Protrusive Dental Podcast

Welcome to my 2nd Interference Cast – based on Jordan Peterson’s book 12 Rules for Life. David Bretton and I came up with our very own 12 Rules for Dentistry! I had David come on for this because he IS Mr. Positivity in UK Dentistry. We hope you find these relevant, engaging and ‘real’. This is the audio version of my Video Podcast recorded earlier this month – if you prefer to watch the video (which I prefer, you get to see our silly facial expressions!) then you can watch it on YouTube or my Facebook page Facebook.com/protrusive or my IGTV https://www.youtube.com/watch?v=3qvDBz06WC4 Need to Read it? Check out the Full Episode Transcript below! Rule 1 – See Everyone (and it’s not quite what you think this means!) Rule 2 – Create a Positive Environment Rule 3 – The patient in front of you is the most important person Rule 4 – Don’t own the patient’s problem Rule 5 – Do not care about your patients’ teeth more than they do Rule 6 – Trust your gut Rule 7 – Take time to take care of yourself Rule 8 – Focus on your own journey Rule 9 – Have mentors (it has never been easier!) Rule 10 – There is no shame in admitting you do not know something Rule 11 – If you’re not enjoying things, something needs to change Rule 12 – Enjoy the present moment and the journey Click below for full episode transcript: Main Interview: CLICK HERE... [Jaz]David Bretton. Mr. Positivity? [David]Jaz, Good to be here. [Jaz]Absolutely. And I when I thought, right, I want to do something like 12 rules for dentistry because, obviously the book by Jordan Peterson, and a lot of other industries and professions have sort of made their own 12 rules if you’d like. And I thought, right, if I do something like this, there’s only one person in the world I can think of who would match it so and who will do it justice. And that’s, you [David]I appreciate that. I didn’t know it’s your may have connected me since on the sorts of topics I think, really, we’ve always talked about things beyond the clinical side of things of dentistry. [Jaz]That’s right. Remember the first time we met and we discovered our mutual interest for self development and positivity and that sort of stuff? Do you ever do remember? [David]It was [inaudible] award? [Jaz]It was. It was British and ronix. And it was actually you introduced me to Tony Robbins. Yeah. That’s quite life changing. If you’re the one who introduces someone to Tony Robbins, you’ve changed someone’s life for the better. [David]You’ve definitely helped people to that, I’d say we’ve definitely people. [Jaz]Awesome. So let’s just dive right in. [David]Dive right in, so about 12, our big rules to go for I think so. Yeah, let’s get on a chat about that really. [Jaz]Absolutely and for those tuning in, and thanks for joining us, you know, these 12 rules are what we make it, have your own 12 rules. It’s you know, you might enjoy some of them. You might hate some of them. That’s completely cool. Okay? Weird is this something that me and David sort of looked at and agreed on that? You know, actually, and there might be some things that we haven’t actually rehearsed this. So there might be some things and I said today Look, it’s completely cool if we disagree on something. So let’s go. So rule number one for rules in a 12 rules for dentistry or 12 rule for dentists or everyone involved in dentistry is see everyone. So David, I came up, well I didn’t come up with this rule. I pinched this rule from a book that’s called If I could just tell you one thing by Richard Reed, have you read that one? [David]I haven’t. No. [Jaz]So Richard Reed, he he’s basically meets all these powerful people in the world. And he just answered one piece of advice. And what Bill Clinton said was See everyone. And what that means is basically that Bill Clinton, he has a very special talent, or a gift is that he makes everyone feel important from the person who opens a door for him, from the taxi driver, from you know, big or small, whatever, he will make a child, an elderly person, he will make everyone feel seen. And he will make everyone feel important, which I think is so beautiful. And the way I apply that at dentistry is sometimes you know, when you’re having a bad day, a rough night’s sleep, and you go into work, and the nurse knocks on the door, Knock knock, opens the door and says yeah, ‘Good morning, Jaz.’ And you know, what if I’m, if I’m on my computer, and I go ‘morning’, and I don’t even tend to look around, that’s not doing it justice. So to basically make that eye contact, make that smile, make someone feel important, make everyone feel important. [David]Me, I think, can’t know enough to be said to how much of a team thing dentistry is. And you know, you see your nurse in particular more than you’d see your other half. You know, you’re with them all day in [Jaz] work wife. [David] `Yeah, work life. Absolutely. And I think to make them feel appreciated, and some nurses definitely aren’t paid and appreciated some time, which is a whole different topic. And as an associate, you know, it’s a stranger. So I think beyond that, to make them actually feel appreciated and cared for. But as you say, you go well beyond that. And that’s to the cleaner to the, you know, everyone else you’re going to see in the building. And I think [Jaz]Just the other day, we will in for a Christmas party. And I’ll use the term as odd the cleaner. Okay, she was, we didn’t need to lock up. So we all said, Oh, yeah, the cleaners say we don’t lock up with the cleaners right there. And yeah, I said, hang on a minute. And I looked at and I said, What’s your name? Her name’s Evelina. Okay, no one, no one knew her name. So now we said, okay, Evelina’s here. She’s gonna lock up. So she’s not the cleaner anymore. She’s Evelina. totally right. Even now, the cleaner no matter who you are, we as in our profession, for positivity. For all these reasons for just life, we need to see everyone and even that sometimes the person who’s accompanying the patient, or the people sat in the waiting room, when you’re going down to collect a patient or go into the waiting room, collect patient, say, Good morning, smile at everyone, make everyone feel at ease, and then collect your patient. That’s completely cool. [David]I’ll tell you why that’s a big one, you know, when you have patients who, for example, don’t speak English, and you have a translator. And what’s really strange that people do is will speak to the translator and sort of actually don’t speak to the patient anymore, you know, is having this dialogue with because you tried to communicate with both. And I think, you know, it’s a massive one and I think on the topic of speaking to our patients and definitely seen our patients. What I always think about our patients is throws the dentist we have, we might have, you know, 20 exams in a day, for example. And each of those is just your, you know, if you want to look at like this, it could be your 11 o’clock exam. But to that patient, you are their one dentist, and you know, they are only going to be seeing you once every six months to a year. So if you have one bad encounter with them, you’re probably going to forget about it, whereas they’re not, you know, that’s like a big thing for them, it says the dentist about this bad experience. And it was a 15 minute exam. And you could have just read through relationship because of that, really. So I think it’s important to realize that, you know, these are big events that people sometimes comes for a tooth out, it might be a third tooth that had out. To you, it’s just another tooth that you’re gonna take out and to them, it’s like sometimes a really big life moments [Jaz]It’s a big deal. It’s a big deal, which leads us nicely to rule number two, Dave. So lead the way with Rule number two, [David]Rule number two, me and Jaz decided that was create a positive environment. So rule number two, create a positive environment. Now this goes, you know, beyond dentistry, it’s again, it’s just a whole life concept, I think creating a positive environment. And, you know, like Jaz said, we’ve got to see everyone. And that’s all about the environment that you’re in, the people that you work around. And I think really, you know, if you’re in a negative toxic environment, then sometimes is goodwill as you can be, doesn’t matter what books you read in and you know, how you’re trying to fire yourself up, I think you are going to go into work and be sucked down, you’re going to have that energy sucked out of you. And about each other. I go on courses and meet certain dentists and certain practices. And you can