient the best. And also outcome D, which is about maintaining the right skills, behaviors, and attitudes. Now, talking of CPD and being lighthearted, I also did something live last night on our brand new shiny platform, Protrusive Guidance. If you’re a member of the old app, even if you did like a free trial in the past, that old app was good to host the videos, but we totally outgrew it. We now have a thriving community. So the website for that is protrusive. app, but the whole network is called Protrusive Guidance. It’s a name that you guys helped me to come up with. And actually it was really nice going live on a light hearted topic, which was my biggest regrets in dentistry. And I had like some clinical regrets I had, including some radiographs, some perforations I’d done in the past, as well as some more non clinical and lifestyle and general work environment regrets that I’ve had or some of my colleagues have had. I just want to give a quick shout out to some of the people who were there engaging on the live last night. And these are all members of Protrusive Guidance. So, April, Alex, Mustafa, Zach, Oli, Megan, Shilpi, Anna, Nisha, and Lorna. I mean, there was some others as well. I mean, thank you so much for engaging last night. I think that was quite a special connection that we’re building on Protrusive Guidance. So, if you’re a dentist who craves a sense of community and a safe place. The way we’re keeping Protrusive Guidance a safe space is that to be able to enter the network, you have to answer some questions. And if we’re not convinced, if you have any little doubt that you’re not a dentist or dental professional, we will email you. And sometimes we’ll be asking for certificates of proof if you can’t find you in the dental register. This is all a bit like airport security. Like, no one likes it, it’s a nuisance, but we’re all glad that it happened. To make this network a nice and safe place that we can actually share our failures. That’s what I’m most excited about as we grow our community in the next year. I have added the replay, the one hour replay of my biggest regrets in dentistry to the webinar replay section, which is part of the ultimate education plan of Protrusive Guidance. Home of the nicest and geekiest dentists in the world. So do check out protrusive. app to get in on that. There’s also a one week free trial you can do of that plan to watch that video and maybe vertipreps for plonkers or quick and slick rubber dam while you’re there, and of course soon we’ll also be launching sectioning school. Now in the sequence of recording, I don’t even know if I introduced myself or not for some new listeners, maybe. Protrusive Dental Pearl:Hello, Protruserati. I’m Jaz Gulati and welcome back to another episode. Every PDP episode we give you a Protrusive Dental Pearl, a quick win and some clinical or sometimes communication-based advice. But today is recommending a product that I’ve been in love with for the last 18 months. It’s completely changed my restorative dentistry. It’s a matrix band. Now, as you might’ve seen mine in Maciek’s video on YouTube and the previous episode, which is called Which is the Best Matrix System. And on that episode, we discussed my challenges of using different matrices, but recognizing that actually you do need different matrices. You can’t just have one matrix to rule them all. It’s just there’s no such thing as a perfect matrix for every single cavity design. But since I’ve been using the greater curve matrix patterns for about 18 months now, about 70 percent of the restorations I’m doing, I’m using the greater curve, which is pretty impressive. It’s still not 100%, nothing’s 100%. But to go from a matrix that I knew existed in America to it now becoming a staple in my daily restorative dentistry is pretty cool when I think about it. Now, those of our colleagues from America listening, they’re thinking, wait, has Jaz just discovered the greater curve matrix band? We’ve been using this for years. And it’s true. In fact, there was actually some UK dentists that were importing the greater curve matrix band. Because they realized on forums like in Dentaltown that actually this is the best matrix. Now, what happened a little while ago is Dr. Sunny Sedana got the license to dispute the Greater Curve Matrix Band in the UK. And he’s the only one who does the courses on the Matrix Bands. Now, wherever you are in the world, find your Greater Curve dealer and check it out. It’s a really fantastic matrix and it’s going to blow your mind that you don’t even need to use a wedge. Like, the seal it makes is so good, you don’t even need to use a wedge. And then you’re thinking, well, how are you going to get a contact then? Well, this is going to blow your mind even more. There’s some special techniques, which I don’t want to freak you out, I guess, but there’s something called the contact opening technique, which means that actually you don’t need a wedge. You don’t even need a ring, which is why for convenience sake, and also for those subgingival areas, like the seal, it gets subgingival is brilliant. And if you’ve got patients like me who are typically over 60, have got root caries, inflamed gums and bleeding, it’s just solid matrix to reduce those direct restorative headaches that we have. If you’re working, like, a high end aesthetic clinic, then probably you’re not going to be using greater curve that much. I mean, actually, Sunny would disagree with me. He actually uses it for everything, including, like, veneers and stuff, and I actually use it for class threes, and it works really well anteriorly. But for me, my bread and butter is posterior dentistry. But just a standard matrix band with a greater curve has just done wonders for my efficiency and my stress. My stress is way lower now that I’ve discovered greater curve. Now you could just do what I did and buy the GreaterCurve and start using it and we could talk about it on our network, Protrusive Guidance, some tips and tricks because Sunny’s on Protrusive Guidance. But sometimes I was falling short and it’s only after I went on Sunny’s course that I realized those little nuances and little mistakes that I was making. So top tip is wherever you are in the world, use a greater curve matrix band. And number two is sometimes to get the best result, you have to kind of go on the course. Now Sunny’s course covers a lot more than just a greater curve matrix band. But if you just walk away with that one skill of using this new matrix band day in, day out for your challenging cases, you will absolutely thank me. Sunny has put together a little discount code. It’s called Protrusive. So if you go to drecomposite.com, like DRE Composite like Dr. Dre. So it’s drecomposite.com and if you use a coupon code Protrusive to book on to the Direct Restorative Excellence Composite course, Sunny’s going to throw in a hundred pounds worth of the bands themselves. That’s a lot of bands to get through. That’s particularly good if you’re an associate and you want to just get the ball rolling. You don’t want to go on a course and not be able to implement straight away. So although you get a starter kit to get those extra bands for a hundred pounds to keep you going while you work on your principle and convince your entire practice to start implementing and using the greater curve, it will be a nice start. So once again, the coupon code as ever is PROTRUSIVE, all capital letters on drecomposite.com. I’ll put the link in the show notes so you can see yourself what the fuss is about and exactly why I’ve partnered with Sunny to bring you this pearl today. That’s now dive into the main interview and I’ll catch you in the outro. Main Episode:Nik, Nikhil Kanani, just in case you never know, I promise you I won’t introduce you like this, but Nikhil Kanani, welcome to the Protrusive Dental Podcast. How are you? [Nikhil]Thanks so much for that intro Jaz. I can’t believe you did that. [Jaz]You’re the first person ever who’s been introduced on the Protrusive Dental Podcast with their own song, right? So for those who don’t know, I mean, I feel like you’re my tribe. You truly no gains by Serrani. Obviously, the classic song we used to dance to a lot about 14 years ago, right? That’s how we kind of used to party together at dance school. That’s how I got to know you. And so it’s funny, right? Who would have thought all those years ago that we’re here, sat in front of a laptop, having a chat and helping others, right? [Nikhil]Absolutely. It’s been a journey. I would never have thought we’d be sitting here right now, 14, 15 years ago, so it’s great to be here. [Jaz]Today, we are tackling something quite big, quite, I don’t know if the right term is endemic. Is that a good word to use? Like, we all do it, we’re all guilty of it, and it happens for various reasons, but through this podcast, with our time together, Nikhil, I want the Protrusive to walk away with some tactics and strategies to make sure that we can stop running late. Now it’s funny we’re saying this because obviously I’ve turned up 24 minutes late to our recording. Right. And so just to give people the background sub-story but save the violins for another time. So my son unfortunately has been hospitalized for a couple of nights. Last night was our first night back at home, but the two nights before then I spent in a cold hostel room worrying about my son. He’s okay now. It’s all good. He was a nasty vomiting bug. But the lesson there is and why it’s relatable to what we’re talking about is sometimes shit happens, right? Sometimes you need to extirpate the pulp and you just need to do right by your patient and you’re going to run late. Sometimes that extraction, which you thought was simple, wasn’t simple after all. And it just, the bone was like marble and you’re going to run late, right? And so when sometimes those big things happen in your practice, it’s unavoidable. What we’re talking about, Nikhil is daily reasons for running late, right? And people are on a daily basis, they’re finding themselves are five, ten minutes late consistently, a bit like me. So I’m actually excited to hear about all the things that you have to say. Before we dive into that, Nikhil, tell us about yourself, about the kind of dentistry that you do. How did you get to think about these kinds of topics and obviously share these with your colleagues and teach on this kind of stuff as well? [Nikhil]Well, Jaz, I graduated dental school like yourself in the UK, and then I went on a journey. So I did my first year as a foundation dentist, like a lot of graduates do in the UK. And then I wasn’t quite sure what I wanted to do. So I went exploring. So I did a couple of years in the hospital, working in different hospital departments and gained some valuable skills and insights. And then I decided actually general dentistry was for me. So I went back into general practice and I worked in the NHS. Which worked there for a few good few years in mixed practice and I found this really tough for a number of reasons. Firstly the system was very tough to work in for me because I’d like to provide like yourself gold standard dentistry And I didn’t feel I had the time or resources to do that. So I went on this whole journey to figure out what I wanted to do, but also to do the type of dentistry I wanted to do, which has allowed me to end up where I am now, which is in private practice in London. And I love what I do. I offer a wide range of treatments to my patients and I like to focus on aesthetic stuff, but I do offer general dentistry as well. So it’s somewhere- [Jaz]Something you’re a true generalist, you’re a true generalist like me, you’re a true generalist. [Nikhil]I am. [Jaz]Are there any things that you don’t do? Like sometimes part of the lesson that I want to pass on to Protruserati always is, it’s okay to say that, okay, these are four or five areas that interest me, that I want to do to serve my population of patients. And all these things, the specialists have to feed their families as well. Let me refer these out. So what have you accepted as, your main things? And what are the things that you’ve accepted that, you know what? I don’t need to think about this anymore because I’m going to choose to refer this. [Nikhil]So, I think it comes down to two things. First thing, what do you like doing and what don’t you like doing, and also what are within your competencies and what are not, and whether you want to expand your skill set, in which case go and learn more, or you want to refer to someone who has those skills. So, I don’t particularly enjoy doing non surgical perio treatments, so I refer that, as well as at the moment, soft tissue grafting for perio. I tend to refer all of those things and recently I started to cut down the number of root canals I’m doing. I do enjoy it, but I find that there are people who can do it faster and better than I can. So I refer a lot of my endos out in-house to our endodontists in house as well. So those are the two things we- [Jaz]A funny story about that, Nikhil, if you don’t mind just a detour, there is, you mentioned about people being able to do it faster, better than you. And that’s so true. I used to work in a practice whereby our hourly rate was pretty good, right? It was fancy practice and not earlier. It was good. And because I was doing everything by the book and endo something you want to be very meticulous and stuff the amount of time I was spending on endo meant that the patient was paying a fee that was sizable, which is good it reflected my hard work and I was proud of it. So don’t get me wrong. There’s no mindset issue I was proud to charge that fee but the specialist endodontist down the road was about 20 percent cheaper than me. It’s just the way it works. And so that didn’t sit well with me. I know that that is a mindset issue there, right? That didn’t sit well with me, but just in the theme of sometimes what’s in the best interest of the patient is to actually focus on certain things and be the best you can be in that and be happy to refer us. So it’s good that you’ve identified, okay, root canal says there is someone available in house in your practice. And I’m a big fan. We had this meeting, like, the other month in our practice, Nikhil, with all the other associates, right? I’m an associate as well. That’s it, okay, like I do the TMD stuff. I’m happy to tackle your more difficult extractions. I’m cool with that. Any complex tooth wear occlusion type of people, send them to me. But what do you guys want, right? So all the Botox I’ll send to you. All the sort of alignment that’s a bit more simple. That you’re, hey, Wilson, you’re starting Invisalign. Let me send those simple cases to you kind of thing. So it’s nice to have that sort of skill mix in a practice whereby we know, okay, who likes doing what and who’s good at doing what? So even within the practice, you had this referral network. [Nikhil]So if you keep all the work for yourself, that’s fine. However, if you refer patients within the practice, quite often patients can get better care if the other practitioners are more skilled in certain areas, but also they can get their treatment plans done a bit quicker sometimes because they’re able to see different people simultaneously in different streams. So I think if you work within a multidisciplinary team, it can really elevate your dentistry and make it more smooth and a better journey for your patient. [Jaz]Perfect. And now part of making your patient’s journey better, it’s important to run on time, right? It’s like, especially if you’re in a kind of practice that pride yourself on quality and your whole marketing message and everything is all about quality, then if you’re consistently making your patients wait. It’s not nice and something that I’ve suffered with and so I’ve had some strategies that we’ve employed to help stop me running late. Basically. It’s like a practice effort to help start Jaz running late, right? And quite often I’ll skip my breaks because I will do admin or I’ll just catch up or I’ll just you know spend a bit more time with this patient or whatever. So sometimes these things that we we do with the way we torture ourselves but what are the strategies so if you start with the first, I think you have got five strategies want to discuss basically. [Nikhil]That’s right. [Jaz]What’s the first strategy? And maybe before we do that, maybe in tandem with the five strategies, maybe you’re going to cover the subject of why we run late. [Nikhil]Yes. So number one, like anything in life is preparation. So for those of you who work in the hospital or have seen the way surgeons work, at the beginning of their list in the day, they will have a team meeting and they’ll go through every single patient on the list. What equipment’s required, any special considerations, and then every member of staff on the team will know what’s going to happen, and roughly their plan of action. Okay, so why don’t we do the same in dentistry? So what I would recommend is, before you start your day, get into work a bit earlier, and every day have this meeting. It’ll only take a minute with your nurse. With each patient you will write down or verbally agree. with the nurse, what they need. So for example, if you’ve got checkup, filling and an extraction on the first patient need checkup tray or need bite wings, second patient will need your specific equipment for your composite. Third patient, you’ll need the specific forceps, this specific anesthetic. And over time, of course, when you work with your nurse, you’ll get more familiar, but there might be some specifics to each case which you need. If the nurse is aware of this beforehand, okay, the room will be set up right, you’ll have the right equipment in the room, there’ll be less faff, so the nurse won’t keep going in and out of the room to get equipment that you need. And therefore you’ll be more efficient and you can focus on the task at hand. So that’s my first key tip, that be prepared. [Jaz]It’s a simple one, but so effective. It’s something that me and Zoe do and if I’m working with a different nurse, Zoe’s doing other things on decon whatever, then especially because we don’t have that as good a relationship that me and Zoe have at work, then I’ll spend a bit more time doing that. But the way Zoe does it is that she’s kind of done all this stuff for me, and then she’s just double-checking Jaz, the third patient. I think I’m using G-ænial. Is that correct? I’m like, yes. Or the fourth one, you’re using the greater curve matrix band and usually the matrix bands. I’m like, I’m not sure, but more, 70 percent chance, looking at the radiograph is subgingival. I’ll be using this matrix man, for example, right? So she likes to know and set that up basically, which is great. And that has helped us profoundly in terms of running in time and just being organized and slick and making sure that sometimes we’ve got one scanner, right? And so just plan. Okay, who’s going to use a scanner first rather than panicking at the time. So looking ahead and being prepared is totally a great tip. Okay. I had another guest before, Dr. Nick Simon, who talks about doing ortho as a GDP. And he mentioned about coming into work every morning at 8am, just like you said, basically, and just going through it all, basically. And other business gurus would recommend that have a team huddle, right? So what you’re describing is kind