just tell that had the life sucked out of them. And I think some big corporates, again, a name, and they’ve had this tarnish to them a little bit I think that sort of feeling where actually people didn’t feel like they were in a positive environment. [Jaz]But where I see that the most, and where it’s evident for everyone is when we go on these, you know, on the Facebook groups, okay? And it’s so important, I think to sort of make your mind like a sieve. If you detect the tone of a post is really quite negative, and the usual politics, you know, I just skip past it. I’m so much happier for it. It’s like in some of the books that you read, like some of the some key people in the world CEOs, one, one piece of advice they give is don’t watch the news. It’s similar when I applied debtistry is that, you know, I only really engaged in posts that are uplifting or positive or important. Sometimes, you know, things can be a bit down, but they’re important and we must engage. But anything that’s just got a undertone or [Jaz]Yeah, gossipy drivel. I mean, that’s the problem. Social media has become this extension, from, you know, you’ve had a bad day, you’ve got a few things, And I was criticized a while ago for blocking and delete in loads of people on Facebook. Why not? Like, what why would I just for the sake of, you know, not getting? Why did I feel like I have to have all these people on my Facebook? [Jaz]Absolutely not. And, you know, I commend you, that’s the right thing to do. And the same way, you know, the part of creating a positive environment is filter out negative people, negative experiences, negative vibes. So that totally goes hand in hand. [David]Yeah, and on the other tone, if I ever made someone, you know, I had someone delete me quite a while ago. And then they messaged me saying, sorry about deleting you, you just kept posting really positive things. And I was in a really bad place. And it was making me feel worse. And, you know, fair enough. I wasn’t feel bad by that and just felt well, you know, if that’s what made you feel better, then yeah, block, delete me. And you’ve got to do what’s working for you, I think, and create that environment around you, that’s going to make you feel better, or do what you need to do. [Jaz]If you adopt a mindset that everything around you is collapsing, it will be. So you’ve got to adopt that mindset, and that, you know, create the positive environment. And that’s, you know, in all manners, be it your online environment, your physical environment. So that’s a great piece of advice. [David]And I think, you know, that’s why I know for you and me, the environment we have in our home lives, it’s just in like I said, just as important. We’re having to nurture this positive environment around us, our family, people support in you, it means so much, I think good thing to just end on this is a quote that I just love, I think, you know, it says that, you know, when a flower doesn’t bloom, you fix the environment in which it grows, not the flower, and I think so often, a dentist we try and think we’ve got to fix ourselves, but actually it might fixing the environment you’re in, and ensuring that you’re in a positive supportive environment. [Jaz]Beautiful. So dentists and anyone connected dentistry out there you are the flower, nurture your environment. So rule number three, the patient in front of you is the most important person ever when they’re in front of you. So sometimes you’ve had a bad sort of week, bad day, you might have had an argument with someone important in your life, you might have not slept very well, you might have a flat tire, you have to forget about everything when that patient’s infront of you, you cannot have anything in your mind, a voice that’s distracting you, you can’t be thinking about the ashes, the World Cup, you can’t be thinking about the general election. When that patient’s in front of you. You need to give them your everything. And they’re our most important things. And someone who echoed this recently was Finlay Sutton, is at the Tubules Congress. And he said, is that really resonated with me, I think, yeah, make that person, you have to forget about everything for that patient. [David]I mean, I think it’s just, we’ve almost already said it in terms of, you know, like I said, this person is coming to you. And it’s such a big event for them. And as was said, if you’re not then making them the most important person, then you really doing yourself a disservice as well as the patient, I think, because they’re going to go away and not feel that you’ve had the right positive impact on them. And I think [Jaz]At some patient acceptance or treatment as well, you know, we have talked about that it’s important. [David]I mean, you know, I think this is one of the things that really riles me and bugs me and as much as I think things like Instagram aggress. I think what’s happening with dentistry now is a section of dentists almost to, actually, it’s no longer about the patient’s best interest, it’s no longer about the person what’s in the best interest and what’s right for that patient, it’s what’s gonna look best on a photograph, what’s gonna look best on their Instagram feed? And for me, it’s everything that’s wrong about dentistry at the minute, it’s this ego driven and I need a good before and after photo. Is that the right thing for the patient? Did the patient care about the gold crown on the Upper premolar that you want to replace just because it’s going to look better on your photograph? I don’t think so. And so, you know, I think that’s a big thing in dentistry at the minute. And I think some people’s whole workflow almost is driven by what’s going to look good, talking to other dentist and showing other dentists. And actually, we need to remember that it is all about that patient. And, you know, if they’re happy with that big amalgam on that tooth, and they understand that it may fracture, they understand the risks and problems and consequences. If they’re happy with it. [Jaz]It’s okay to compromise sometimes in all things being balanced, it’s okay to compromise sometimes for the best interest of the patient. [David]Absolutely. As long as you had. And like I said, best interest because as long as you have had that discussion, and you discussed and given them options about these things, it’s ultimately about them. And that care not about what is textbook, right or [Jaz]what not, I’m gonna pay you a massive compliment. What you just said is literally most almost like so similar to what Tif Qureshi said, in my recent episode, when we talk about dahl and stuff, you’ve literally said the exact same thing. So that’s my massive compliment to the fact that you’re in synchrony with Tif Qureshi. [David]Do you know every time Tif post something, I’m just like, even in WhatsApp about the the recent politics. Everything Tif ever says everything I’m just like, Yeah, I agree. I agree with that Tif, because honestly, like, say, is a massive compliment to be. But it is. It’s what it’s all about. And I think as soon as we realize that, and I think it’s when people talk about Don’t think about the money, the money will come. You know what just like to have them, if you put the patient’s interests first and tell them about things, give them the options. Yeah, the treatment will come, the money will come. And I’m finding that that’s that for myself, you know. And, you know, as we’ve both done, we both have skilled endodontic skills. But if I see a tooth and it has no area, sub optimal root filling, I’ll just discuss we can redo it. There’s pros and cons, always. And it’s never the most important. And now I think it’s a really important rule. And, you know, it’s funny how some of our rules can have as much criticism as things like the general dental council get as many of our rules actually when you look to the core of it, what the general dental council would want us to do, you know, put patient’s interests first, we like to make patient the most important person it is. [Jaz]Rule number four. [David]Rule number four. {Jaz] massive one [David] it comes on just from that last one. Rule number four, don’t own the patient’s problems. You know, when you may sit down to look at these 12 rules, as we were really conscious, I think and focus to make it about 12 rules to have a happy and relaxed and stress free life in dentistry. It wasn’t just about how to be clinically the best dentists and it’s so much beyond that. [Jaz]And then there are those rules out there already know how to get loupes, get magnification. That’s been done, this has got a different twist to it. [David]100%, actually this is bigger, this is more about whatever you’re doing, all these rules can be applied. So don’t on the patient’s problems, I think my experience is one of the reasons that dentists are so stressed is that they own the patient’s problems, they carry the patient’s problems around with them, the biggest ones, you know, deep filings, the patients come in, they’ve got massive, massive, massive caries in a tooth. And the dentists are all stressed about this might flare up. That’s not your fault. That’s not your problem. It’s only your fault. If you’ve been seeing the patient for years and years and years and years and years not taking some x rays. If the patients presented to you as a new patient, and you see a huge hole, you just have a conversation that this is their [inaudible] not yours. And you know, I work half a day a week at a dental hospital with undergraduates. And I see this all the time. I see this all the time, you know, they just own all of their patients’ problems, you know, “oh, boy, he’s got really loose teeth. And like, you just, like, you take an X ray, and you just go do the things you got to do. You got to take an X ray, tell them about the problems and make them own their problems. So if someone has a deep filling, you say it to them, “Look, I’ve taken this x ray, this is what we can see. And as a result of this, this is what we, this is what’s going to happen, you know, we can do our best to try and do a filling, however, there is a risk that it flares up. In fact, that’s very high, because this is the x ray, you just communicate and communication obviously, is so important. But that’s not our problem. It’s our patient’s. Similarly, with bone loss, you’re going to let people know about it. [Jaz]That has I mean, that affected me a lot in my first three years in clinical practice [David]Oh, absolutely. Couldn’t agree more. And I think they’re the people that does affect the most, young dentists too, who just carry all their patient’s problems around with them. Because as well, you know, you go from a hospital environment as an undergrad where people aren’t paying. So reality is what happens in that environment is everyone gets what the told to get, you know, you said to a patient come back for multiple cleaning appointments. [Jaz] They’re cerainly not listening [David] Yeah, you know, that’s how it’s gonna be. The difference is when you’re going to pay in into practice is that what happens there is suddenly compromises have to come. Because suddenly, if I’m charging 500 pounds for a root canal filling, that patient needs to know, at that appointment, “Look, this is what’s going to could happen, and this is what’s going to cost you” and that patient may then be saying “well, I’ll look out for that.” That’s not your problem. That’s not you who should be carrying that problem around with them. And I think we you know, we both probably found that we’re things like tooth wear. Tooth wear is complex, it’s expensive to treat. And all we can do is tell people about it and not on that as a problem now I feel this is where I struggled in national, in NHS practice, I really struggled in NHS practice because you know, the final straw for me I just practice, when a girl who came to me and I’ve already done about three root canal fillings for the band to charge so you know what we’re talking 10 pounder root canal so they’re not even [Jaz]And you spent hours [David]Hours good quality, your root canals a good quality and we don’t want to and if you’re not the central and it was retreated, massively build up with composite and it fractured. And she said to me, you know fractured at gingival level. And I was like it’s broken, these are options, bridge not really an option because the neighboring teeth just weren’t suitable, an implant which is the ideal, the gold standard option here, not going to damage any of the teeth it’s going to be the ideal or a denture, and we do her a denture because that’s what she wanted. She was an NHS exempt patient, we did her a denture and it wasn’t good enough for her and, you know, it didn’t match how the teeth next to it looked. A upper central denture. And, you know, for me what happens to the NHS is you are made to earn the patient’s problems sometimes, they come in ‘your my NHS dentist, what are you going to do about this?’ And what I find for me in private practice is that patient can come in, and they can go and see any dentist they want. So I don’t have to own their problems. I’m just here as someone who can offer them some solutions. And if they say, well, so and so down the road that he can do this, great, go and see so and so down the road, I am obviously not as good as he is. And I think since I stopped owning the patient’s problems, since I just started stepping back, telling people what I saw, giving them the options, and a hell of a lot less stressed. You know, [Jaz]This is a massive one, this right here is probably I think this is my favorite rule, what we’re discussing right here, because affects so many people, and if for my mental health, and my cortisol levels, this has been the real game changer. I know the word game changers use banded around. But this really was such a massive thing. So if you’re listening out there, and you’re owning the patient’s problems, and then I’ll expose myself a little bit, in my earlier years, I’m a highly empathetic individual. So when I remove a tooth from someone, as a DF1, I’d go home and about to go to sleep. And I’m thinking, ‘I hope that patient’s Okay, I hope they don’t get a dry socket, I hope they’re not in too much pain right now,’ which is a beautiful thing in a way to be so empathetic, but in a way that is going, it’s a bit too much for people to affect my personal life and my emotional health. So I know some people who do that, you know, young dentist do this. And it’s a very deep conversation with have. So I think don’t own the patient’s problem. And then this leads beautifully on to rule five [David] absolutely respond go ahead, Jaz [Jaz] which is Don’t care about a patient’s teeth more than they do, just absolutely do not do it. Because you’ve had those situations where you’re again, owning the patient’s problem, you’re stressing about it, and the patient as led themselves or you know, through negligence or neglecting themselves into this path. And they’re not that bothered. So why should you be? [David]That absolutely I mean, this is, I think, where we really struggle, because we value as dentists we value oral health. So highly, we value it so high, we think it’s like it’s our lives, you know, teeth are everything. Oh my god, how could someone lose an upper central tooth, I have sat and had conversations with someone said, Look, this tooth really broken down. These are your options, we can take it out and look at replacement options. Or we can try and say there are all costs. And patients who just turned around and said, Oh, just check it out. And I’m like [Jaz]It shocks the system, isn’t it? It shocked to system. [David]And so I’m like, ‘so what we’re gonna replace it with?’ And they’re like, ‘honestly,leave the gap.’ And I was like ‘what?’ Some people do not care. And some people do not care because they just don’t value oral health. Some people do not care because they might have other things going on in their lives. You know. And I think again, reducing stress for people, for dentists, I think, it’s again, such an important rule don’t care about patient’s teeth more than they do. [Jaz]I think you summarized it quite beautifully with that. We made it very tangible without central incisor I know we’ve all had patients who for us to have that same issue in our mouth, it’d be the end of the world. But they don’t seem bothered by it. So you shouldn’t, you know, have those feelings in yourself. And that’s another important step to being more fulfilled and happy. [David]Absolutely. And I think, you know, I saw this a lot with gum disease, a lot with periodontal disease. I tell people, I worked in a very, I worked in Yorkshire, as you know, you graduated there. And it was a very, very, very like, it was a affluent area, both very sort of, a lot of the men in particular had a lot of tooth wear and a lot of Perio and didn’t care and every conversation and it was frustrating because he kept coming to have the same conversations. And they would just say, ‘Well, can you just give me one of those little cleans?’ And I was like, and you know what? I got to the point where it’s like, ‘well, yeah, I can, but as long as you understand that that’s not the ideal thing. And eventually you may you may lose some teeth’ ‘Oh, that’s fine.’ Just crap. And that was it. And I was wanting to do six point pocket charts and multiple perio treatment appointments. They didn’t want to do that. They didn’t care. [Jaz]Right example because people always posting on there that Oh, I’ve tried Vaughn surgical root service, and the patient comes back and it obviously not using tepe and not so brushing. That’s an example of someone who doesn’t care. So why should you? You just had to use the minimum standard and advise but there’s really not much more you can do [David]No, absolutely not. And that’s why I was really happy recently when the perio guidance all changed. I was like, finally, thank god a little bit of common sense that actually, Hey, you know what, someone’s got a lot of inflammation, you’re giving them a toothbrush, you getting rid of some of the big deposits and sending them away till they start using it. And, you know, again, it’s something I think we struggle with, in particularly young dentists, when they just graduated. They’re coming out all keen, and threw all the gold standard treatment, I need to do a six point pocket right here, I need to do this year, I need to do that here. And here, you’re going to see some people and they just got ridiculously high caries risk, doesn’t matter what you do, they’re going to come back with new caries lesions every three months. And if they don’t care, why should you? Why should you spend hours trying to do these restorations that you saw on Instagram? Just restore the caries. And honestly, I just think people sometimes they literally we do, we care more about our patient’s teeth and some patients do. And I think at the same end, I think when we have patients who have extremely high expectations, and they care about something very minor, we should still care. Because on the topic of you know, don’t care about patient’s teeth, they do. If they really care about them, then we should, I think respect that. And we should care just as much [Jaz] Beautiful. I loved that [David] As the people who come in who said, ‘I really don’t like and it’s something really minor’ and I just say ‘Have you not discussed it with your dentist?’ and they say ‘Yeah,’ he said it’s fine.’ And I’m like, ‘Does it bother you?’ ‘Yeah, it bothers me.’ ‘So why we don’t discussing options for you?’ [Jaz]It bothers them, they’re the most important person once again, [David]I said, we’ve got a huge spectrum, and some people don’t care. So we shouldn’t care about their teeth, we should still give them all the options and et cetera, et cetera. But when we have those patients with ridiculously high expectations, and they care a lot, we should honor that and respect it and head, you know, what, if someone’s got good ones, in all the Sexton for the BPA, and they really care about their oral health, we should be looking to see how we get to them to all zeros. [Jaz]Beautiful. That’s so true. [David]Why are we not talking to those patients about tepe brushes? When they’re not using them? They’ve already got an electric toothbrush. And you know, I think especially if you’re busy general dentist, does that worry that someone like that comes in and they’re just like, ‘Oh fine, someone with not doesn’t need anything, see you in six months,’ and no, everyone we should be, like we said, we should be treating everyone as the most important person is their expectations are high. And they they demand a lot from themselves, if they’ve got the slightest thing that we detect some minor tooth wear, a little bit of bleeding, we should tell them about it. And we should take them to that next level. I think. [Jaz]A beautifully said and that leads on again, beautifully to rule number six, which is on the topic of ultra high demanding patients, if you like is Trust your gut. Now we all have that patient where we regret taking this case on and maybe you took it on because you wanted the experience. Or you wanted to do a specific type of case, or you generally want to help someone, but you really did not undersell, and you really found it difficult to over deliver in that case, because the expectations are sky high. So sometimes you get that feeling that really sick feeling in your gut before your, even during a new patient consult that actually ‘am I sure I want to do this. There’s something quite fishy about it.’ I mean, do you have that feeling? Right? You get that gut feeling as well. Right? [David]100% You know, it’s funny, because you talked about Tif Qureshi before and just to bring it back onto Tif Qureshi obviously, he advocates a lot of ortho, GDP-ortho for his patients, don’t even assess wear. And what Tif talks about quite a lot recently is how a lot of young dentists are going looking for these Instagram patients. Or let me do some marketing. Let me pull in some new patient. And actually what a lot of people are doing is they’re ignoring those regular, everyday patients that they’re seeing in their practice. They are the safe people that you know, you build a rapport with, you’ve got this relationship with. And actually, you’ve already got that gut feeling and everything else is usually fine. I see you know, when we do bring the patients in from places like Instagram, it’s never been more important to trust you go and sometimes you just get these vibes of people and they’re just never worth it. It doesn’t matter how much you’re going to charge. They’re never worth treating and because you’re constantly then see their name that you booked and if you just think we should never touch them. [Jaz]Don’t treat someone that you can’t have a laugh with. On that same vein. [David]Yeah, absolutely. Someone who you are never going to be in rapport with and it makes it really difficult. I think if you can sort of cool to the A patient best who seems like you think you will just have the easiest time because you’ll be in [Jaz]You will have such a great career. [overlaping conversation] [David]Absolutely, you’re going to love you do. [inaudible] in a positive breath for Instagram denies the benefit. When you do your own marketing, you will attract the patients that you want to treat who are like you. It’s why on my Instagram, I’ve always had my personal life, hey, I get patients coming in? Well, I came to see you because you’ve got a Dalmatian, I’ve got a Dalmatian. It’s bizarre, but it’s why I sometimes think it’s hard to separate your dental life from your personal life, [Jaz] it shouldn’t have to be the case [David] absolutely not an issue. And similarly, if you want to showcase what you do, and you want to market, make sure you’re very genuine with that. So you’re marketing, what you’re actually about. Because otherwise, you’re gonna attract people who you actually don’t want to treat, you don’t want to treat those people. And I think trusting your gut. And one thing that we can never overlook is just like you said, is the patient attached to their teeth? So what we see on on things like Facebook, it’s a little case and say, Oh, you know, I do some teaching with Invisalign, and some will bring a case along, and they’ll say to you, ‘Do you think I can treat it? and you’ll go through all the dental side of it. And fundamentally, you think, ‘I can’t tell you what it’s treating patients, because I’ve never met a patient.’ And that can be the make or break whether you should treat them. [Jaz]You don’t know what the goals are, I think ultimately you hinges on the patient’s goals. [David]Absolutely. And it hinges on what they are expecting, do they want the very best, and if you can’t provide that or in any doubt, then No, you don’t want to treat that, you know. [Jaz]So everyone trust your gut when you have that sinking feeling you’ll never regret not seeing a patient. It’s what the basic what we’re trying to get to. So [David]You can’t remember the ones you never treated ever. [Jaz]Exactly. So that’s the first half of rules done now complete switch. Day take away the next two rules, quite nice ones. [David]Yeah, so an extra rules. I think the first ones all seemed more focused on the patient. And that interaction between dentist and patient, I think other rules are more focused on you as an individual, as a dentist. Rule seven, take time to take care of yourself. And, you know, we talked a little bit about Jordan Peterson’s book, this is what kind of inspired us to sit and write 12 rules. And you know, Jordan Peterson said in his book and one of his rules is treat yourself like someone you’re responsible to help him. And Jordan Peterson talks about people who own dogs and cats. And the statistics show that people are actually better at administering prescription medications to their pets than they asked themselves. And you know, this when I read the book, it just ran a chord with me, I was like, it’s so true is, you know, our dentist, we spend all are there helping others and trying to care for others, that actually what we do, or what we seen so often in the profession, that people are running themselves into the ground. They are just not taking the time to care about their own health, to care about their own mental health, their own physical health, and as a result, we’ve got this asolutely. And you know, stressed and tired profession. [Jaz]Can I just interject that I mean, before I forget this point is that I went to Barry Oulton’s two-day communications course. And one interesting stat that he shared, which really was mind blowing, and I felt as though almost I knew it, but the real scale of it was, you know, surface, which is about 17% of our profession. Okay? When they did the surveys have had suicidal thoughts. I mean, we know that dentistry supposed to have the highest suicide rates, but when you actually you know, there’s five dentists a room, one of you may have had suicidal thoughts. That’s really scary. And one thing that he discussed about and also Hassan Khan discussed about in terms of his communication courses is Amy Cuddy’s TED talk about power poses, and how actually in dentistry, we’re all like this, right? And your physiology, your body, okay? It has a big effect on your sort of the neuroscience in your positivity. So take time to take a look after yourself. But also, I think one thing you’re gonna talk about now is stretching and actually lifting your body posture, because that has a profound impact on your overall mood and mental health [David]Oh, absolutely. I think, you know, I, one of the first things when I graduate, and I became kind of known in the middle dental communities for like the fitness side of things and the gym. And what was funny about that was I was very into kind of bodybuilding. I was and you know, I kind of hit this point where I was like, actually, you know what, I need to take better care of myself. I looked like I was physically fit, but my health wasn’t good. I went to the gym and killed some work. That’s all I did. I didn’t. I’m all being well, I didn’t do enough stretching, I didn’t do enough cardiovascular work. And I think, you know, for me, we’ve actually got to really think about the health side of things. And, hey, we know the personal, the physical and mental health are so well connected. So as you say, when you spend that entire day, in physically draining positions, be that kind of muscularly tiring positions. And, yeah, you’ve got to have the magnification, we obviously try and do a list like this without mentioning it, it was hard not to, because [Jaz]That’s why magnification is one benefit. But actually having a microscope and your postures up is just a great thing to consider. [David]And then, you know what, stand up, like I said, stand up between your patients, stand up, walk around, you know, any dentist who’s ever worked with me will know that I’m one of these dentists too, if I have everyone’s books up, and I see someone doesn’t have a patient in, and I don’t have a patient in, I always get up and leave my surgery, I got to talk to them. You know, for me, these are sort of taking care of yourself, as making sure that you’re interacting and you’re walking around, and you’re not fat in this one position. And I appreciate that there are dentists listening to this, who don’t even feel like they’ve got time to rush the toilet. To them, what I would say is, I would just say redirect yourself back to rule two, which is create a positive environment and recognize that things have to be different than that, there has to be otherwise, all you’re going to do is you’re going to run yourself down. And you know, it’s just something that, you know, early, you know, being forced to retire early with financial commitments, and I just don’t think it’s something that anyone should be having to do, [Jaz]or back problems. So so you know, one thing that we have, because this is 12 rules for dentistry, not just for dentists is that 94% of dentists will retire with backache. I don’t know if you knew that 94%. But do you know what percentage of nurses will retire with back problems? [David]At a higher percentage [Jaz]100%. It’s true. So one thing I’m always doing is that when I’m doing my dentistry, I’m actually looking at my nurse, and I’m actually sometimes ‘Jessica, are you comfortable? Are you okay, there? How’s your back feeling?’ And sometimes that’s a reminder for my nurse. So you know what, yeah, you’re right. Let me pick up here. So look out for one another. And one good piece of advice I was also given on the same vein was how much money do we spend on equipment? Right? As dentists and in dentistry, the most important equipment, most important machinery is yourself. So maybe go to the yoga, have a physiotherapist, get some massages, because you know, your body is an important piece of equipment, everything hinges on that. So that’s a good way to sort of reflect on it. [David]Yeah, absolutely. I think I couldn’t agree with you more, I think we have to, you know, the analogy, I kind of which book I read it in, we read that many kind of development books. But in the book is talking about when you’re on a plane, they always say, when there’s an emergency, put your own oxygen mask on before you help anyone else. And that’s what it comes down to it, it’s like, if you don’t help yourself, you will no longer be able to help other people. So if you retire with backache, suddenly, you’re not there for all your patients, you’re having to take time off work, you’re having to. So if you’re not looking after number one, if you’re not looking after yourself, you can’t help your family, you can’t help your patient, you can’t help the team. So actually, like we said, everything hinges on you and your health. And what’s really frustrating is I think, a lot of us notice, we still continue to drive ourselves into the ground. [Jaz]This is common knowledge, but we don’t surface it. [David]Absolutely. I work seven days a week so I can help all my patients, you think long term, are you helping your patients really? Working seven days a week, at some point that will break you, it will. It will break you because you’ve not had the time to have a good personal life and life outside of dentistry or it’ll break you from a health point of view because you spend so much time unsure the doing that, you know, in positions that are bad for your back and for your neck things like the musculoskeletal system [Jaz]Cool. Rule 8. [David]Rule 8 is Focus on your own journey. And, you know, we’ve talked about social media a few times here and it’s I think the hardest thing now is there is so much noise, there’s so much noise that, you know, do you and suddenly be bombarded with what other people are doing. And I think the biggest challenge here is what you’re actually being bombarded with is never the reality. It’s this distorted highlight reel. And you know, you’re being bombarded with positive messages about Oh, my dear, so great. Look at this, look at that. And I think sometimes we just have to block out the noise and really focus on ourselves, focus on our own journeys. And I’ve had this conversation so many times with particularly young dentists to a particular dental school, I just graduated in I say, you know what? What want to do? Well, and my friends are applying for hospital position. And that isn’t that and, and I, and I’m like, Well, what do you want to do? What do you what do you see? Where do you see yourself? What is your journey? What is? What are you destined to do? Why excites you? What interests you? Hey, you know what? It may be something that doesn’t interest me at all. I’ve talked to people who say, Oh, well, I’m really interested in dental public health. That was never for me. But if that’s somewhere else, and they should absolutely run with it, they should absolutely run with it. [Jaz]We need more people like that. [David]Absolutely, this is how the profession is all built. The profession is built on some people enjoying things and some people not enjoying them. And then everyone should just really as cheesy as it is about following your passion. You’ve got to really think big inside yourself and say, Okay, well, what is it that I like doing, and then find the path and go do that. Focus on your own journey. Focus on things that you