of like a team huddle, but almost like in a surgery specific, just you and your assistant having that in a mini huddle to make sure that you’ve got a nice smooth checklist for the day. [Nikhil]Absolutely. Yes. And I found it. It’s allowed me to be more time efficient in my appointments and cuts out that a waste time where you’re waiting for things to come for your patients because you haven’t prepared well enough and before the appointment. [Jaz]If an assistant or nurse is not used to this and then you imagine being that practitioner who’s trying to lead from the bottom and say you know what I’m going to suggest a change. Any change can be met with some resistance. So I think what we can learn from just basic psychology is you can’t just come in and give all these orders for change. Two techniques that I can think of, one would be to just give a good, clear justification of why we’re doing this, so they understand why. But the other one would be, and this is a little bit cheeky, okay, a little bit cheeky, which is basically, you go to your assistant and say, hmm, I’m having this issue where sometimes we’re running late because I feel so bad for you, you have to run down the stairs and get this piece of equipment, and then suddenly you have to get the Panavia, and we didn’t know. Is there any way that you think we can maybe streamline this and if you make it their idea, then it’ll happen. [Nikhil]That’s a great way of doing it. And actually, it is, it’s sort of almost like co diagnosis. It is. [Jaz]That’s exactly it. So just if anyone’s getting some resistance, hopefully you’re working with a nice individual and you can streamline this. But if you’re getting some resistance, those are two ideas. So I think that one for me, Nikhil personally, that’s no longer the reason I run late. I think we’ve dealt with that one. doing all the things that you said to make sure we got a nice checklist. What is the second strategy? [Nikhil]Number two is also a very simple one, but it’s very hard for low dentists. Stick to your time allocation, and that sounds very simple, but make sure you have booked enough time for the procedure you have in hand. Now, that’s not always going to happen, but 9 times out of 10 you should run on time. So have enough time for what you’re doing, and enough time for the record keeping, so that everything runs on time. Because we all know the knock-on effect, running late. Has on the whole day and it can have an effect on your stress levels. It can have an effect on your nurse’s stress levels and her mood with you. It can have an effect on the quality potentially of your work and later patients because you’re rushing. So having that extra time is not just about the patient in the chair. It’s about the whole day and the whole running of the practice. It can put pressure on the reception team because if you have patients waiting in the waiting room, they’ll be asking how long is he going to be? How long is he going to be? And that. Again, they send you what it’s like, you get a message pop up on your screen. Just going to ask you Jaz, sorry to disturb you, but are you going to be much longer? The patient’s annoyed and then it’s even more stress for you. [Jaz]So it’s a vicious cycle. For reception, by the way, they have a button they’ve click on that automatically generate that message. So how long will it be? So they don’t have to type it out anymore. We’ve been through this a lot. So, totally man, totally. [Nikhil]But also another factor is a lot of practices. I mean, I mentor quite a few younger dentists and they are sometimes. Not get taken advantage of but they think they’re a bit of a pushover by reception trying to squeeze in patients during the day and they shorten some of the appointments that are there so for example a checkup appointment or a treatment appointment and then they’re squeezing them in without your consent or your permission sometimes And that has a big knock on effect so making sure the greater team is involved in the process and understands where the boundaries are and what they are and allowed to do and that they’re not allowed to change your diary is so important because otherwise you can get yourself in a right old mess during the day and it can really have a bad effect on you. [Jaz]When things go wrong, like, why do airplanes fall? It’s not because one thing, it’s about eight or different things that align and happen. So if you look at medical legal issues, right? Of the eight things that you’re having a bad day anyway, you didn’t have enough sleep and then you have the patient is really awkward and on that day that material that you needed was running out and on that day they squeeze in a few patients. It’s just another reason to lead to issues basically. So definitely that’s a huge red flag for your list to be managed in that way. Let me tell you the way that we do it so that it’s actually done in a favorable way. What we learned is that I can run late because I talk a lot and I try and give my patients lots of value and stuff. And so what we do now is if I say, okay, Zoe, I’m going to need 45 minutes per procedure. Okay. Zoe has my full permission to use her judgment and her excellent experience to put 50 or 55 there. She’ll never shorten it. Okay. But I said, listen, Zoe, if I’m just in this, I haven’t really thought about it. I’m just talking to the patient. I’ve said something just put that there basically. Okay. Just give it extra time. If you think it’s a new patient, it’s an awkward patient, whatever. Right. So Zoe’s got full permission to add extra time and that’s fine. I think where that can run into trouble if that happens too often is. In a practice where I work, we charge by time. So you don’t want to keep giving away free time, because if you’re charging 45 minutes, you’re keeping 50 minutes away, then really you’re not doing anything. So what Zoe is happy to do, and I’ve trained her for this, okay, if this is happening a few more times, then actually you should say, actually Jaz, I think it’d be a 50-minute procedure, and we need to charge for 50 minutes. Because you can’t be giving away free time. So there’s a little bit of leeway and wiggle room for like the odd case here and there. But Zoe’s totally cool to be like, hmm, okay, she’ll give me the look. I know. Okay. We need longer than 45 minutes and then we’ll charge accordingly. And I think part of the issue why dentists perhaps don’t, when they’re calculating how much time someone’s going to take, instead of saying 50 minutes, which is how long it’s actually going to take. Cause five minutes run late, they say 40 minutes cause they’re trying to, time is money. They’re trying to make see increase the hourly rate or whatever it might be. And I think respect your hourly rate. But the patient has to just pay more for your expertise, for your time. And it’s not like you’re fapping around in that extra time. You’re actually giving your patient excellent care. So the lesson there is basically if you need more time, need more time and charge for it with pride. What do you think about that? [Nikhil]I think that’s absolutely perfect. And what I would add to that is maybe start off with a longer time. And cut down as opposed to the other way of running late. That’s what I would recommend, especially for the younger dentists. Also, a big problem, especially younger dentists have is, do not change the plan on the day. So if you’ve decided you’re doing X, Y and Z fillings on this day. Do not go and do other stuff on the same appointment on the same day. Unless of course there is a mitigating circumstance where the patient’s in a lot of pain, et cetera, then that’s fine. But otherwise having that change, first of all, violates the first rule, which is preparing ahead with your nurse in the morning, but also it can affect the timings, which will make you run late. So that’s a top tip from me. [Jaz]Absolutely. Sticking, making that plan and sticking to that plan is going to go a long way. What’s the third way that we can help ourselves from not running late? [Nikhil]So I would say for all your procedures, have a protocol list. Now as you go through your career, you will know this a lot better, but when you’re in your first five years, I would say having, breaking down each procedure you have into stages so that you know exactly what’s required when and then actually timing yourself and coming up with an average over time and then applying this to all your future appointments. So let’s say for me, for example, a two sided filling under rubber dam with local anesthetic will take me about 45 minutes. So I booked 50 minutes in the diary and it will run like clockwork. My assistant knows exactly what matrix system I need, which anesthetic I’m using, which composite I’m using, which instruments I’m using for my composite construction. And that won’t change unless I can modify that if I go on a course or I’ve learned something new, then I’ll add it to this protocol list and it will change a bit. So if you have that written down, it was all well and good in my head, but if you have that written down, you can actually physically edit that. So I know I’m like a- [Jaz]Google Doc, for example, that’s available on the cloud. So it’s at work or at home, right? [Nikhil]Exactly. I have mine on my desktop on my work computer, but actually Google Doc is even better because you can access it from anywhere and that way you will stick to your times better. And you will know to the minute how long it takes you it’s funny once you do this enough times, the etch will take a certain number of time by the time building up your wall will take pretty much apart from maybe slightly easier difficult cases the average will be the same and it will be 25 minutes to do certain thing and then another 15 minutes for something else. So having that in your armory and knowing that you have that protocol to fall back on which is the same every time you’re more likely to run on time. [Jaz]And patients get better care that way because you’re less likely to miss an important step and it’s just it’s all like clockwork. And one good tip I have here and if you’re going to start taking photos DSLR photos you can check the time stamps of the first if you take a photo of every stage you know when you got rubber dam on what time it was, you know when you removal or restoration, you know the carries removal completion. So you can actually build up a library of okay, let me just have like two hours of my day just to audit my last four months of photos and see roughly how long I’m spending. That may be a good way of doing things. If you can’t do it then there in the moment. And just one little side tip, I think from that I have is, as in my earlier years, the thing that was taking me a long time, which should not be taking us a long time, is removing the initial restoration, the old amalgam, for example, right? That is completely sacrificial. Go for it. Don’t be too shy. Obviously, you want to be conservative, you don’t want to run right into the pulp, but don’t be so slow in that bit. That’s the bit that should be quite quick. And so the terminology of bur to tooth time, came into my mind, and the bur to tooth time I was taking to remove old amalgams was far too much, right? And now, I tell my patients, okay, it’ll take me about two minutes to remove the old filling. And so, clockwise, I’m done by nine seconds, two minutes. With something that used to take me, like, eight minutes before, it takes me two minutes, just because I’m purposeful with my hand movements. Okay, so, Nikhil, hit us with the fourth tip you have to stop us running late. [Nikhil]So, the fourth tip involves your dental assistant, your nurse. So, If you work simultaneously and in flow with her, you will achieve the best results that includes during your consultations, which are the most unknown time allocated sort of events in your day to help for her to help you with your note taking with any documentation as much as you can and you to train her up for that the flow between getting the x rayed in getting scans in the photos. Minimizing the waste time in that area of the appointment and also preparation for that appointment as discussed earlier. So my fourth top tip is get your nurse involved as much as possible, get her on board and things will be more efficient that way. Also, in a lot of ways, being very not strict is the wrong word, but very professional in the sense that making sure your nurses on point and not wasting time outside of the room, let’s say. And that’s something which I’ve experienced not now, but in the past, especially when I was a younger dentist. Sometimes my nurse used to disappear a little bit, and especially in consult, because I think a lot of assistants think that it’s just the dentist doing their thing, but it’s important for them to be there as well. [Jaz]You’ve hit the nail on the head there, Nikhil. I’ve worked with some younger nurses, training nurses, and the first time they do a consult with me, and I’m having a deep conversation, I’m all eyes on the patient, I’m not facing to the side, I’m not facing the back, I’m just talking. And I stop, and I look at my nurse. And she’s also looking at the patient. And later I’m like, listen, you were just staring at the patient. The conversation I was having with the patient, you pretend that this is the, I don’t know, courtroom. Pretend it’s a courtroom. You’re transcribing everything. I want you to be a transcriber, you’re my part time dental assistant. You’re part time transcriber. Think of that as your role basically. I want every single thing that comes out of my mouth recorded and I want every single thing that comes out of the patient’s mouth recorded. Now, I am experimenting with AI at the moment so that notes will write themselves. I only have two dreams in life. A, the notes will write themselves and B, never have to wash dishes again. If I can achieve these two, I will die a happy man, right? We don’t have a dishwasher yet so I’ll have to wait for that one but I’m almost we’ve always cracked it in terms of notes that will write themselves. So watch this space. But the thing what you said that has meant the least, the biggest reduction in stress for me and allowing me to get home to my children the fastest is once the patient’s left, I’m just checking over and adding and refining my notes rather than writing them because the nurse has written everything. If I say that, okay, I think you’ve got a nerve that’s dying and therefore we’re going to either have to go down a root canal extraction, that’s already written there. And what the patient communicated back to me; everything should be there. So I totally agree. And I personally think that’s, so of all you said, all the wonderful things you said, for me, that’s been the most profound change for me. [Nikhil]I absolutely agree. Almost, you’ve kind of sort of lent into the fifth one I had there, but yes, having, so the fifth one I would say, which is kind of merger of the fourth is having templates or other methods such as AI or I know you worked with some, I don’t know whether I’m not allowed to mention them on the podcast, but with other companies who allow you to have drop down boxes and more, more specific ways of writing notes. [Jaz]I’ve tried Kiroku. It wasn’t for me, but people swear by it and love it basically. For my TMD consults, I use a Dental Audio Notes at the moment. because it’s nice to refer back when I’m writing my report and stuff. I’m also experimenting with other softwares, namely Heidi at the moment, an Australian company who works with, who mostly have products for doctors, but I’m so determined to make my selfish dream come alive. I don’t want to sell anything to anyone. I don’t want to be the next revolution, revolutionary in the way we record notes. I just want my notes to write themselves. That’s why I keep switching from softwares and stuff to find that winning formula. But you’re right. Using the systems that we have technology that we have, or just templates like on SOE exact for those who use it, we’ve got custom screens, right, which is like drop downs, tick boxes. So it’s become so much easier to do that. [Nikhil]Absolutely agreed. So you don’t have to be very specific, obviously, but this ties into the other point. So if you have all your protocols in place, and your stages, and you have that already in your notes, especially for procedures, and even for your consults, it will make your life a lot easier when you’re writing your notes. Also, if you have the templates laid out, if you’re not using any AI or other things, if you have your templates laid out in a way, which is very easy for your nurse to input, which is one liners or empty spaces, which they can fill in, it will make your life so much easier. The amount of time I’ve spent in the past where I haven’t had help with the notes and going back, remembering everything from what you’ve spoken about, I have to go back, look back at the scans, I have to look back at the photos and remind myself of what we spoke about, whereas even if there’s something written, which is not quite right, it will jog my memory. It will be a lot easier and quicker for me to execute the notes and move on. And having, speaking about notes also, how doing your notes, as soon as you can after the appointment helps a lot. So as I said before, having that time allocation within your appointment to do maybe five minutes, make your appointments five minutes longer so you can actually finish the notes on that at that time, it will mean you can leave on time from work and you’ll be a lot longer run in your practice. So will your nurse. [Jaz]I think having that extra five minutes of bliss, even if it means you run a couple minutes late, it just means that your notes will be contemporaneous, which is so important. But I think if you really think about it, the notes that take you the longest are consults, right? Because everything’s so unique. The notes for my two-surface restoration, they’re the easiest because I have a protocol. I do the same thing every single time, air abrasion, the same chat, the same warnings, everything, okay? Only thing I’m adding is specific changes to the protocol. Right? And little quirks, the patient’s dog had a fifth birthday, whatever, little quirks I’m going to write in, okay, and that’s it. Everything else with the same bond, the same time I etch basically my same protocol, I always have there basically. So, I find that the notes that take me the longest are TMD consults or just general new patient examinations. discussions, consent, that kind of stuff. Whereas actually the procedures themselves, because I’ve done all the hard work, a front load of the hard work with the templates, because I have a set way of doing things. It’s just checking. And even the nurse, he or she has had time to just tweak the right protocol that I selected that day. [Nikhil]Yes, absolutely. That’s exactly how I do it. And I think you can apply the same principle to referral letters or treatment planning letters as well. In the sense that If you have that probably won’t necessarily do this during clinic time. But if when you do them, you have a set structure and certain things in place, you can really expedite your timing so that you’re doing stuff you want to do in life, not just dentistry, but stuff outside work, instead of doing treatment planning letters and referrals after work. So I would say it’s a game changer if you can do that. [Jaz]Amazing. Nikhil, you’ve covered five good ways to help us start running late and I hope you didn’t mind me chiming in with my own experiences because I find it very helpful. I think I resonate with all of them, and I’ve been through the whole shebang and I think everything you said is very relatable and very implementable and just needs a little bit of hard work from you to initially set these things up. But the dividends that come in the future are just profound. Because time is the most valuable asset. And if it frees up more time, makes your notes more watertight. And in the case of medical legal issues, it’s just a win-win formula. Nikhil, I know you do a lot of mentoring to younger dentists about designing their ideal workflow, design their ideal work environment. Tell us more about how we can learn from you. [Nikhil]So Jaz, I run a program for younger dentists, typically one to six years qualified. The program is a four-month program and it essentially teaches younger dentists how to increase the amount of private work they’re doing. So private work meaning work that the patients deserve and that you enjoy doing. And I take the delegate from day one to improve their mindset, understand other patients and humans. So the personality typing, I take them through the processes and protocols. can have in place to make them more efficient and better dentist. And then the most important part is I take them through their consultation process. I break it down. I make them more likable to patients. I will teach them how to understand the patients better today. They are actually focusing on the patient’s problem, not just a set structure that we were taught in dental school, and then providing a bespoke solution. In addition, I provide mentoring throughout these four months so that they have the support for treatment planning for any problems they’re having at work, and it’s something that I love doing. I love seeing younger dentists grow because I know how much I struggled when I was that young. So it’s something which I’m really passionate about. And if you are interested, just give me a, drop me a message on Instagram or I do some webinars, which it’s okay with you, Jaz, I’ll leave a link in the thing, which you can join as free webinar. Perfect. So yeah. [Jaz]Your Instagram handle just lastly? [Nikhil]@dr.Nikhilkanani. [Jaz]Award winning dentist. There we have you guys. You knew I’d bring it in eventually. Thanks so much for your time, but I know you’ve got a patient to get to, so thank you so much. [Nikhil]That’s right. Thanks so much, Jaz. Jaz’s Outro:Well, there we have it, guys. Thank you so much for listening all the way to the end. Now to get half an hour CPD, you just have to scroll down and answer some questions if you’re on the right plan of Protrusive Guidance. So those who are on the Premium CE plan or the Ultimate Education Plan, and you’re watching or listening to this on the Protrusive Guidance app. Just scroll down and answer the questions. Now, one example question is what list was Dr. Nikhil Kanani referring to as being imperative for you to be able to run on time? Is it A, a bucket list, B, a protocol list, C, a procedure list, or D, a materials list? If you get an 80 percent mark, the CPD Queen Mari will send you your certificate. And if you’re used to listening to our episodes, then you could be racking up some serious amount of CPD by the time you get to Christmas. I want to take this opportunity to thank my team which is Mari who is a CPD queen, Erika who’s a producer, Krissel who’s been helping me so much with the Protrusive Notes and the videos and reels and of course our new recruit Gian who’s absolutely amazing at video and will be helping Protrusive to level up our videos so we can actually deliver even better content to you. As you can see, Protrusive is a young and growing team, and we’re on a mission to really cultivate this nicest and geekiest dentist in the world. So if you’d like to support the podcast and help us to continue to do the good work we do, this is where your subscriptions really count. So as well as you getting CPD and access to all the different webinars and workshops that we have, you also keep us thriving. I want to so much once again for coming to the end, and you do check out the show notes to reach out with our guest Nikhil Kanani.

Welcome back to another Interference Cast! Today’s episode is a bit unique—for once Jaz wasn’t the one asking the questions. Instead, he had the pleasure of being interviewed by the a cool dental student, Nav Bhatti. During the interview, we explore Jaz’ story, origins, and what fuels his passions. It’s a deep dive into who he is and what drives him. Plus, he shared insights into one of his top strengths, according to Tom Rath’s Strengths Finder 2.0: being a learner. Join us as he discusses the importance of focusing on our strengths and the joy of continuous learning and sharing. https://youtu.be/JyQ3qpZNQLk Watch IC045 on Youtube Need to Read it? Check out the Full Episode Transcript below! Highlights of this episode: 6:51 Get to know about Jaz Gulati  8:35 Jaz’s Journey in Dentistry  11:49 Ensuring Quality in Dentistry vs Income  15:33 Highlights and Challenges in Studying Journey 18:42 Advice for Dental Students: Balancing Academic and Social Well-being 21:18 Journey to the World of TMD 26:36 Difference between TMD and TMJ 28:13 Q&A: Dentistry and Kids – is it possible? 29:12 Why is Dentistry better than Medicine? We recently took a bold business risk, urging subscribers to cancel with the ‘Old App’ and switch to Protrusive Guidance for a sleeker, more user-friendly experience. The response from the Protruserati has been overwhelmingly positive. It’s our free Community! We also offer paid plans for educational content and CPD options. Students, stay tuned for exciting updates coming soon! Join us on Protrusive Guidance for the home of the Nicest and Geekiest Dentists in the World! If you loved this episode, be sure to check out Value Your Skills – How to Stop Underselling Yourself – AJ006 Click below for full episode transcript: Jaz's Introduction: Hello, Protruserati, I'm Jaz Gulati and welcome back to an Interference Cast. This one I feel kind of selfish posting this one, but it was interviewed. It's about me today, right? It's my story, my origin, what drives me. But I was interviewed by a very fascinating dental student called Nav. Jaz Introduction:Nav Bhatti And he’s an up and coming content creator. I liked his style. I liked his realism. Very real world. I always got time for people like that. He’s actually a British citizen studying dentistry history in Slovakia, previously having studied in Egypt and Ukraine. So he’s got a really interesting story and we didn’t actually get time to unpack it because he came to my practice where I work and he shadowed for a bit and then the plan was to record. But while recording about 25 minutes in, which is why this podcast is as long as is, which is why it’s a kind of shorter episode. My wife calls me and at this stage, it kind of sums up the entire sort of month I’ve had, right?  My family has been plagued by illnesses like my baby, Sihaan 10 months had like back to back viruses and when the kids are not sleeping we’ll get like 2 -3 hours sleep a night and then unfortunately my eldest, almost 5 years old, he was in hospital for 2 nights on IV drips, severe dehydration, projectile vomiting, you name it, the whole shebang and then it finally got to my wife as well. I was the last man standing, I kind of told the universe and this is crazy, I had Gary Vee say this once, he said, I told the universe I’m too busy to fall sick. Right? And so that’s my theory of why I didn’t fall sick. I just told the universe, no, not today. But anyway, it’s been a really challenging few months and then it kind of got epitomized by what happened while we were recording that my wife called me and she was in bed, she just couldn’t move. And she had a baby and I was like, oh my God, I better rush home. And thankfully I live very close to where I work. And I said, Nav, I’m so sorry. I’ve got to go. And so the reason to share that with you is just to remind you that we’re all going to have bad months. Okay? We’re going have bad months, bad weeks, and it’s part of life. And one of my mentors, Lincoln Harris, once taught me that when you don’t know someone well enough, that’s when you think their life is perfect. And that really resonated with me. And I guess we always have to be careful, like when you listen to this podcast or any podcast or what you see, especially on Instagram, dangerous, dangerous Instagram, right? Where you look at everyone’s cases and think, wow, they’ve got it all made up. Their life is amazing. Ferrari, Rolex. You just don’t know what’s happening behind closed doors and no one’s got it perfect. You don’t. I don’t, but we all must do this together. And togetherness has been a big theme this last month because we just launched Protrusive Guidance, which is the new website. It’s protrusive.app. So the old platform, we totally outgrew it. And so I did something very dangerous in business terms, right? So you guys know that your subscriptions are the reason that this podcast is alive and thriving today. I’ve actually given up a lot of clinical time. I only work three days at a clinic now. So I could focus on the teaching and the podcast and I have a team to make sure that I actually get to see my wife and kids. And so things were going great, except we totally outgrew the old platform. When I realized that, Protruserati, you guys were going on this rubbish forum that we had on the old platform and you guys were like, hi, I’m so -and dentist from India and this is what I like. And I was like, wow, this is beautiful. You guys are connecting. And I didn’t envisage the community part to be a significant part of it. But I realised you guys actually crave community, which is why our Facebook group is doing well and we’ll trust each other. Protruserati trusts Protruserati. But you know what? Facebook is a**** because there’s too many ads, too many spammers and a lot of you aren’t even on Facebook and you message me saying, Jaz, how can I get involved in the community because I’m not on Facebook? Which is why, Protrusive Guidance is not only taking all the epic content that we had and now it’s got a search engine and it’s just visually beautiful and a lot less buggy. The previous one I found was starting to get buggy on my Android device. This, Protrusive Guidance is just a whole level above. And so the business risk I took is I asked all of you to cancel your subscriptions. Right? It’s pretty crazy, right? I asked all of you to cancel your subscriptions and I said, those who want to, those who want to, yeah, I’m just enforcing on those who want to come over to a brand new experience, come on over. And so this is a very risky thing to do, but I absolutely believe in the future of Protrusive. And what we’re trying to build here and our community and I’ve just been blown away. Like your guys’ engagement so far, how happy you guys have been with the platform, a few teething issues like Android, the quizzes aren’t working on Android at the moment but they do work when you go on your chrome browser, on your mobile or the web. So a few teething issues, excuse the pun, but it’s just been great to see so many Protruserati on the Protrusive Guidance on Android, iOS, but the best place to start, the best place to actually take a look at what we have to offer and choose a plan, It’s protrusive.app on your web browser. And then once you have a login, you can use it on any device, including the native apps.  So let’s hear the episode about what drives me. And I guess in a nutshell, I’m all about being a learner. One of my strengths is learner. One of the five strengths I discovered by doing Tom Rath’s Strengths Finder 2.0. I was recommended this book like 12 years ago. Strengths Finder 2.0. I’ve mentioned the podcast before, but if you haven’t heard it, it’s a really cool quiz that you do and it gives you your top five strengths. And it argues that actually we should be working to our strengths. Weaknesses maybe a little bit, but actually let’s focus more on our strengths. And one of my top five strengths is learning. And on the taxonomy of learning, when do you learn the most? You learn the most when you’re teaching and sharing with others. And that’s what my true passion is. And most of the time I don’t have the answers and I’m desperate for that knowledge, which is why I bring on amazing guests. Some that are internationally renowned and some who don’t have an international reputation. But you know what? Those episodes are just beautiful in the real world journeys of the Protruserati. So I hope you enjoy this slightly different episode and I hope that you will consider joining us on Protrusive Guidance. It’s actually free. If you want to just enjoy that community magic of the Protruserati, it is absolutely free. So check out protrusive.app. There’s also payment plans for the educational content and CPD for those that want it. And students watch this space because something epic is coming for you. Main Episode:Anyway, enjoy and I’ll catch you in the outro. [Nav]First and foremost, I’ve been given an amazing opportunity today to speak to the world renowned, I must say. Definitely world renowned. [Jaz]That was really awkward to me.  [Nav]Anyone I speak to, no matter where they’re from, and I have people in America to speak to, they know you. [Jaz]They know you. That’s crazy. Yeah, that feels crazy to me. [Nav]That is why it’s world renowned for a reason. Obviously I’ve been to Egypt. I’ve been to Ukraine. I’m currently in Slovakia. Everyone knows you and everyone’s a big fan. So as I say, well, renowned for a reason. I’ve got here, podcaster, clinician, as we know, teacher, mentor, and of course, father, the great, the one and only, Dr. Jaz Gulati. Thank you for having me today actually at his clinic.  [Jaz]So I appreciate it. Now it is nice when people come in shadow, but it’s nice that we get to record. Not often someone comes an idea today and let’s record together. And so it’s good. And I’ll be excited to hear about your journey as well through all these countries actually. [Nav]It would not be as exciting as your career today. I’ll say that much, but we will definitely get into it. For me, first thing, as I said, thank you once again for having me in. And I think we want to just kind of start off for anybody who doesn’t know, and they should know. Your background, tell us more because you’re usually the guy asking the questions so today we’re going to flip that around and find out a bit more about yourself.  [Jaz]Okay, I think the most striking thing when I’d have to start, I think I’d feel compelled to start is where the journey begins, your big why in life. And I think I can take everything back to when I was six years old.  [Nav]Oh wow.  [Jaz]Fled to Afghanistan as a refugee, came to the UK at age six, didn’t know a word of English, my father’s still illiterate. I’m just about to get to my and so I’m feeling incredibly grateful now. Yeah, when I look back that I received a British education and I got a chance and I remember those days coming as a six year old to England and this new place and fleeing all the bad stuff I was going with Taliban and being subject to racism seeing some of that being chased by skinheads on motorbikes or like all sorts of things that I’ve seen in that regard. But I think that’s all made me resilient. We lived in a council flat for up until I was 24. So I went to a dental school and when I went to dental school, I was like, oh my God, I’ve got my own room. I’ve got my own bed. So that was a huge thing to me. And if I was to show you where I live now, it’s like a small little two bedroom. Okay. But for me, it’s a castle. [Nav] I’m with you.  [Jaz]So that’s kind of the beginnings I come from. And I think probably the reason why I focus so much on education is that relationship I had coming very hungry and then trying to do the only thing my parents said, just just work hard at school. They never had any more input on that. And then I just took that on board and I tried to embody that.  [Nav]OK, perfect. And then to the next question, white industry, I mean, Asian background yourself. Similar in terms of origins. And I think one thing that we could probably agree on culturally, it’s very much driven towards medicine, dentistry, being a lawyer, being an engineer, something along those lines. You just said your parents didn’t give you that kind of pressure. So what made you think actually dentistry, maybe not medicine, for example, what was the key driver there?  [Jaz]Definitely no parental pressure. Like I remember doing my A levels. And my mom was laying down to like Jaz, what are you doing at the moment? And I was like, I’m just working on this project. And they’re like, what do you do? Are you doing English, math, or science? What do you do? And I’m like, beyond GCSE, like she had no idea what I was doing in school, right? And so that’s the kind of level of input my parents had in that regard. But I’m so grateful that they still made a difficult journey and decision to come to a brand new country and set up the foundations for me. So I’m so grateful. But in that way, I had no pressure. So it’s very much my own choice. If it was up to my dad, I would probably be doing eBay. But my dad was like at a time where he owned these two corner shops, one corner shop at the time, and I kind of did a bit of work experience there. And I got to see what life was like in that regard. And then he was like, oh, so and so son is doing, you make a lot of money on eBay and that kind of stuff. This was maybe, what was it, like 2005? And that kind of stuff.  [Nav]Oh, just when it was breaking through.  [Jaz]  Yeah, exactly. And so my dad was like, why don’t you do eBay kind of thing? And it wasn’t on my radar kind of thing. I just wanted to be a dentist because I had this one upper left central incisor. which was like a dilacerated almost, so sticking out. Very embarrassing, hated it. And then when I had that treated orthodontically, it completely changed me as a person. I completely broke out of my shell. I just wanted to bottle this up and spray it everywhere.  [Nav]Okay.  [Jaz]It’s very cliche. I got to say, oh, I had ortho and therefore, but it was my own personal experience. And I thought, okay, this one would do it. In fact, if you’d asked me at dental school, I wanted to be an orthodontist. Okay, when I look through dental school as I want to be restorative, then suddenly a specialist. And now I’m just a general, just a general dentist.  [Nav]Okay, so you’re clearly not just a general dentist. I’ve just spent some time upstairs with Jaz actually, fortunate enough to shadow. And I’ve seen stuff that I have never seen before. And I’ve shadowed a few dentists in my time. Most of the things-  [Jaz]If you come on a different day. I would have been seeing little old ladies with low left caries, premolar root caries, but yeah, you just look at the draw.  [Nav]They came through. I would say one thing that I picked up with most dentists and maybe that’s what most of the public perception for dentistry is, is that they will look for the quickest and easiest fix and try to get you in and out the chair as quickly as possible. What I saw today was a lot of empathy and understanding of the patient and it was very patient focused.  