enjoy. [Jaz]Sometimes the earlier years you are on a path of discovery, and that’s completely cool, just to be open yourself, like I’m discovering. I think I like this and you give it a go. Because if you don’t give it a go, then you’ll never really know. So you give it a go. But in your sort of feeding back and said okay, is this what I’m really enjoying? How can I make this even better? How can I now change my environment to design the life how I want it on you as part of your own journey? And the other thing I want to say Dave is, or never compare yourself to someone else, especially on social media, never ever compare your work on someone else? They’re in a different place. They’re on a different journey to you. But always do compare yourself to where you were a few years ago. Totally, that’s completely acceptable to do that, because that’s how you know if you’re making progress. Are you growing? [David]Yeah, absolutely. And, you know, I think that is one of the again, and it’s the mental health side of things. That is one of the biggest problems now. And, you know, I totally agree with you about the first few years of dentistry trying to get that exposure to as many things as possible. You know, it’s well known now that undergraduates are graduating with far too little practical experience, and that no fault of the dental schools. That is a lot of different factors involved in that. But what we’re graduating having done one molar endo, no orthodontics, and one surgical extraction, perhaps. And there’s no way that at that point, you are ready, in my opinion, to decide what you want to do for the rest of your life. And I think [Jaz] Agreed [David] it’s where we really need to bring in specialist pathway for people later on. You know, at the minute, everything is built on from day one of graduate and you have to go into this hospital position, go into this and go into this, if you want to become a specialist [Jaz]MFPS tick box. [David]Absolutely, tick, tick, tick, all you’re doing is ticking off the boxes. And before you know it, you blink and tick it. Yeah, I’m a specialist in this, and I’m a professor of you know, this, but I never actually got to go out and experience as much as possible. And, you know, I think my view is the first five years, which is what we’ve just probably come to the end of I think we’re about year six or seven. And now. Since five years for me was spent going on courses in everything. I went on an implant course, I placed implants. I didn’t enjoy it. It wasn’t for me. [Jaz]Same here I placed about four implants and it just wasn’t for me. [David]It wasn’t me. I think, [Jaz]But that might change, Dave, that might change me and you might look at 10 years from now look back at this episode and think, oh, we’re both placing implants now. But in terms of our progression, what we enjoyed the moment it doesn’t fit in with our what we enjoy and and that’s totally cool. It’s completely cool to say, here’s a bits that I would want to do because I enjoy them. Here’s the bits that are not for me at this moment in time. And that’s completely fine. [David]Yeah, absolutely. And you know, I was always like that with dentures. I’ve never enjoyed dentures. I don’t like doing dentures. I have no interest in them. And so sometimes we down to and you’ll talk about shortly, sometimes the people you meet, sometimes you meet someone, you go on you know you enjoy dentures, you go on one course with Finlay Sutton and suddenly you’re like, I love dentures. Dentures are my thing [Jaz] He totally has a effect on people. [David] And I think that is what it’s about. Sometimes I think you can only kind of go on how you feel at the minute. And I think if you don’t enjoy aspects of dentistry, and I don’t mean to criticize the National Health Service, but the NHS probably NHS dentist is you do not get that choice. You do not get a choice, you are in a contract to do everything, you can’t say and if you do say this, which some do with things like molar endo, you are breaking your contract, it is unethical and wrong to be in a contract ment and say, well, I don’t really do molar endos. So you’ll have to go private, no, it doesn’t work like that you have signed this contract. That’s what you’re saying you can do. If you don’t like aspects of dentistry, in private practice, you tell people, I am not the best man for this. I am not the person to help you with this, my colleague, and you direct people to the right people. And that’s how these private practices really thrive. That actually what ends up happening is the people who like doing certain things, do it. And the people who don’t like something, don’t have to do that anymore. [Jaz]Would you want your family member or even you to have brain surgery by someone who doesn’t like doing brain surgery? [David]No. Never. [Jaz]I know, we’re talking about teeth, it’s just teeth. And again, guys these are just teeth, right? But it’s important, okay? And this is what we, this is part of our values. So you need to see someone who actually enjoys what they’re doing. And you’ve got to be enjoying what you’re doing. So to make it work for everyone. So what you touched on was meeting the right people, having the right people on board. So rule number nine is amongst make quite quick one because I think you know, we have touched on this in previous reincarnation is have mentors. And one thing I want to say is that people always say, Oh, it’s so difficult to find a mentor. Well, it’s 2019, almost 2020. Okay? It has never been easier to have a mentor. Okay? If you’re a dentist in the 1950s. Okay? How do you find a mentor? Maybe local meetings, you definitely wouldn’t see new international dentists are very difficult to do. So if you want to discuss the case, you probably weren’t taking photos, to be able to show someone you sort of just describing things. Nowadays, you can take photos, you can beam across the internet within milliseconds to someone else in Costa Rica, who is a great dentist, for whatever reason, and then you’re just exchanging radiographs, information, you have video calls, it has never been easier to find a mentor. And I always say a mentor is not necessarily someone who you’ve actually met. You can have mentors who are you’ve never met before, but who are sharing excellent information and you’re learning from them. They are in some ways a mentor to you. And you are the average of the five dentists, you spend the most time with that. And that includes people who know what books are reading, who you listening to, what courses you’re going on. So find a mentor. And it’s never been easier and don’t say, It isn’t, Oh, I can’t find a mentor, just send that email, send that message. And you’ll find that some of the most successful and best Dentists out there are so generous with their time and knowledge. [David]So willing to help. I couldn’t agree more, I think like you say it doesn’t need elaborating on because I have just been blown away since graduating, how many phenomenal people are willing to just help out of the goodness not looking for anything in return. And, you know, and my goal has always been that, you know, eventually, I want to give back just how they are to me. And I think it’s to try and do so much with young dentists where we’ve been already because you can relate to where they’re coming from, it’s safe to give back and help with that. And But no, absolutely. There’s no better time to be a dentist, there’s no better network and opportunities to do things and than what there is now [Jaz]Opportunities are plentiful. So to exploit them everyone. Rule number 10 is there is no shame in saying to your patients or saying to anyone that you don’t know, it’s completely okay to say the three famous words. I don’t know. I sometimes patients ask me some is like, why is this like that? Or why was that not found? Or Why do I have this bone type appearance on this radiograph? I don’t know I’m just making up something random. And if you don’t know that, you know what? I don’t know. But I know someone who might be able to help. Or if you want sound really clever, you can say it is not known. And these nuggets have been given to me by someone called Barry Glassman, who does a fantastic lecture for S4S. And it’s completely you know, it’s a great sense of joy that you get in a way that you break the shackles from having to know everything all the time. So I don’t know if you want to elaborate on that. But I think it’s fairly it’s fairly self explanatory in the sense that, you know, if someone asked you something you don’t know just smile and say ‘You know, I don’t know or it’s not known’ if it genuinely isn’t known why something is the way it is. So it’s not known and there’s no shame in not knowing everything. [David]I think, I totally agree with you again, it doesn’t need much elaboration but it is for me, one of the most powerful phrases I have brought into my practice and you know, ‘I don’t know’ and I think what patients really see with that is that you’re genuine and real, you’re not trying to be bs, you’re not trying to, you know Well, it’s because I don’t know. I don’t know. And as you say, and I think that the power is when you can say, ‘I don’t know, but’ and you can say, ‘I don’t know but I can find out’ or ‘I don’t know, but I can.’ And I think this goes for, you know, when people do lecturing, and you ask someone a question and you don’t know, and they stand there and dribble out this answer to you, and you think, [Jaz]Just say you don’t know [David] Just say you don’t know and nothing wrong with that. And a huge one is conducted with things like choose where and more complex dentist to get, people come in and say, ‘Can you help me?’ And I think we probably saying, ‘I don’t know,’ or ‘can you help me? What do I need?’ at the minute, ‘I don’t know what you need but I can find out.’ And this is what we need to do to do that, we need to do photographs, we need to do mounted study models, if you’ve given them a journey, what you’re telling them right now, I don’t know. And we saw drilled in as dentists, you know, give patients a treatment plan, the first time you meet them. Complex dentistry can’t do that, you have to say ‘I don’t know, I need to do some certain investigations, I need to go and find out. And I think now like you said, I think there’s a lot of power in that.’ [Jaz]Brilliant. So the last 2 rules. 11 and 12. Come on, Dave. [David]11 and 12 the very brief because I think we’ve covered so much. And rule 11 if you’re not enjoying things, something needs to change. And I think we don’t really talk about this too much. Because everything we’ve been talking about creating a positive environment, about trusting your gut and enjoying your journey. Everything comes down to if you don’t think this is how you’re currently operating. And this is how things currently are for you. I think the first step is recognizing something needs to change. And once you recognize that, and you come out of the denial of well, this is how it is, don’t be a victim, don’t be a victim, take off that victim t shirt and just realize that actually things need to change. And you need to identify what needs to change. And it may be to do less UDAs, it may be that you need to maybe as extreme as you need to move practice, you might need to work with different nurse, you may need to take another job elsewhere. So you can get some experience and some insight [Jaz] you might need to work in less days [David] you may need to drop a day. You know, and I think as soon as you recognize that something needs to change, that’s when you’re in control. That’s when power happens. Because at that point, then suddenly, you can make things change, and you can go on to have such a happy time in dentistry. [Jaz]It’s like the flower analogy again, basically, you know, it’s not the flower that needs to be changed, it’s the environment. And that, you know, it’s already been touched on. So that’s quite good in that way. [David]That’s it. And it’s down to you, as I say, to recognize that, hey, if you’re unhappy and you’re miserable in dentistry. Why? Why are you unhappy and miserable? Get a piece of paper write down all the reasons why you think you’re unhappy and miserable. And, you know, it may be Well, I need to treat different sorts of patients, how are you going to do that? Come with an action plan for each one. I’m working too long hours, go and have those conversations. Do I need to work these hours? Can I condense my time and do different things? Can I book longer to a new patient exam? Or an examination in general? You know, for me, five minute children exams, 10 minute adult exams was not enough. And, hey, I appreciate that some people feel false that they have to do that. What why not just work five minutes, have five minutes more, you know, 15 minute exams, these five minutes is crucial to for your own sanity I think really, nevermind anything else. And I think I picked on really nicely again to rule 12 which is Enjoy the present moment and the journey. And I think as dentists we are very, a lot of us are very type A personalities. We’re very focused and very driven. And, you know, I was reading Michelle Obama’s book recently, which is very good. And she talks about the cycle that she found herself caught in which was the effort achieved, effort achieved, effort achievex. And what we do is, when we doubt him, we do GCSEs and his effort and we achieved we get all those near stars, or whatever the new grading systems are ones and nines. We get all the top grades, what happens, we move on to AS we move on to A levels, effort achieved, we get all our is A level, what do you want to do next? All those dental schools, effort achieved. Again, constantly, you’re moving to that next level. You’re at university each year, it’s an effort achieved, and sometimes you’re too busy. You know, there’s a quote that says, you know, life is what happened. You know, it’s all about, sometimes it’s so busy making goals that actually we miss out on life. We actually forget to just enjoy the journey, and we graduate, and then we’re dentist, then we want to specialize, and you constantly on this actual activity to enjoy [Jaz] chasing the next big thing. [David] Absolutely constantly chasing something, you’re chasing the next thing, you’re chasing. And you know what? There’s always going to be a next thing if you’re not careful just to be present in the moment and think you know what, if I do, like you say, you’ve got to compare yourself to where you were two years ago, if you can look back and say, this is where I was two years ago, if I’d have said to myself two years ago, this is where I’m going to be now. Would I be happy with that? And [Jaz]Another question for everyone to ask for themselves, and there’s no right or wrong answer. So everyone should just reflect. And the answer is, I’m not happy than you that sort of sets a tone for your next few years. [David]Yeah, absolutely. You’ve got to always be a, but for me, as I said, it’s really trying to be present and really enjoy and appreciate where I am. And, and I think we should all do that I think we should all for better or for worse, stop and reflect on where we are. But enjoy the journey, not just getting some more letters, because every letter you got at CNN, you know, if you get into that cycle, you end up very lonely and miserable feeling like life passed you by but with the hundreds and hundreds of letters at CNN, for me, that’s not success for me. But successes is we can always talk about it’s so personal and so different. So anything you want to add on that? [Jaz]On that I almost say is I think it’s a beautiful thing that saying too, so important to enjoy the now. On the flip side, I do think that as dentists, one word, one good piece of advice I was given by an oral surgeon was that never as a dentist, stay stagnant, don’t become stagnant, always be upskilling, or trying something new or putting yourself out of your comfort zone, because that’s where growth happens. But not for the sake of present happiness, and to actually be mindful of the present moment. So you’ve got to find a balance, you shouldn’t stagnate, don’t think you’ll try to stagnate and just accept the status quo. But really, yes, develop yourself and look for the next big thing, but also appreciate the beauty and the power of now. [David]Yeah, absolutely. That’s it, you know, I was always told, you know, if you stay still, you’re going backwards. And it’s true, because things are changing all the time. So you have to keep evolving, you have to enjoy that journey, and appreciate and have the gratitude to just be like, wow, you know, things are really good. And I’m enjoying what I’m doing. Whilst you know, still looking at the next thing. So appreciate where you are, whilst still looking forward and trying to move forward. I think. [Jaz]Thank you so much for that. Thanks for joining me, it’s been really fun chatting about these 12 rules I knew it would be and I just want to say I’m so excited for you. You know, you’re hoping that you’re going to become a father soon and it’s going to be life changing. So I wish you all the best, you and Chloe all the best for that. And thanks so much for injecting our profession with positivity with more muscular hypertrophy. [David]It’s been an absolute pleasure, the last six, seven years knowing you and appreciate coming on.