And it was what I felt from my lack of experience, but for want of better words here, you really did focus on the treatment and not just the time involved. It was very much focused on what’s the patient feeling and how can I make sure they have an easy journey through this. And this wasn’t the end of the journey for the patient. Your patient’s coming back, of course, for the rest of the treatment as well. What makes you have that feeling of I need to focus on the patient and not my bank account? Because a lot of dentists, with all due respect, I would say I’m quite money driven myself in all honesty. How are you not tempted into the dark side? What keeps you looking up with patients?  [Jaz]Good question. And I see that sometimes when you’re there and you’ve adjusted this denture 50 times now, and you’re there calculating your hourly rate, and you think I was already better off working at Tesco, right? Sometimes you have this patient, right? Other times you’re winning, sometimes you’re losing. I think when you stop focusing, whether you’re winning and losing, and you focus on quality, that relationship, the patient, I was always taught, at that dental school, I had some good mentors and they taught me, if you do a good job, the money will come. If you refine your skills, the money will come. I can definitely vouch for that. I mean, the more I invest in my skills, like what you saw me today, that machine I was using, the T -scan, right?  [Nav]Amazing, yeah.  [Jaz]I was doing this T -scan assisted equilibration, so exclusion time reduction on a TMD patient, a purely muscular TMD, a real live wire, as my physio called her basically, crazy referral patterns everywhere. And so we’re trying to get a, we’re closing her AOB, so Anterior Open Bite with Ortho within the invisalign, and to get a nice occluding scheme on her own teeth. She will go on to have a retainer and occlusive appliance, but what I was doing with her was using this T-scan, and that T -scan cost about 8 ,000 pounds, right? So the training with that, spent 1,000, the kit itself I bought myself. I kind of pitched it to the principal, but I feel the only one using it. So now I’ve got this arrangement, if I use it and I charge for it.  Like a subsidy. I get that basically, right? Just paid for itself. But whether or not I was making money from it wouldn’t be the main thing. It’s about actually getting the outcome. So I told you that what I liked about it is I’m not chasing red and blue marks on teeth. I’m led by data and that me feeling as a safe practitioner that I can adjust this and then medico-legally. I’ve got all those scans to show that. Okay, what was the occlusion like before? What was the occlusion like after you don’t truly get that from a photo. So I invested in it. Not to get money back at the end of it, but so I can give better care. It’s a bit like an endodontist investing 50 ,000 pounds on a microscope, right? Patient not gonna pay any more for it, but you’re going to get better outcomes.  [Nav]Correct.  [Jaz]So I’ve got your question now, mate. You said about the patient.  [Nav]Yeah, it was about the patient. What keeps you focusing on that and not the money and I think you’ve explained it quite well that at the end of the day, it’s more so you’re investing to ensure that the patient’s happy with the outcome, but also for yourself, you’re not really cutting corners doing it. And it’s a long term investment. And I think, again, when you do speak to not all but a fair few general dentists out there. It is more about just can you reduce chair time and can you just increase input, output, input, output?  [Jaz]So that’s important as well. I’m not a practice owner, but that’s important to respect your time as an associate. I’ve got a friend, Sunny, DRE composite, he talks a lot about making sure you value hourly rate and how to improve that with composites and that kind of stuff. It’s important. Yeah, but it’s not the only thing, right? You want to go home and sleep at night knowing that you know what? I did a good job. You want to have fun. To make dentistry fun, day to day, to fall in love with the little details. That’s where the longevity of your career comes from. If you focus on just the money, money’s numbers, numbers never finish. Eventually, if you focus on just the money, there’ll come a time where you are clock watching, you’re not involved. But if you actually dare to visualize the end result of some treatment to really care about the mechanics of what you’re doing to fall in love with a little details, gamifying dentistry if you like. That’s where I think longevity comes from.  [Nav]Okay, that’s a very good point. I think I need to do that a bit of a game by myself. So I think I need to take that tip on board and try to enjoy the process as it goes along. So my current situation being a student, that’s my process. Let’s wind the clock back a little bit. So we’re which university did you study at? [Jaz]Sheffield.  [Nav]Sheffield right and for the students out there, what would you say were the highlights and the lowlights of your studying process? And not the dentistry now as it stands, but if you can think that far back, let them know.  [Jaz]Highlights is just, it was a great time, the community of these 80 odd people that you followed through with five years, the social aspect. Partied a lot in first year especially, second year. And towards the end, I got a little bit more level-headed. But it was great.  For me, it was like living out for the first time, getting my own place. It was very special. But then obviously, the dental school aspect of it, it’s like you’re the sponge. You’re the sponge, and you’re there to learn. But it can be a little bit dark as well. I mean, I guess the low light of it, and I’ve spoken about this before, is whereby, and a theme of my life now is when things get difficult. When you’re stretched as a husband, a father, a dentist, a content creator, when you know all these things are pulling at me and my patients are emailing me this, I’ve got five different inboxes and they’re full, right? And I feel that pressure, right? And stretching you. The thing that often has to give way is health.  [Nav]Right.  [Jaz]Whether that’s through sleep or no longer going to the gym, no longer looking after your body or your diet. And so during dental school, I had this like this strange fixation on I want to get 100% in exams. It’s stupid. I look back now and it was just stupid because no one ever hires anyone thinking about what percentage they get in finals. But yeah, it’s all about your emotional intelligence. By the time I was just determined, I did achieve it. I was the first person to get 100% in the final exam in Sheffield. That was one exam basically in finals. But at the cost of my health at that point.  I stopped going to the gym. I was literally just not in a good place. So that’s a dark thing. I wouldn’t recommend it. I want students to have fine balance and I would have done fine without sacrificing my health.  [Nav]Of course, of course.  Interjection of Erika:Hi guys, it’s Erika here, the producer of Team Protrusive. I’m just interjecting here with the announcement that we’ve now got this amazing community platform. You can access it from your laptop. It’s called Protrusive Guidance. There’s also a native Android and Apple app. What we really want to do is to harness the power of the protrusive community and create a platform you can share and grow together. And you know what? It’s way better than Facebook. So if you haven’t already, check it out. Just do bear in mind that we manually approve every single application. So it might be a little bit slow to approve you, but we only want dental professionals on this network to keep it a safe place and so that we can share failures together. Head over to www.protrusive.app to know more.  [Nav]Because I think that’s the thing that we see nowadays, sorry, excuse me, that dental students are almost falling out of love with the profession itself just simply because of the amount they’re putting into the studying aspect. I see students as well, they’re burning themselves out before they even hit the chair, for example.  So it’s one of those things that hearing it from yourself as well. It’s seeing yourself now is successful where you are. And that’s great. But even you’ve fallen prey to that. So what would be the best way to give advice to these students that are trying to push for the best grades and really killing their social life to just keep a balance so that they still enjoy dentistry at the end of it? Because one thing I kind of see is dentists, they come out into the world and they are just grumpy, they hate everything because they’ve hated dentistry. Now they’ve despised the trade. So by the time they’re out there with their patients is basically, how much money can you bring in?  So I think what you’ve done is you’ve fallen in love with dentistry and therefore you love treating patients and all the rest of it, which is good for everyone. Now, how do we make sure that students that are currently in that university aspect, how do we make sure that they’re not making the same mistakes that you might be? So what would be your advice there?  [Jaz]I would firstly say it’s a noble thing to want to do well at university. It’s a very noble thing, right? To have to desire that for whatever reason, why make your parents proud, you want to do it for yourself. You just want to master something even if it’s as a dental student, you don’t really master a book, right? You can’t actually master anything except memorizing the words, right? It’s like a memory test in a way. So it’s a noble thing. I wouldn’t discourage trying to aim for the best. But you have to draw the line somewhere to see, okay, what are the sacrifices I’m willing to make? If I ask myself that now, now all those years ago, I wasn’t willing to make my health sacrifice, but I did. And I just need better ground rules to understand what I’m trying to achieve here and for what reason. And number one thing to remember is your grades at dental school will totally not determine your success in the future. Your emotional intelligence, your charisma, your network, how nice you are to patients, the quality of care that will eventually build on time. But these are things, these are factors that are gonna determine your success, not how much you scored in these exams. I think when we focus so much on books and less on people, we have to remember that dentistry is a people business. And so the more you remember that, and remember that, okay. You’re better off and you’re finally done dental school to do the bare minimum to get the pass. But then the rest of the year go to toastmasters, which is like public speaking. Put yourself in awkward scenarios. Learn about body language. Learn about the art of communication talking to people getting out there. That’s gonna be far more important in your success in the future. I think.  [Nav]Okay. That’s actually fantastic advice and I think that’s somewhere where people do slip up that we focus way too much on the educational side of things so take that advice on board for anybody listening, but that’s huge. I think people skills are so underrated and undervalued. But in reality, that’s kind of what takes you on to the next step in your career and with your patients as well. So amazing advice. Thank you very much. Let’s move it along.  So you’re a massive advocate of TMJ as a whole, the temporomandibular joint and TMD disorders of. What pushed you into that other than the story about the orthodontic side of things and obviously your teeth being dodgy from the start and all the rest of it.  You said earlier, what made you really focus on TMDs as a whole thing? And that’s basically made you who you are. That’s your brand, essentially what people know you for. So guide us through that journey. And what made you get there at the end?  [Jaz]It’s a scary one. I think about it because I often think, am I doing the right thing? Am I on the right path?  [Nav]Right. Okay. Interesting.  [Jaz]I had a book to call with someone recently. I can’t see, I can’t reveal who, but this is like someone who’s really up there in the world of TMD academically, especially, but clinically as well, but very academically. And I arranged a meeting with him just to talk about, okay, if I’m committing to this, what do I need to watch out for? Because when you start treating patients with chronic pain, things can become very tricky for you as a person, the communication required from you, how you deal with people’s emotions. Managing expectations.  And so, famously on some videos that I did like two or three years ago, an episode was called, I think it episode 39 or 40, it was like, Stay Away From TMD. And I said, are you sure you want a cue of pain to the patients outside your door? Because I kind of miss doing more standard dentistry. I love doing crowns. I love doing tooth wear and stuff. But I’m seeing more and more TMD. It’s a double-edged sword because I love helping people with pain. I love getting a diagnosis, getting into all the detective work, getting the right diagnosis and explaining that to a patient and figuring out, okay, what are the different ways to go? And with that, I do still find the more deep I go into TMD and I’ve learned from several different courses and people. But I still find that it’s the Wild West when it comes to TMD.  But I mean, you can do all sorts. So my philosophy at the moment, 2024 is my philosophy right now, might change five years later. My philosophy right now is get a diagnosis, figure out, okay, what are the range of treatment options we could do? And if it aligns with the patient values, do the most conservative first. Try and do the most reversible. Some people say, oh, splints are not a cure and then that kind of stuff. And I understand that. And I see where that comes from. But I believe in symptom modification, i.e. if I can modify your symptoms, like I told you about that email I got from the patient, right? He’s got a KOIS deprogrammer, and we don’t want to go into that basically, but he’s feeling, he’s had pain for 11 years, and he just emailed me saying that, wow, this is amazing, right? So to have that impact is absolutely brilliant, but by modifying his symptoms, now I feel okay to recommend to him to have orthotics to improve his overjet.  Now I feel okay about that. I feel like, with chronic pain, anything that’s been longer than three months, what the evidence suggests, which isn’t amazing evidence, but the evidence suggests is actually the more hands off, the better. I don’t fully believe that, but I have to respect it because that’s the evidence. So in a roundabout way, what I’m trying to say is I’m sometimes worried about am I in the right space because it is a challenge. I do find it challenging. I’m not going to lie. I sit down, I do a TMD report and it takes me a lot of time because I really want to proceed carefully.  It’s not like, caries removal, like it’s very definitive, you restore it, tooth extraction, restore it. With TMD as a whole, patience, emotion side of things. That’s what I found the toughest, right? Because they kind of, they want me and they want me for life and they email me and stuff and I’ve got to be there, I’ve got to be their advocate. So when I spoke to this guy about the top dog in TMD and I spoke to him, he told me, do you have a contract with patients? I’m like, no, I don’t. So I’m gonna continue some mentoring sessions with him, because he’s got 20, 30 years on me. And so I appreciate that you see me as this up and coming TMD, but I’m very, very careful. I don’t know if you’ve seen on social media, especially on my personal Instagram, I very rarely would advertise to patients that if you’ve got clicky joints, come and see me. If you’ve got-  [Nav]True, true.  [Jaz] I talk more about family now and cosmetic stuff. I’m already swamped with TMD patients. Already swamped. And it’s more than I can handle. And it takes a lot of personal strain to manage these pain patients. So whilst it’s very rewarding and it’s like a thinkers game. Professor Okeson in Kentucky, he says that TMD is a thinkers game. I like that. But I’m constantly like, hmm, is this the best thing for me in my future? And I’m committed to it. I want to help my patients in pain. But I am perhaps from an outsider looking in. They say that Jaz, he’s a bit too conservative. He’s a bit too cautious and that’s me right now.  Okay, and I’m happy here, right? I might change in five years, as either new evidence comes to light or my own personal experience change. Yeah, but I’m very careful about over-promising and under delivering when it comes to pain patients.  [Nav]I’m with you. That’s the perfect response. I think for anybody I know there’s a lot of people that are full-on dentists They know this stuff inside out but anybody who’s coming through via my route is probably a student and won’t know much about TMD. So would you be happy to do like a 60 second or a bite size crash course on TMDs? What they are and the importance of treating them in comparison to just typical dentistry to see it. Okay, so that anybody who wants to know what the hell we’re talking about, we’re just throwing TMD, TMJ at each other. It will give them a bit more insight.  [Jaz]TMJ is two of them. It’s a joint. It’s anatomy. Don’t confuse TMJ with TMD. TMD is a disorder. TMJ is anatomy. TMD isn’t even a diagnosis. There’s many different types of TMD, okay? So you have purely muscular TMD, right? Because the stomatoma system is full of teeth, muscles, and joints. Even the joint has got a capsule. It’s got so many parts of anatomy that you should learn first. So if you want to not embarrass yourself in the future when your patient comes in with that TMD emergency, first thing, and serve your patient, number one thing is learn anatomy of the TMJ and the muscles. If you can learn anatomy of the TMJ and the muscles, you’re pretty much halfway there. Combine that with a history and then you can get a diagnosis. And then how do you know the range of diagnoses? If you look at the international classification of TMJ disorders, they’re all there. So if you know the anatomy, you’ve got the history and you look at the different diagnoses there are, you can actually begin to start making diagnoses. Only when you start making a diagnosis can you think about helping a patient.  [Nav]Right, right, right.  [Jaz]And so that’s my six second crash course.  [Nav]That was crazy. And then you’ll end up in this crazy wild west as you call it, where Jaz is sitting at the moment. And good luck to you if you follow that route as well. So, that’s awesome. Thank you so much. I had questions from people online actually, specifically for you because we did a little Q & A thing. The first thing actually ties in with family. So we had a message from a girl who said, I’m considering doing dentistry, but I want to have kids in the near future. Does it work?  [Jaz]100%. Okay, like mother mothers who want to say work part time and stuff. in the right place, right environment, you can be supported, you can, the world’s your oyster, but to have kids and be a part-time dentist in that phase of your life works really well, I think.  Especially if you happen to be a practice owner or something, then you can manage your own hours. If you want to work 10 till two, you could. I know it’s a bit of a unicorn in some ways, but what I’m trying to say is you can totally fit dentistry around your children’s life. And it’s something that pays more than most professions. So even if you’re working part time during that phase of your life, you can still be doing financially well to support your family. I think overall it’s a great profession and so and then that includes being a parent.  [Nav]Okay, perfect. Let’s give you two more quick ones and then we’ll wrap it all up. Why is dentistry better than medicine? This is actually a question I got through. So in your words, you can’t say it the other way around. Now you have to stick with the statement. [Jaz]Okay, why is dentistry okay? Okay, because I get to look down someone’s mouth rather than look up someone’s ass. Did you know this one already?  [Nav]I always advocate for this, always say I’d rather my fingers going one way than the other way. So this is think alike, okay, perfect. And the last one I’ve got is from somebody who’s actually had a really bad experience. He said, I feel like the dentist I went to is like a mechanic. He went in there and just found problems, right? And maybe this is public perception as well. One, how do I find the right dentist that I can trust? And two, how do I know they’re not just fobbing me off and finding problems that they’re going to make me pay for? What would be advice for most patients out there?  [Jaz]It’s a real tough one. I see on YouTube, even though the podcast is for dentists, I get loads of patients commenting. And my stock answer is look, I’m not here to give advice on YouTube. It’s not what I’m here for. I’m here to serve my dentists and raise a game of education. But now and again, I’ll give some looks to do this, do that. And the number one advice I give is they’re doubting their dentist. Just have a conversation with your own dentist.  And it’s totally fine to get a second opinion. But if you’re getting a third, fourth, and fifth opinion, then maybe something’s wrong with you, not with the dentist. So second opinion, cool. Maybe a third opinion if it’s really complex. But it’s totally cool to get a second opinion. It’s totally cool to question what your dentist is doing. But ultimately, you’ve got to trust in your dentist. You always have to put the trust in.  Now if you find that you can’t trust that dentist, then that’s where the second opinion comes in handy. Eventually you’ll find someone who communicates in a way who you can resonate with, who then you can trust. And once you trust them, then it’s very difficult in dentistry because most issues are painless. And that’s why the patient trusts issues there because most issues are completely painless. Caries, unless it’s to the pulp, it’s often painless. And so I totally understand why patients are skeptical, but they have to at some point find latch on to that individual that they’re not buying the dentistry, they’re buying that. Yeah, they’re buying you that okay, I like this guy. I like everything about him I trust this guy and the way he explains things I would like him to to do it if it’s aligned with my values and budget and if my values and goal is I don’t want to have pain anymore I want to keep on my teeth and great, but if you’re suggesting something that’s not in line my goal, then of course that’s different.  [Nav]Perfect and that obviously goes back to the point that you made earlier about it’s all about interpersonal skills as always very.  [Jaz]Always, always. You can have the best crown margin in the world. The patient’s not going to know. But you’ve got the worst paralysis in the world, but you’re so sweet to your patient. I’m not advocating that. I’m not advocating this, but the value of communication and just being nice to patients. It’s a really great one, actually. Three things. It’s not mine. It’s a dentist called Amin Aminian. You came up with it, read it in a book. Three things. If you could do two of these three things well, you probably won’t get sued. You probably won’t get in trouble. Three things. Doing the correct treatment plan. Doing it well and being nice to your patient.  So you might have done the wrong treatment. It really needed ortho, but you did veneers. Wrong. But you did really good veneers and you’re really nice, you’re going to be okay. If you did the correct plan, you did it really well, but you’re rude to your patient. Well, you’re technically excellent. You’re probably going to be okay. You see what I mean? But that’s an easy one to get at the end.  [Nav]I’m with you. I’m with you. Keep those in your mind. That’s perfect. Honestly, I can’t ask for anything more from you. I think this has been an amazing insight.  [Jaz]I’m sorry. I have to be cut short.  [Nav]No, no, we’ll definitely reconvene over the summer. I’m sure we’ll find that.  [Jaz]We’ll continue on the usual route online. Right. We’ll just get it from there.  [Nav]No problem. And like I say, it’s been a pleasure. Thank you so much. I’m sure everyone’s going to enjoy this one. And I hope to see you again soon. My friend. Thank you.  [Jaz]Thanks so much. Well there we have it guys, thanks so much for listening all the way to the end. We had to kind of cut it short obviously because I had to go and attend to my wife and she’s absolutely fine. She’s an absolute soldier. It’s actually Valentine’s Day today, I’m recording in the morning so I’ll be taking her out for lunch today. I’m not the most romantic person in the world, I’m a typical bloke. In fact I was going through Google Photos and I was searching for, Google Photos is brilliant, you can actually search for like know, Jaz wearing orange and you’ll find all the photos of me wearing orange. So I typed in romantic photos, right? And I had to scroll a long way to find photos of me and Sim together basically. And they all seem to happen before we had kids.  So there we have it guys, I’ve been taking my fair lady to a nice lunch. I hope you guys had a good Valentine’s Day. I hope you enjoyed that post I made on protrusive guidance with the endo access cavity on a molar in a heart shape and if you’re not on protrusive guidance yet head to protrusive.app and of course I look forward to interviewing Nav in the future to find out about his fascinating journey. How did he end up at three different dental schools and well into his 30s and what drives him? Bye for now and catch you at the same time, same place next week.

Dr Lane Ochi is such a legend that I wanted to throw ALL of Dentistry’s tough questions at him – and as you guys requested, it’s MOSTLY about CRACKS! Dr Ochi practiced in Beverley Hills for 43 years and embodies the Protrusive values of a lifelong learner, avid sharer and with so much humility. Dr Lane Ochi and another of my mentors Dr Michael Melkers will be visiting London on 27th and 28th July in London for a 2 Day course. Click here to book on! https://youtu.be/ox9Jqc_f4pY Watch PDP175 on Youtube The Protrusive Dental Pearl – Intraoral Photographs: encourage your patient to capture intraoral photos on their phone, giving them a copy for reference. This empowers the patient to stay informed, facilitating their understanding and ownership of the situation Need to Read it? Check out the Full Episode Transcript below! Highlights of this Episode: 01:24 The Protrusive Dental Pearl 03:40 Dr. Lane Ochi 09:11 Amalgam Restorations 16:16 2 Types of Wearers 19:27 Virgin Teeth  20:00 Mechanical Failures in Dentistry 27:33 Force Management to Prevent Cracks 34:35 Micro Leakage – When to and When Not to Intervene? 39:32 Should you chase cracks? 45:17 Second Molar Problems 48:41 Posterior Severe Wear without Anterior Tooth Surface Loss 53:42 Management of Symptomatic Cracks 57:42 Direct Composite Overlay Protocol Join the Nicest and Geekiest Community of Dentists in the World: Protrusive Guidance ​​If you liked this episode, you will also like I Hate Cracked Teeth with Kreena Patel – PDP028 Click below for full episode transcript: Jaz's Introduction: Should you chase cracks? Should you be concerned when composites come back with staining? Is that actually caries though? Or is it just harmless staining? Is there something we can do to prevent our patients from cracking their teeth? And that age old question of when should we think about intervening on someone who's exhibiting hairline cracks in their teeth? Jaz’s Introduction:You see, Protruserati, these are dentistry’s tough questions. There’s no hard and fast rules. There’s lots of opinion because we lack the clinical trials. But you know what? If I was going to ask someone their opinion, I’d want this person to be very experienced. So how is 43 years? Is that good enough for you? I think that’s pretty good. Okay. What kind of dentist should this person be? Okay. Well, let me tell you the guy who we have on today. This is Dr. Lane Ochi. Not only is one of the most brilliant dentists ever, he’s also the most humble dentist ever. This is a beautiful combination. And he really embodies everything that Protrusive is about, everything our community is about. This guy practiced for 43 years in Beverly Hills. He treated Miss Americas and celebrities, but when you speak to him, he’s just the loveliest, most humble man. So it’s a great pleasure to host him here today. We actually went live on YouTube and Facebook, but now this is the sort of polished and cut up full PDP episode complete with Protrusive premium notes and CPD. We’ve got one hour of CPD credits in store for you today by answering the quiz at the end. Protrusive Dental PearlThe Protrusive Dental Pearl is actually taken from this episode. It was just so brilliant yet so simple. Many of you are probably already doing this, but you know, sometimes it resonates with me that you know what, this simple little tweak, I can use this in my practice and what it was and what the pearl was, is to get the patient’s photos. What I mean by that is the intraoral photos that you take, for example, of cracks like the big theme of this episode is talk about communication and crack teeth and predicting longevity. All the tough questions, like I said. But a powerful tip is to take a photo of the crack. Now, we’ve said that tip before. You know that already, but how about now escalating this and getting the patient to take out their phone and use their camera to take a photo of their photo. What I mean by that is now they’ve got a photo of their cracked tooth on their phone. It’s kind of like them finally inching towards owning the problem. I just really like that because the patients kind of have this and they come up in the next checkup and what Lane says that they come and they show you the image like, hmm, how’s this tooth doing? So it’s kind of like digitally consumed and internalized by the patient, it becomes part of them, which obviously it was already, but they may not have been aware of this crack. But now that they’re taking a photo of it, it might just pop up in their sort of gallery again as they’re looking through photos of their grandchildren and stuff and be like, oh, yes, I have a cracked tooth. I must speak to my dentist about this. So Protruserati keep taking photos, but let the patient take a little snap as well. It’s a great little tip. I hope you agree. Just before you join the main episode, just a reminder that our new platform has been launched. So you can go ahead to protrusive. app. I know it’s the usual link, but now it’s going to look completely different. It’s got the completely new interface. It’s got the new platform with the search function, and now it’s free. Before it was a paywall, but now the community aspect of it is completely free. I’m going to be basically phasing out or archiving the Facebook group, which has been brilliant, but I want to move all the good questions, the good chat, the intellectual debate, the random funny dental memes that we share and the case specific questions that we ask in a safe space on Protrusive Guidance. So Protrusive Guidance is the name of the platform and the website you need to go to is protrusive. app. I want this to be the home of the nicest and geekiest dentists ever. And this platform needs you so we can continue to celebrate the magic of caring, sharing dentists just like you. I hope to see you on the platform, but otherwise, let’s join the main episode. Main Episode:Yes, we are live! Okay, the technology works. It’s a huge stress sometimes, Lane, when I promise to go live and stuff. It adds a lot of added pressure, especially on like multiple platforms and whatnot. So, guys! [Lane]Wait, we’re live? Oh no! [Jaz]I know, I know! Lights, camera, action! Okay, we are live. I am just so, so happy to be here with you today. Just while we wait for the room to fill up, I’ve had a crappy few days. Okay. Because yesterday I slept at home, but the two nights before that I was sleeping in the hospital because unfortunately my son was sick. He had a really nasty stomach bug. He was on IV fluids and it wasn’t looking pretty and it wasn’t looking good, but kids just bounced back. And so I’m just in a good mood that he’s okay. My son’s okay. He’s back to himself now, which is exactly. So it’s so good. And so I’m in a great mood and to be able to speak with you Lane on these really tough questions, guys. So we’re covering dentistry’s tough questions. And these have all been sent in by the community. Okay. All of them from the community, which we’re live to now. So Lane, we call the community, the Protruserati, like Illuminati Protruserati. And our favorite thing is chopping onions. So, so far we’re chopping onions because one time someone told me that they like to chop onions when they listen to a podcast. And that’s why they’re now famous for that everyone. [Lane]All right. Well, I promise I won’t cry then. [Jaz]Well, we’ve got comments already. Alex saying thank you for organizing this. Alex, thanks so much for always being part of it. Lovely. I’m just going to give it maybe 20 more seconds to make sure it’s definitely working. Okay, amazing. It’s definitely working. The technology’s all working. So guys, we have some really great questions to cover today. It’s all about, like, the theme is, really, tough thing that we all hate as dentists, which is cracks, right? There’s questions which don’t really have a black and white. There’s lots of gray. And I know that’s going to be the way it goes today. But what we’d love to learn from you today, Dr. Lane Ochi, I’m going to call you Lane from now, is your philosophy, your why, your angle that you approach, because every mouth is different. Every patient is different. Every patient has different values and different biomechanics. I just want to hear how you unpack these sorts of scenarios. Before we talk about those, I just want to introduce you as one of, this is all me from the heart, I’m saying one of the most humble people I’ve met in dentistry. I first came across you, I did lots of CE with Michael Melkers and he used to just like talk about, oh yeah, Lane this and Lane that and Lane this. I was like, who’s Lane? And then Mahmoud Ibrahim came to my life and he was like, oh my God, Lane this and Lane that. I was like, who is this Lane, Lane guy? And then literally I saw you everywhere. Like you were literally on all these podcasts I was listening to and just your humility and whatnot, like, I read your bio, you’ve treated Miss Americas and all these celebrities and stuff, Beverly Hills, you worked in, how many years were you in Beverly Hills for practicing? [Lane]Almost 43 years, so quite a while. Enough to make a few mistakes and learn from them I hope. [Jaz]Amazing, right? So it’s just absolutely amazing to have you on the show today and like you were a co director of Occlusion, you received all these amazing things. And so this is why I’m particularly excited to unpack everything today. So Lane, you haven’t retired yet fully, have you? [Lane]Not really. I’ve actually stepped away from full time practice in Beverly Hills. It was just time. I searched out. It took me two and a half years to find the right person to entrust the practice to. I found that person. I worked alongside for two years, and it was time. It’s just time for me to go. So now, I’m actually hanging out in the office of a young doctor that I’ve had the honor of mentoring over a number of years. And so, I’ve tried to stay in little relevance still. [Jaz]Amazing. Very good. And when you making that decision to sort of reduce your clinical. What were the emotions you were going through after 43 years in dentistry in Beverly Hills? What were you thinking? It’s like, okay, it’s time, or I’m going to miss this, or I cannot wait to break the shackles and escape. What was your mindset? [Lane]So, it’s funny that you said that. I love clinical dentistry. So I didn’t want to stop. Because you didn’t want to hit that spot where you left your best work on the table, right? Behind you. And that’s a bad place to be. You know what? They all say that a commonality that we see in people who are really, really good at dentistry are the people who really, really love dentistry. And to love dentistry, you have to have fun. And the problem is, after COVID, in a state like California, it just wasn’t fun to be a business owner anymore. Then something else happened. And the most exciting, important thing in my life happened. I never expected to be a grandparent. My daughter had a grandson. I had a son, so I have a grandson. Now I have a second grandson, so I’m a full time, more like a full-time grandparent, and that was the really deciding factor for me. [Jaz]I love it. Those are all beautiful reasons. So it’s great that you’re still doing the teaching and the mentoring like you are at the moment because there’s so much that we can learn from you. I’m actually listening to a book called Positive Productivity by a chap called Ali Abdaal and he talks so much about making sure that work is a fun place that when you are having fun. Then that’s when you’re at your most productive when you’re feeling good. That’s when you’re most productive. And so one of the episodes I’ll be releasing soon, cause I’m listening to that book and I’m trying to draw, like, how can we bring this into dentistry? How can we bring gamification and fun and good vibes into our daily dentistry in a high stress environment to make sure that we can be practicing for years and years and years. And I probably appreciate when that after COVID and stuff, it doesn’t become fun anymore. And you recognize your time. Amalgam RestorationsAnd I think, 43 years, you’ve done your time, sir. So congratulations for your pretty much retirement. So let’s go and tackle these questions because now the room is hot. We’ve got people commenting. Thank you, Sarah, for joining us tonight. YouTube as well. Thank you. Thank you, Raphael from YouTube. Thanks for writing your name as well, right? Because sometimes it’s difficult to know who’s written a question. So a lot of these questions were inspired by one of the biggest Protruserati his name is Yazan. And Yazan always asks wonderful questions. And guys, by the way, Lane, like he didn’t read these questions, right? He’s the kind of guy who just wants to just have a lovely chat. And so we can make this very engaging, right? There’s a very rare live podcast that we’re doing. So as he’s answering this, you might think, oh, here’s a secondary question. I will be checking periodically both YouTube and Facebook to see your comments, your reactions, your reflections, and your questions. So the first question Lane is, is it possible to prevent fractures of posterior teeth with amalgam restorations? Now, before you answer that, I’m trying to unpack that question myself. So we know amalgam restorations stronger than tooth, and we often see like broken custom stuff. So it’s a daily issue. And that’s one of the other questions that are later on, actually. So fracture teeth are common. They’re more common in teeth with big restorations. It just makes sense. A weaker tooth. What I’d like to know is not only how can we prevent fractures of these teeth that are heavily restored, but just generally, how can we change the trajectory of a patient to be less crack prone? I’d love to know that from the back of this question, actually. So please, what do you think about this question? [Lane]I feel like a mosquito in a nudist colony. I don’t know where to start. [Jaz]How about we start with the fact that you would have seen so many patients with MOD amalgams and you would have seen them for year and year and year without any issues. And then you get people who seem to be breaking them off quite regularly. I think that’s a great place to reflect. Maybe you’re being rhetorical there anyway, and maybe you know exactly where to start. [Lane]I do actually. So, you mentioned something really critical, right? You mentioned how, what and why. Okay. And so I’m going to break this out in different conversations because there’s a lot to unpack. So the first part, I don’t think we all understand what our concerns are, right? With large amalgams and teeth, we know the enamel is a wonderful material, right? It makes a compression dome, which holds the tooth together, right? Unfortunately, if you drill a hole in it, it’s no longer a compression dome and it’s not a torsion box either. It becomes very weak. So, anything you stick in it that is going to weaken the tooth. And unfortunately, as time goes by, fillings need to be replaced and they get bigger holes. And then they need to be replaced because they’re bigger. We get bigger holes till ultimately we end up in situations like we’re describing with a multitude of people with large MOD amalgams. Now one of the things that what we look at as dentists is like, we don’t want these things to fracture. Right? That’s how we’re training. We’re trying to prevent disease from exacerbating. But when we look at these teeth, we have to look at a number of data points, right? We not only need to look at how the tooth presents, right? Are there cracks in it? Are there symptoms? We also have to look at the demographics of the person that’s attached to this tooth. Is it an older patient? Is it a younger patient? Is there occlusal wear? And so, to answer that question, it always depends. Now, we also know the how to treat this problem, right? We have to strengthen the tooth in terms of redesigning a restoration. So that’s where indirect restorations typically follow next. So the most important thing that I think I learned in this, I think which is what you’re asking me, is the why. Why are we replacing? So how do we predictably replace them? But the question or the problem is, is that the why doesn’t really apply to us. It actually applies to our patients. [Jaz]Mm hmm. Mm hmm. [Lane]They need to know why. Because here’s the biggest problem that we have as dentists, and I see this across the board, is that we tend to always narrate and dialogue with our patients as doctors, which is how we’re trained. But patients don’t understand dentistry, and if we talk too much like doctors, there’s just all they hear is blah, blah, blah, right? So, the why relates to the patient. If I may go back a little bit on a slight tangent, so this isn’t anything new. I mean, this is a concept of co discovery. This has been talked about since the 80s when I started coming, when I came into dentistry. One of the biggest advocates, Avrom King, said something really cool, and it doesn’t matter what your level of technical expertise is. It’ll go unused unless, unless you learn how to properly communicate. And what she meant by that is the ability to profoundly listen to our patients, right? Because if we aren’t hearing them, then we’re not going to be able to do any dentistry. They’re just going to look at us and say bye. In other words, when patients try to learn a why, when they ask us a question, they’re speaking to be understood, where we have to change, and this comes with maturity and time. We have to get away from listening for how to reply, because that’s what we do. So, when it comes time to educate patients, get them to be co discoverers of potential problems that we see. Fractured teeth, large amalgams, right? So if we can educate them, involve them in the co discovery process, this is how our patients, right, learn to take responsibility for potential problems in their dental health later. So then when we make recommendations. And Asians don’t go, why, they’ll just go, oh, okay, well, when should we schedule? So I think it’s a whole mindset that we have to take into consideration. So again, as a very broad overview, but Asian centric first, right? Because we just know, are you really going to start messing around with a large filling on somebody that has no parafunctional habits. They have they haven’t broken anything. They’re mid 30s my answer to you the way I practice is no I’m not going to but I am going to make good note of it I love you know what I love to do. I love to take pictures with patients right put the picture in their file they always have it to look at. It’s surprising how much- [Jaz]Oh, okay. This is a new one. So, we’ve been banging on for years on this podcast about taking photos and I’m a big fan of the intraoral camera. This is the first time I’ve heard someone say to get those images to a patient’s phone. [Lane]Right. So put it on their phone. You know what? They look at it. In fact, I can’t tell you the number of times I’ve come into Hygiene, for Hygiene checks, and they’ve got their picture open. Can we talk about this again? You know, so again- [Jaz]This is amazing. I’m just thinking about how I’m actually doing this. It’s very simple on the software that we use. Just email them their intraoral photos. Right. This is great. I love this. [Lane]Put it on their own phone. They could see, you could take a great picture of a crack with a, you know. [Jaz] 2 Types of WearersYou could just use their photo to take a photo of the screen. Yes, of course. Use their camera to take a photo of the screen. Okay, got it. Lovely. That’s my top tip already. I love that. So we’ll, I’m just going to unpack some of the things you said there. Firstly, you mentioned about someone who’s got wear. And one thing I heard, I think Pasquale Venuti said this actually, is that there are two types of people. There are cracker wearers and there are wearer wearers. Do you think this is something that you’ve observed in your 43 years in dentistry as well? [Lane]Well, maybe I want, I need to fully understand that narrative. So is he breaking it into there? We have to differentiate between, pure clenchers or bruxers, right, because I’ll take a clencher over a bruxer any day, okay, as bruxers are, their parafunction does way more damage. So while the clencher, may clench very hard on a solid material like an amalgam. Then our worry is, of course, the amalgam is hard and can act like a wood splitting wedge. Which, oh my gosh, sounds like a very typical talking point dentists use to patients, right? Well, it can act like a wood splitting wedge, you can crack your teeth and their eyes glaze over. But the real problem is with the grinder, the person who’s parafunctioning side to side, that’s where the tooth wear comes. That’s where the restorative wear comes. And there are very few absolutes in dentistry, but there is one. Okay. Everything, including the tooth. It’s strongest under compression and weakest under shear. So it’s the para functioning patient that you’re going to see, if you’re going to see cracks associated with these amalgams, right? Where you see them on. You see them with teeth that have O shear wear. You see the occlusal tables a little wider than it should be, and those are starting to be red flags where you start initiating these conversations with patients, right? And these are where I start to get concerned. And where does that typically happen? Again, demographically, it happens in older patients. We start to really see some of the damage in the 40s if they’re really parafunctioning. And this gets worse through the 50s and 60s. Now, this is an interesting, I’m glad you asked me this question, Jaz, because one of the things that we also forget, right, that the demographics of our patients follow us. When I was a young doctor, nobody old wanted to trust me. I was too young. Now that I’m an old doctor, all my patients got old with me, but none of the young ones want to come to me because they don’t think I know anything about technology. I’m a dinosaur. So you have to consider that. Where are you in your profession? What is the demographics of your patients? [Jaz]Very good. And what the whole cracker wear away is just an observation that some people are, I’ve got very steep cusps and they got more, more cracks. And so people got through the parafunctional wear side to side, just as you said, basically they tend to wear away and you get cracks as well, but just an interesting observation there. Now, virgin teeth with cracks. Yes, please. [Lane]Yeah. I was just going to do a finger puppet thing, if I could. I understand if you don’t have a crack, you’ve got cuspal inclines, right? And if you’re still occluding on two cuspal inclines, the force, they’re still going to be a horizontal vector as well. [Jaz]A shearing force. [Lane] Virgin Teeth  Exactly. Even under clenching. So these are, something that, again, we have to evaluate. What the patient is doing in terms of habit. And so, sorry to- [Jaz]No, that’s fine, because it leads very nicely to the next question, actually. This is all a subdivision of the main question about preventing cracks, right? Virgin teeth with cracks, for me, that’s a sign of high forces, right? Virgin teeth has cracks, right? And on the other spectrum you have that sweet old lady who’s had the amalgam for 60 years and you’ve been looking at that buccal cusp with the amalgam shining through the enamel and it’s been there and it’s got no cracks and whatnot. Mechanical Failures in DentistryAnd that’s a patient on the other end of a spectrum of tooth that should crack, every right to crack, in occlusion with an imposing tooth and doesn’t crack. So there’s a whole spectrum. So my question to you is, how much of the mechanical failures in dentistry you think are attributable to functional forces and function versus parafunction? [Lane]Oh, well, okay, that’s kind of easy. So in function, our teeth don’t touch, right? When we’re masticating, there should be food between our teeth. So the better question to ask is what’s more damaging, impact force? Or static load, right? Static load. It is a parafunctional problem, and that’s what puts a lot of stress and strain on teeth. Even if the teeth do touch when we’re chewing, that’s more of just a quick little impact. There’s a big difference. Then to take, you’re wearing Posselt’s, I mean, how can I not talk a little bit about a occlusion? You’re wearing these teeth. [Jaz]Of course. [Lane]So, one other thing is that we have to look at is, again, look at the little old lady with very narrow masseters, they have a very high mandibular plane angle, they don’t have any wear of their anterior teeth, they’re not chipping. Parafunctioning patients, when you look at them, and a number of studies have tracked patients over time, that wear on parafunctional patients starts on the lower incisors, so when you start seeing wear on those lower incisors, and what’s the result of lower incisor wear, compensatory eruption, so you’re seeing the gingival levels changing a little bit. Now go look at the back teeth and see if you have a posterior interference, because as they wear their anterior guidance, they’re going to start putting more stress and strain back there. So, muscle evaluation, I mean, you can tell a lot from a face, even mandibular plane angle. People with lower mandibular plane angles, right, the angle of the muscle pull is going to be more curvilinear. Flat plane, mandibular plane angles, your brachiocephalic patients, the muscle straight vertical, right over what? The molars. [Jaz]Short face, long face, and then you can see these, when you take portrait photos, you see that they’re weaker muscles versus the latter having the stronger muscles, higher forces. [Lane]Exactly. And this is why facial photos, profile and straight on, are a critical part of your data collection. So again, if I may, you’re asking all these beautiful questions. And I think the problem is that, there is no absolute answer. As you said there, it’s great. And the best I can offer you today, and I hope I’m offering you is a whole bunch of data points that you have to look at to help make and guide your decisions. [Jaz]Yeah, for example, if someone has been having a series of broken cusps, then in that patient, when you look at the other undermined restoration, you think, okay, this is a point where we need to be more proactive, whereas that sweet old lady with the long face and the very rare mechanical failure, we don’t need to be rushing in, even though the tooth looks like it should just crack by looking at it. Now interesting one, just going on this and we’ll spend probably three, four minutes on this theme before we move on to the next one is I know Jeff Rouse has said this and I saw someone that was lecturing on Friday and an ex Kois mentor used to say this about most failures is what they said that happened during function during eating. Oh my, I was eating bread, soft bread. It was soft, but it’s always soft bread and my cusp broke away. Whereas people don’t complain of, oh yeah, I woke up with a tooth in my mouth. And so what these guys are trying to say is actually it was during function that it broke. Now, what I say to them is, okay, well maybe that was the straw that broke the camel’s back. Maybe all the forces from the parafunction weakened it, and it was the soft bread, hence why it was soft. That’s what I think, but I just want some input from you and your many more years of experience. [Lane]Oh, I agree a thousand percent. It is the tipping point of that, right? And if I can give you the best question you’re asking, but I don’t have an answer for it, is when does that tipping point occur? And how do you get right in front of it? And the only thing I can really tell you is that’s where long-term clinical experience comes into play, observing your patients very carefully. And then you start evaluating things in terms of, occlusion, disclusion, as well as muscle activity. You have a patient that, and again, the pendulum is kind of swinging away that sleep apnea does a lot result in a lot of arousal bruxism responses. It’s kind of like, okay, but still, these are all these things that we have to look at. It’s like peeling away layers of the onion, right? It’s not one thing that makes your eyes cry as you keep doing it for, so, the system’s overwhelmed and it’s the same thing with the teeth. So experience. And this is also where, people, I just have this deep healthy respect for people and educators like you, Jaz, is that you want to share your experiences with the younger doctors. One of the biggest problems is that in the way we’re brought up, the way we’re educated, right? By the time we fight to get into dental school, we fight to pass dental school. We basically come out of dental school as competitors, which is a terrible thing, right? So, those of us, we’re out for a little while, then we learn to be colleagues, because we have to be colleagues to survive. But what we all need to do is evolve to where you’re trying to round everybody up in our wonderful profession and be collaborators. And so this is why forums like this is so great, because there is no right or wrong answer, but it’s just nice to hear people reflecting on what they’ve experienced and how they approach things. So thank you for everything you do. [Jaz]Thank you. That means the world to me. I mean, it’s all about the community of practice and the community of learning. The new app and the platform launching Protrusive Guidance, which I’m sure you love. And it’s tagline, basically, which is the brand new for us, Protruserati. It’s not home of those who chop onions. It’s home of the geekiest and nicest dentist in the world. That’s what exactly. So these are the two factors I’m looking for. If that qualifies you to be a Protruserati, it’s someone who’s geeky, but you know what? Someone who’s just nice and someone who’s willing to listen and not dogmatic, which is exactly why I’m so excited to have you on today. Protrusive Guidance:Hi guys, it’s Erika here, the producer of Team Protrusive. I’m just interjecting here with the announcement that as Lane was talking about community, we’ve now got this amazing community platform. You can access it from your laptop. It’s called Protrusive Guidance. There’s also a native Android and Apple app. What we really want to do is to harness the power of the Protrusive community and create a platform we can share and grow together. And you know what? It’s way better than Facebook. So if you haven’t already, check it out. Just do bear in mind that we manually approve every single application. So, it might be a little bit slow to approve you, but we only want dental professionals on this network to keep it a safe place and so that we can share failures together. Head over to www.protrusive.app to know more. Final question on cracks. If you don’t mind, final question, there might be other ones, but that’s a different question. Now here’s an interesting one. There’s been no study that shows that if you give a patient an occlusal appliance, like a population A on occlusal appliance, and population B, you do not give them occlusal appliance. Force Management to Prevent CracksAnd does population A suffer with more cracks over time? There’s no such clinical trial. It doesn’t exist from what I’ve seen. So in your experience, either a equilibration or an occlusal appliance or canine rises, whatever, something you’ve done to change or divert those forces versus and not doing it. Do you think it makes a difference? And the reason for asking this question is I speak with some dentists and they say, my patient couldn’t afford the crowns. Therefore, we just settled for an occlusal appliance. Because, at least they’re rationalizing that it will divert those parafunctional forces and hopefully this will reduce the rate of cracking. What do you think about this? [Lane]I’m going to go to my default answer, all right? And I learned this from probably the finest prosthodontic educator that ever walked the face of this earth. Yeah, Ralph Youdelis. Ralph Youdelis was the program director for Frank Spear and John Kois. And Ralph said it the best. We can never stop people from exhibiting or doing these damaging things to their mouth. All we can do in terms of a rehabilitation or rejuvenation is to help patients Brux safer. I think that’s a brilliant answer, commentary. Brux safer. How do we get patients to Brux safer? Certainly a nocturnal appliance helps, right? The question is what type of nocturnal appliance do you want to use? Is it full tanner or full Michigan? Many people you put something between all their teeth and what do they want to do? I’ll clench harder on it. So for bruxers or clenchers, maybe that’s not the best appliance. You may want to try a different type of appliance to change the force factor. And so when we talk about I can’t afford, okay, this is what we’re going to start because you can’t afford. You know what’s also amazing? These same patients in the conversation of educating them, so they answer their why questions, right? Come in, and he holds up their nightguard after six months, and it’s got a crack in it. Did you see the crack? Oh no. Then, they come back and a piece is missing. And they go, look, Dr. Ochi, your nightguard doesn’t work, it broke. You go, well, actually, it worked exactly the way I wanted it to. Wouldn’t you rather have the night guard break than your tooth? This is the evolution of the discussion of managing. So before they start breaking off those cusps down the line, right? Now they’ve kind of went, wow, this is kind of cool. Then we morph into what you’re talking about. Do we start taking teeth and picking the worst ones that we can project are going to break? Based on location, which is also force management, or do we start thinking, all right, do you believe in equilibration, right? And understand equilibration, equilibrium is positive, is additive or subtractive, right? So we can do equilibration, selective equilibration, or we can think about how we’re going to put their mouth together. So this will open up into a very big discussion. But manage the forces first, so if you have a nocturnal parafunctioning patient, of course a piece of plastic is wonderful. As they realize our rationale for giving them one, because they’re breaking it, that takes us to the next evolution of our relationship and what to do next. Because we know, already know the what and the how, right? [Jaz]Well, the only thing, last thing I have on this appliance therefore, because you mentioned that wonderful thing, is that once they start breaking it, it’s further co diagnosis and then think, what’s next? Now, let’s say you do a rehab. I’m of the opinion that centric relation is not a vaccine for bruxism, there patients will still exhibit the muscle behavior of bruxism. Therefore, even though, and feel free to, I’d love to know what you do actually is once you’ve finished a bigger restorative case, whereby you’ve tried to implement all the features of force management through the restorations in the most ideal way as possible. Because of the history of bruxing, despite now having the occlusion set up kind of like an appliance that you’ve got like the bruxism, safer bruxism through the restorations, for example, are you still supplementing it with a appliance to protect those restorations? [Lane]Absolutely. Now you just keyed in on the most important thing, and I don’t think you realize this. So you talked about reorganizing the occlusion, right? So we’re no longer building to MIP conformative. We’re building to a new place. And you talked about all the lovely dots on our nocturnal appliance. So we’ve also evolved from an occlusion standpoint, we’ve gotten away from tripods. We’ve even kind of moved away from reciprocal contacts. So we’re talking about landing pads now. And so a landing pad, if you’re not familiar with the term, is just simply we want a stamp cusp to hit and a flat spot on the opposing tooth, be it in the central fossa, you just kind of make it a little flatter so that there’s a little side to side room or you put it on a flat marginal ridge that doesn’t have any triangular ridges so that there’s a little side to side. So this kind of freedom to slide around without engaging. A shear on a cusp slope is really critical for our success, as well as, again, supplementing with a piece of plastic. So, you know what, part of my protocol is, for a big case, is it’s always done in phases. And if we can’t complete a phase, we don’t move forward. Phase one is, I’m a show me kind of guy. I’m going to consider doing this much work on you. I’m going to give you an appliance. You want to call it a deprogrammer, you want to call it an orthotic, call it whatever you want. It’s just a goddamn appliance. So I give it to them is to see if they actually don’t wear the thing. Right? So they’re coming in and they’ve got a nice shiny appliance with no tartar on it, they’re not compliant. So why would you want to reconstruct them and give them for belt and suspenders, a nocturnal appliance where they’re not going to wear, which also brings us to the second thing, right? That there are still some occlusal camps out there that think CR is forever. Well, no, CR is not forever. The joint’s constantly remodeling. The occlusion is constantly changing. And that’s why we moved away from this organized tripod occlusion, because it demanded a solid centric and immediate disclusion, but if the centric slipped a little bit, then all of a sudden, those tripods become deflective contacts, and those don’t really solve the problem. In fact, they exacerbate it. So, so the hard conversation is because nobody’s talking about. [Jaz]I loved your answer. And I just want to highlight one thing that maybe someone missed and maybe someone was multitasking when they’re listening, watching in the future, but the whole get them to brux in a safer way. I love that. The way I’ve been saying it is get them to brux in a more dentally beautiful way. That that’s how I’ve been saying it basically. So I love that. So I’m definitely happy to make sure that we emphasize on that point. So next set of questions. Micro Leakage – When to and When Not to Intervene?Okay. The theme of leakage. I’ve read these amazing, fantastic papers that kind of say that it’s a myth, the myth of micro leakage, i. e. dentists have been accused of being aggressive because they see a yellow line around a composite and they say, well, there’s micro leakage, there’s caries, we’re going to replace it. And so I’ve done it before where I’ve I’ve suspected something’s not quite right with that composite and I started removing it. And by the time we moved the composite, everything was sound underneath. It was just literally the very outer marginal area, which was collecting some, some plaque and some discoloration basically. And so you kind of have to pick and choose your cases carefully. The question from Yazan is leaking posterior composites, when to intervene? Is it harmless staining around the margin or something more sinister? Which data points are you using now to figure out which of the two is this tooth or is this patient sitting on? [Lane]So, restorations go through three phases of failure, right? Staining first, right? Then you get leakage and then ultimately decay follows leakage. So, the problem is when do you move from stains to leakage? And I don’t think anyone can give you a solid answer. But what we also have to take into consideration is the age of the patient. Again, always, every tooth is connected to a human being. And when you, for example, just because you have a crap margin doesn’t mean you’ve got leakage. So how many amalgams have you looked at with the big oxidized layer, around the cavo surface margin? You know that sucker’s leaking, you drill it out, and I’m using amalgams because they’ve been around for so long. And then you get to the deepest part and you find a whole bunch of Dycal that is soft. It never hardened. And you find the residual decay that the doctor left because they didn’t want to involve the pulp, right? So obviously there is no additional decay. It hadn’t moved up the actual walls. It just sat there underneath this amalgam that was leaking. Composites are a little bit different and this is the problem and this is why you’re asking the question. So when I go back and talk about the demographic of the patient in front of you, is this a younger patient, right? Because what is the current trend in composite, in direct restorations? And that is partial caries excavation, right? You want to get rid of the active caries, but you don’t want to remove all the dentine that may be affected. Want to just have enough solid border to seal it and maintain the bulk of the restoration. So, now, on a younger patient, I’m assuming that may have happened, and probably did happen, so I’m going to be a little bit more proactive on that patient if I see stain beginning. Because the run from leakage to caries is very short and very quick. An older patient. Again, if I look at that restoration and I could tell a large particle fill restoration from a small particle fill, if it’s an old larger particle fill, I’m probably going to be more watchful of that restoration. And when I say that it comes with the caveat, and again, this is the co-discovery with the patient. I show them the picture. I said, I don’t know if there’s caries underneath it. We can take x rays every week all you come in because you’re a good patient. You come in every four months. Let’s do this for a year and see if we see any changes. If we don’t, then okay, I’m going to continue to watch it. It’s just the way you present it. The other thing is too, and surprisingly, this has a very profound, powerful effect on people. Just having this conversation with somebody. What’s wrong with doing a little exploratory? Just pick a margin and open into it. You don’t even have to numb them, right, for this, for God’s sakes. [Jaz]Mm hmm. Like a test cavity, almost. [Lane]Exactly. If it’s not leaking down the side, then fine. Just like, all right, let’s just etch it and seal it up again. Again, I’m not telling anyone how to philosophically practice, nor are you. We always have these concerns. And guess what? I have yet to meet a patient who was disappointed when we did a little exploratory. That we actually said, yes, it is a lot deeper than I thought. I’m going to have to reschedule you to do this properly. And you know what? I always got to thank you for at least trying, rather than again, committing a patient directly. Because this is what you want to do with practice, right? You want to have patients that trust you and that is the whole point of co discovery. [Jaz]I think if you’re sitting on the fence and you’re not sure that is a really great practical solution that is a practice builder. So thank you for sharing that. That’s fantastic. I’m very happy. I’m just going to just go on the Facebook and check for any additional questions. No. Good. Thank you, Alex, your comment. I appreciate it. Brilliant. So we’re doing, we’re on track now. Lovely. Should you chase cracks?Next question is, back on cracks, but should you chase cracks? So let’s say you remove that amalgam now, you see all sorts of cracks, which cracks do you chase? Which cracks do you not chase? I know I’ve talked with people, dentists on both sides on the continuum. Some saying that it’s damaging to create, you’ll chase it and you’ll never actually get to the crack. And others say that if you leave a crack, then you’re leaving a problem there. How have you managed it in your decades of dentistry? And has that, I also want to know, has that changed? Have you changed philosophy over time? I’d like to know that as well. [Lane]Yeah. So when I first started practicing unfortunately I learned under endodontic philosophy of stressed pulp, right? So if you stress, if you stress the pulp, the data points told you just do it endo, intentional endo on a crack tooth that tested vital, which acts, bothers, I don’t chase cracks today. Okay, I, as long as there’s no caries associated with it, but, and this, again, if I can kind of backtrack a little bit, this is also one of the things we have to be very, very careful of when we make recommendations and to replace a restoration, amalgam restoration with cracks in it. Completely asymptomatic, you touch the tooth, you overwhelm it, it hits the tipping point, drilling out the caries, following a crack, whatever, prepping it for flow coverage, and the pulp goes south. I mean, you know, 5%, 10 percent of teeth that we prep for indirects will go south. And so now you have mud on your face. This patient is not going to trust you or we need to do this too often. So always go into it with, again, the education with the patient. This is where also you’re taking a photograph and then making sure they have a copy of the photograph of the restoration and caries remover that shows the crack and you tell them look, we don’t know if this is going to be a problem, but I want to share it with you now because I’m conservative. I don’t want to go into the nerve because once we take out that nerve, yes, you won’t have any pain. But we also take away the blood supply of the tooth. And what happens when we take away the blood supply of anything in our bodies? It gets very brittle. Do we want a brittle tooth to make, that’s got a crack in it to be more brittle? And we surprised at the number of people who said, no, let’s try Doc, I understand. And they, if it does go south, they rarely get mad. So, I don’t chase cracks. Okay, I try to do, I’m still a total etch person. So, I’ve been fourth generation dentine bonding, everything under rubber dam. [Jaz]Opti bond FL? [Lane]No, I still use the All-Bond, so I- [Jaz]Okay. Mm-Hmm. [Lane]John Kanca developed All-Bond, so that’s- [Jaz]Mm-Hmm. [Lane]Surpasses a wonderful product. Also, I just mentally it’s a little too, looks too thick to me, so it bothers me to use it, but it’s a great product. But again, technical execution I think also goes a long way to success and getting away with things that we may not necessarily get away with. Now, if you’re going to ask me, well, should we [inaudible], blah, blah, blah, I don’t know because there’s no good data. There’s no good science on that. So anyways. [Jaz]So the conclusion there was at the moment you don’t chase cracks, but every case on his, if it’s like a carry, if it’s caries within the crack, then you’ve got to deal with that. And then sometimes it’s a tough call, but if you’re just generally chasing all cracks, then you’re going to run into more trouble. You’re going to run into more pulpal issues. And I think I follow that as well. So I’m very happy to hear that. [Lane]One thing. That like is like a crack at different parts of the tooth. If I see a mesial distal crack that goes across my pulpal floor or the prep, not pulpal floor, the bottom of the tooth, then I’m going to probably say, you know what, let’s just stabilize this. Let’s build it up. Let’s temporize it and wait. I may capture the impression at that point, but just wait and get an endodontic consult as well. So. [Jaz]I like that you said that because I’m a temporary crown and weight kind of guy as well in those dubious situations. My internal struggle is how long to wait for. Now, for example, if I’m using something like a Duralon or zinc polycarboxylate cement, I’m happy to admit on the show that I’ve had some patients have my temporary on for nine months to a year. And then we said, okay, let’s change it over. But I’ve heard some colleagues criticize me in a nice way and say which has, that’s a bit too long. I worry about caries. I worry about all these sorts of things, which hasn’t been an issue in my experience. Have I waited too long? Because I just felt when the patient’s ready and I’m ready, then let’s both go for it. I was confident that my restoration was well sealed with a temporary provisional restoration. Any guidelines in terms of how long you waited? [Lane]No, you know what? As long as humanly possible, half a year, just not atypical at all. And nine months, I’d actually prefer. Many times, if I see these things at the cleanout stage, I’ll just go ahead and I’ll do my buildup and I may decide not to prep the tooth and provisionalize it, but actually take it slightly out of occlusion and tell the patient just to be cognizant of that. But you know what, even using bisacryls, which are a little bit brittle and not as durable as GMMA, I find cementing Duralon they’re fine for up to a year, no problem at all. But you should be recalling from the checks of every single month. Absolutely. [Jaz]No, no, totally agree. Totally agree. Just some hellos now. So Mahmoud on YouTube saying, so good to see you guys, one of your mentees obviously. So that’s great. Getting loads of comments on Facebook [live listeners] says cracking show, which is great. [Lane]Love it. [Jaz]Someone’s asked question, which I’ll come back to later. Sunny saying Maha is really happy about the, the fact that you mentioned fourth gen. Alex is asking, is that all Bond plus from Bisco? Is it a Bisco product? [Lane]Yes. Bisco. [Jaz] Second Molar ProblemsOkay. Cool. There we are, Alex. It’s a Bisco product. The next question we have was sent into me by a Swedish dentist. So Protruserati from Sweden, who I believe is a mother of three kids. And an observation that she made in her practice is pregnant women coming in with second molar problems. Now, this is not something that I’ve noticed, but she actually made a point in her email to me about this episode said, I’ve noticed that these pregnant women are coming in and they’re having these second molars severely cracked and shortened clinical height and lots of restorative challenges in restoring the second molar. So I guess my question to you, Lane, is this an observation that you’ve noted? Second molar cracks and pregnancy, that aside, the question she asks is why second molars are so prone to cracks as well as restorative challenges. [Lane]Okay. To the first one, observationally, I can’t, I mean, I am trying to process, my gray matter is not as good as it used to be, but I don’t remember much correlation. Okay. And that may be just lack of observation. I can’t even remember my wife’s birthday. So, it’s like, but yes. So if you look at where studies going back to her question, when you follow people for really long periods of time, nice occlusions, no issues reported TM issues no crown and bridge, either their natural dentition or very, very minimal direct dentistry that you see very specific wear patterns. And we mentioned this before, wear always occurs here first, then wear occurs on the lower second molar. And that’s where you run out of clinical room, right? Because you’ve got the ramus going up, so these are the hardest teeth to restore. [Jaz]Small clinical crowns are often a huge restorative challenge to actually get the enough retention resistance form on second molars. [Lane]Correct. And then the question is, well, why lower second molars and not upper second molars, right? We all see this. I don’t have an answer. I have a theory and the theory is an occlusion-based theory is that most of the damage in para functioning, right, is this side to side, sand, wax, sand. So if we think about how the whole jaw fossa apparatus works, right, we know that but the non-working condyle, the medial pole of the condyle will be against the medial wall of the mandibular fossa, but not so on the working side. There’s no lateral wall. So as you’re drawing this side, this condyle is actually moving out and up. And as it’s moving out and up, think about the curve of Wilson that the upper buccal cusps are higher than the lingual cusps. So now if that lower tooth is moving that way, it’s going to get a lot of wear and tear, right? So that’s why I think the lower second molar takes most of the abuse. And so not only, again, should you be looking at the second molars on patients that you have seen show a lot of wear. Look at their anterior teeth as well. And if you see that wear, guess what you do? You put them in plastic before they start losing their anterior guidance and damaging their lower back second molars. That would be my side. [Jaz] Posterior Severe Wear without Anterior Tooth Surface LossI’m satisfied with that. So I’m so sorry, Swedish dentists. I forgot your name. I had it written down somewhere. I lost it, but I will be emailing you with a smile and say, check out what Lane had to say. So thank you. Next question is from Jean Marco de Andrea. We went skiing together across in February. It was great to catch up with you, Jean Marco then. Jean Marco would like to know his thought process on management of posterior teeth with severe wear without anterior tooth surface loss. He says he finds these cases super tricky due to the reduced height of the molars. So severe posterior wear without anterior tooth surface loss. [Lane]Okay. That’s a pretty atypical situation. I typically only see those in what I would say are class three tendency types of patients. [Jaz]And maybe anterior open bite patients, maybe over time wearing their posteriors away as well, maybe. [Lane]Yeah. Same thing. Yeah. AOB patients, look at them skeletally again, look at the mandibular plane angle on those patients. And when we have these low mandibular plane angle patients, again, the force vectors just put tremendous amount of pressure on those back teeth, the brachiocephalic patient. The other thing, that this is where we kind of, get into trouble, that none of us are any good at complete dentures anymore because it’s just not taught. And there’s a very classic say, in dentistry, if you want to get really good at occlusion and really good at aesthetics, you got to get really good at complete dentures. What’s one of the first things we learn in complete denture assessment, the, at evaluating the vertical dimension of occlusion, is phonetic speaking space, right? So when you see these wear patients like that, typically, you just see wear. You don’t see any passive eruption of the back teeth. They’re just wearing, wearing, wearing. And if you check these people with the vertical speaking space, you can use S, you can use M, whatever you like to use. You’ll find that they have very, very little space, like half a millimeter. So these are the ding, ding, ding, red flags, danger, Will Robinson, danger. How do you open these cases if they have no space to build it, right Jaz? So before you pick up that hand piece, that’s the assessment you have to make. It’s like, do they have vertical space to build back what they wore away? These are the patients that crown lengthening becomes mandatory. They have a set vertical. They kind of ground themselves to it. So, again, educate yourself, spend more time looking at your data points, that’ll help you make the decision. [Jaz]Excellent. I mean, we can talk about days about that kind of scenario, which is why you’re coming with Michael, July. I’m just going to get the dates up and just talk about this because I really want you and Michael to have the Protruserati, which you’re going to love these guys. So it’s on 27th and 28th of July in London. I think you’re doing at the BDA. Am I correct there? [Lane]Yes, that is correct. Two days, two days of Michael and me. Now, the cool thing, the really cool thing, and that that we make it, we’re probably the most unique speaking combination team out there that, that talks about occlusion, communication, soft skills, as well as hard skills because, again, if you can’t get the patient to accept the why, understand what their problem is, what, how to own that problem, you’ll never be able to get to do these cool things that we’re trained to do that we want to do. And so that’s what makes it kind of fun because you get both. You get the clinical aspect, all the little tricks, if I may say, all my F ups, and how to try to avoid them, as well as how to help your patient understand how they got to now and what the future holds for them. If I may use this narrative, I hope Michael’s not listening. We’re kind of like an old married couple. We’re kind of fun to watch squabble. [Jaz]The way he was talking about you when I went to his course in Sweden, I thought, yeah, like it was like someone who keeps it messaging or referencing their girlfriend kind of thing. Like it was like, oh, Lane this and Lane that. Like I said so I can see the chemistry in terms of the bromance between you and the sort of chemistry and the amazing sort of workshops they’ve done in the past. I’ve seen great stuff about, so this one’s called communication, case planning, occlusion. So I would say if you haven’t seen Miguel and Lane speak before, or even if you have just come again, 27, 28 July, and that’s going to be at the BDA, the link for it, I’ll put in the show notes. Once the live stream finishes, I’ll put it on YouTube and on Facebook for those that are on there. But I think this is going to be a real special one. I don’t think you’ve ever done a workshop in London together, right? [Lane]No, it’s like, well, yeah, this would probably be it, for coming across the pond. You know, we all have issues. My issue is airplanes. I hate flying. So it took a lot to convince me to do this that so, well we are- [Jaz]Let’s make it worth your while and make sure we show you a good time. And so yeah, we will see you in the summer. But we have, let see, before I take any questions from the audience, we have one more question from Satnam that I have, and then I’ll open up to Facebook and YouTube. Management of Symptomatic CracksSo this last question is, it would be great to learn what is Dr. Ochi’s management of symptomatic cracks in those dental emergency. Once again, cracks, those densities, tough questions, right? So symptomatic crack emergency and how you communicate the options and next steps to the patient. So essentially patient comes in. Classic crack tooth syndrome. You’ve tested with the tooth, whatever. What is the emergency management that you found to be most successful? And then how do you have that conversation with the patient? Because the difficult thing about that conversation is the ifs and the buts. Well, the tooth could die and you might need a root canal, or maybe the crack will be too deep and it can’t be savable, or maybe it’s going to be okay and just needs a crown only. So any communication tips once you’ve kind of put the fire out? [Lane]No. Well, I think you kind of summed it up. Putting the fire out is the most important thing, right? Patients are so grateful to be able to be seen on an emergency. We hate them because they mess up our scoreboards royally. And so this is one of the very few times where you’re, if you have scripted responses, and we all do, to really fine tune them because all they’re interested in is getting out of pain. So whatever your typical script is. Well, the symptoms that you’re giving me and what I’m seeing are a cracked tooth, which means there’s a crack that’s communicating to the sensitive part of the tooth, the nerve. So we don’t know if the nerve now is overwhelmed or not, but the first step is to do an exploratory. Let’s clean out this filling. Let’s look for a crack and then let’s just, or a new foundation and make this tooth as strong as possible. And then we’re going to sit back and wait and see how it does. [Jaz]Just the nitty gritty details here for the younger colleagues. At this point, you’ve taken out that MOD amalgam, let’s say you’re going to clean out any caries or take a photo of the crack, of course, send it to the patient’s phone, obviously, right? And then you’re going to reduce those cusps and then put a well-sealed composite as an interim. Is that generally the management of emergency cracking syndrome in your practice? Yep. [Lane]That is pretty much it. And then and I think it’s important when we talk about our buildup materials, right? So not only do we want the best bonding possible, again, we don’t, once we cut a hole, we don’t have a torsion box. So we need bond the walls circumferentially as well as possible. So we have to follow our best bonding protocol and we have to pick for our buildup materials. The higher the fill, the better, and you probably also want to use a self cure buildup material to make sure that there is a cure a hundred percent. Dual cures, or light cures, again, may not fully polymerize, so these are little material things that you may want to think about. So I happen to like Core Paste by DenMat and even though it’s bright white, patients don’t seem to be too upset, they’re just out of pain, that’s all they care about. But basically, I think you and I follow the same kind of protocol the same language, everybody, you’ll develop your own talking points, and that’s fine, but again, one time you can take advantage of somebody really listening to you and saying, go ahead and do it, please, please, please, because I’m in pain. Pain is a wonderful motivator. [Jaz]Yeah. I like what you said that in terms of communicating with the sensitive part of your tooth giving issue, let’s just get out of pain. And then once you deal with the fire, once they’re in a calmer mind, just to say, look, there’s many different ways it can go. Let’s just see you again and see where it lands and go from there. [Lane]Yes. [Jaz] Direct Composite Overlay ProtocolPerfect. I’m going to go ahead now and check the comments. Okay. Thank you so much. Facebook. Okay, Mustafa. I’m going to ask your question now and there’s nothing on there. Lovely. Okay. So Mustafa, I haven’t read his question yet, but Mustafa asked, do you like direct overlays? And if so, do you prefer doing them using stress reduced protocol with fibers or with injection overmolding such as the bio clear method? So direct composite overlays, was that a part of your protocol or restorative skill set, would you say? [Lane]Okay. I kind of need some clarification here because I want to make sure we’re saying the same things. When we’re talking overlays, are you talking like occlusal? On lays on top, or are you talking composite veneering? I’m not. [Jaz]Sure. So this is kind of like the emergency scenario we just talked about, the crack tooth, you’re going to cap the cusps and fill the entire MODBL. So you’re kind of doing like a direct core foundation, basically covering over the cusp as well, basically. So that restoration, because it’s a good question in the sense that our traditional data points that we use to say that, okay, this tooth is now veering towards an indirect rather than direct in the last 20 years. We’re doing more and more huge composites, right? We’re doing them more. We’re putting a lot more faith, a lot of trust, a lot more gambling happening on these large composites, which really a lot of colleagues would be saying, okay, this needs ceramic. This needs something indirect, but we’re really putting our composites to the test. Now, going back to things that you already said in the show today, which is every patient is different. You’ve got to look at their facial features, how much force and that kind of stuff. But was this a restorative modality for you in terms of the work involved to get good contacts, mesial and distal and the kind of morphology and get it right in the occlusion, but to say to a patient, okay, this is it. We’re done. We’ll revisit it in 10, 15 year’s time. Maybe we’ll need a crown then. Or was that always for you a transitional to an indirect restoration? Does that make sense? [Lane]Yeah. So, I got it. So, if you’re asking me, I’ve got taking everything out, everything’s cleaned up, and there is just a shell of tooth left, it’s not structurally sound. We want to put it back together, but we don’t want it to split, so you would reduce it, cover it, the biting surface as well to put composite under compression, and also get, try to eliminate the lateral shear forces of the tooth. I rarely did that because, quite honestly, I suck at building up that much direct composite because you really, if you’re going to not have it break, you’re going to need at least a couple millimeters of reduction anyways. I mentioned the torsion box concept a little earlier. So, what I would typically do if I had that situation where the tooth just looked structurally weak after the internal’s been all gutted out, I would create a torsion box, so I would use e fibers or Ribbond, and I would bond a circumferential as well as two U shapes. And rather than reduce it and put a composite on top of it, because it’s just too hard to manage for. But again, I’m looking at the physics and if you’re not going to do and create what enamel dome does with supplemental fibers of some sort, then yes, that’s your really only option, but that’s a skill set I just never really worked on, so I just did not use it in my toolbox. [Jaz]Great. I mean, so Mustafa just clarified. He did just mean cuspal coverage with composite and posterior teeth. But yeah, as you mentioned, there was a place for it, but it’s a difficult thing because we’re doing a lot more of these big composites and it’s a blurred line about, okay, should we go to ceramic? The one thing I think is, are you going to achieve decent contacts? I mean, when you’re doing something that’s really ambitious for direct restorative, the one thing I say, which no one ever talks about is the reason why a composite compule has the amount of composite that it does in that Compule. It’s because someone very intelligent said, okay, this is probably about the amount of restoration needed before someone’s going to be considering indirect restoration. And if you’re reaching for two compules, then you’re really thinking, okay, are you really doing the best in terms of strength? The best in terms of the contact areas that you’re going to make the best in terms of the final occlusal anatomy. And at one point you’ve got to think, okay, let’s accept this as a foundation restoration. And then communicate that so that it can be upgraded, if that’s a fair enough word to use, to an indirect. [Lane]Yeah, I like that. In fact, I’m going to steal that two compules. I love that. That is a brilliant observation because again, how much tooth is missing if you did more than two compules? That’s a lot. [Jaz]Absolutely. Lane, you’ve answered all questions. One last glimpse on YouTube and Facebook to make sure the Protruserati are satisfied. Even I struggle. It’s getting late guys, like 10pm, right? Amazing. Lane, thank you so much. I can’t wait for you to come to the UK and bear that flight. And so guys, I’ll be putting it in the show notes so you can book on. To visit Lane and Michael, their lecture, I’ll put the image, their banner as well in the show notes. It’d be great for us to show the true Protrusive love to our good friend, Michael Melkers, who’s been on the show before. And of course, Lane now, who’s been finally on Protrusive. [Lane]Yeah. Oh, I will point out on the signup, if there is a five-person signup discount, so she’s got like four friends and you want a little bit of a discount and take sign up for that every little bit helps. Right. By the way, I commented about your shirt, the Posselt’s did you notice mine? Did you notice the little mustaches? [Jaz]Ah, lovely. Very nice. Excellent. Very good. [Lane]Or mine’s not yours though, so. [Jaz]You rock it well. It suits you. it looks great. But guys, you heard what Lane said there, right? So if you’re on the Facebook right now, and you are and you can come see us maybe tomorrow and you’re interested in going to Lane and Michael on the 27th and 28th of July. I’m going to bring a poster up again. Yeah, great. Then maybe if you all sort of comment in the group saying, yeah, you know what? I think I’m going. And then if you all just full club together, you get a little discount there as well, which would be great. the reason I’m supporting this is because I generally think these are fantastic educators and to not miss an opportunity to see them together would be, I really want to show them our support. So, thank you so much, Lane, for making time for it to come on Protrusive. It’s been great to chat with you, and it would be nice to keep in touch and maybe a round two. I know you do talk about all sorts of things, like there’s so many directions we could have gone in. So I’m going to be, as you’re less and less clinical now, I’m going to be trying to really squeeze that brain of yours for everything inside. [Lane]Beautiful. I’d love to Jaz, I consider you my brother from another mother, same passion, same joys, you are actually, I consider you a mentor from afar. So thank you again for the invitation and hosting me today. Appreciate it. [Jaz]Amazing. And Esa has actually said on YouTube saying, could you please talk a little bit about occlusion philosophy? I think next episode we can talk about the different camps over time and what your how maybe you’ve changed your occlusal views and practice and maybe a, a nice history. I think that’d be a really cool thing actually. So watch out everyone for part two and undisclosed date. Maybe it’ll be in September. So September is occlusion month on the podcast, basically. So we’re going to get you back for that. [Lane]Love occlusion month. I’m going to find an occlusion t shirt though. I can’t rock yours. Jaz’s Outro:I’m going to give you a hoodie when you come in July. Okay, sounds perfect. Alright guys, thank you so much. Well, there we have it guys. Who better to answer those tough questions than Dr. Lane Ochi, and you bet I’ll bring him back for Occlusion Month in September 2024. If you’re in England or in Europe, actually, and you want to come to listen to Dr. Lane Ochi and Dr. Michael Melkers, two brilliant dentists who I consider real close friends and mentors, please support their two-day lecture. It’s on the 27th and 28th of July. I’ll put the link in the show notes. I think it’s going to be probably the last time they ever do something in London like this, so it’s a great opportunity to catch them. And of course for CPD, can you answer the following question? The question is, what did Dr. Lane Ochi reveal was his preferred material for a foundation restoration? Kind of like a core. Was it paracore? Was it denmat core paste? Was it EQUIAForte? Or was it Gaenial injectable? If you remember which one it was, then that’s one of the questions answered and you’re on your way to getting a verified CPD or CE for this episode. Some questions test your knowledge that you gained from the episode, and some test your retention to make sure you listen the whole way through. The way to answer it is if you scroll down on Protrusive Guidance app under the premium section, you’ll be able to answer the questions. And if you’re not yet on Protrusive Guidance, then please come and join us. Head to protrusive.app. And if you check out the Protrusive premium plan, you can actually get CPD for all the episodes. I want to thank you again for listening all the way to the end. I’ll catch you same time, same place next week. Bye for now.

Explore the reactivation process of Immediate Dentine Sealing in follow-up appointments, local anaesthetic importance, fit and adjustment of dental restorations, cleanliness in dental preparation, benefits of IDS in adhesive dentistry, and CPD opportunities.