I am joined in this 2 part Episode by Dr Tif Qureshi, the undisputed ‘King of ABB’ (Align, Bleach, Bond). We really and truly geek out over the Dahl Technique over the 2 episodes. There were just WAY too many gems to cram in to one episode, and not all of it was about Dahl! Need to Read it? Check out the Full Episode Transcript below! This episode (Episode 16) focuses on: The prestigious award that Dr Qureshi recently won Importance of long term follow ups for your learning as a Dentist Why you should not chase the big ticket treatment An interesting reason why Tif is not chasing new patients Are young associates moving job positions too frequently? Why the patients that are referred to you are special The Dahl Technique as an interceptive treatment modality Who is the ideal patient for the Composite Dahl Technique? Would you ever do the Dahl technique straight to Ceramic? At what point does a Toothwear case become a Full Mouth Rehab instead? What is the maximum recommended amount of anterior toothwear you should restore predictably with Dahl? How Tif uses Dahl principles to approach a Full Mouth Rehabilitation The next episode will be more focused on the clinical side of the Dahl technique. I promised you a good resource where you can read in-depth about the Dahl technique – as in this episode I assumed you had a basic grasp: BDJ Article about Dahl Technique If you found this useful, tell another Dentist! UPDATE: Dr Michael Melkers Occlusion Course has been moved to November 27th and 28th 2020! Reserve your seat at Occlusion2020.com for Dr Michael Melker’s signature 2 day course Listen to the Episode with Dr Michael Melkers Click below for full episode transcript: Opening Snippet: And I think you know, I think this is the thing we're having this conversation about this now, how often are we hearing this? You know, when you go to a dentist? Yeah, all you hear and I know with all due respect to them because a lot of great guys out there who are great gurus are getting new patients and I think that some of the guys are amazing, but I don't hear enough people talking about this subject... Jaz’s Introduction: Hello everyone. Welcome to Episode 16 of the Protrusive Dental podcast. It’s Jaz Gulati here. So Wow, what an episode with Michael Melkers I hope you enjoyed it. I really love recording it. And once again, it was a video podcast so you can see it on my Facebook page as well. But what can I say I am honored to have the Doctor Tif Qureshi on this podcast. I feel like the guests are getting better and better each time and it’s privileged people to interview these people. So Tif, the story of being with Tif is I went to his course in Sydney. Actually, I was living in Singapore at the time, and it was a great way to see Australia and I noticed that actually, Tif was teaching in Sydney and my wife let me go, so Sim thanks for letting me go. Now Tif is I’m gonna go ahead and say he is the most respectable person in UK dentistry. There we go. I said, if you don’t know about Tif Qureshi, then please join us for his fantastic two part episode. The amount of value he gives in the recording was so vast that I had to split it two episodes. So the way that the two episodes are split as follows. Part One of Dahl is basically talking about the importance of consistent photography, how Tif Qureshi carries out his consultations and what kind of communication he carries out with his ongoing patients in the run up to Dahl because what you’ll find out is that a lot of these Dahl cases, they’re not done as a treatment plan that’s presented to a patient and then they go ahead, it’s a conversation to have and you need to cultivate and discuss with the patient. So it’s some great tips in there. We talk about young associates moving around too much in terms of associate positions, we talk about how much you can learn from your follow ups, you know, you’re already probably familiar with a lot of his ideologies and philosophies which are just fantastic. We talked about in terms of Dahl itself, we talk about it, and I apologize in my last episode, if you listen to audio version about the fact that actually we do go in quite heavy into Dahl, we don’t actually talk about the history or the mechanics about the whole intrusion, joint repositioning to an extent we do. But it’s almost assumed that you know about Dahl technique already to a degree. And then I really grilling about the nuances, the nitty gritty after you done a couple of Dahl cases to actually improve your future Dahl cases. So I do apologize if you’re a bit earlier in your career, and you’re all bit unfamiliar with the Dahl technique. There’s plenty of good resources out there. In fact, I promise you on my blog, jaz.dental soon to be upgraded, by the way to Protrusive website, which I’ll tell you about that another time. I’ll be uploading that on like a PDF version, some good BDJ articles, which I found helpful when I was learning about Dahl, but obviously, you know, Tif’s course two-day course on Dahl Ortho-Restorative is the pinnacle of it all anyway, but he gives away a lot of his gems, because he’s such a generous person with his knowledge over these next two episodes. So part one, what we’ll be discussing is who is your ideal patient forDahl technique? Would you ever do Dahl in porcelain? The importance of Dahl as an interceptive treatment not to leave it too late for the patient to Dahl up because that’s really a full mouth rehab, what we can learn about full mouth rehabs by you know, doing the Dahl technique, and important once again, communicating, communicating with patients the right way, about the Dahl technique. So that’s what it’s going to be covered in part one today. For part two will go into much more depth in terms of which types of splints to use with Dahl before after, sort of the real nuances and the nitty gritty bits. And that’ll be in part two coming soon. So I hope you enjoy interview. And please, if you like it, you know, give me, Leave me a review on Google podcasts or iTunes or wherever you’re listening to. Give me any stars you want. My favorite number is five. So please, yeah, enjoy episode. And thanks so much for listening. As always. Main Interview: [Jaz]I just want to say Firstly, congratulations for the massive prize, because I believe that the prize is named after the dentist that you admired a lot, right? [Tif]That’s correct, yes. But the tourists dog, I mean, it’s a massive prize to me, it’s probably doesn’t mean a lot to most dentists in the UK because, like It wasn’t that well known, I think a quarter of a dentist do know him and didn’t know him. But he’s not that well known in the wider community in the UK. But probably I would put them up there as one of the greatest dentists of all time based on not just his kind of clinical skills of which there was very apparent but really his perception and his kind of ethos in that. It was more about looking after people for a long period of time trying to do the most minimal treatment for the reasons of actually not just doing it for the sake of doing it minimally but because he cared about how things were five or 10 years down the line or 15 years down the line. [Jaz]Which is exactly your ethos and philosophy. So would you say he’s had the biggest influence in your clinical philosophy in your career? [Tif]Yeah, without a doubt of all I’ve got, there’s a lot of dentists out there that I’ve watched and heard lecture and met and know them. And I admire them immensely. But I don’t think there’s anybody had quite an effect on me as watching the circle when I watched him for the first couple of times. And then I was very lucky to actually meet him. And then incredibly, he actually turned up on one of my courses in Stockholm back 10 years ago, I wasn’t actually expecting. [Jaz]Wow, that is really amazing. That is a really key lifting moment for you to have one of your, you know, mentors, when people you really look up to who comes to your lecture. [Tif]Absolutely terrifying as well, because in my presentation, there were some of my, you know, my pre aligned veneer cases, which really looked absolutely hopeless conservative, but to be fair, I mean, you know, he sat there is a student and listen to it all, and actually did some cases and believe it or not, I mentored him a little bit as well. So it was quite amazing, actually. So it’s a Yeah, I did. But he was humble enough to actually, with all the knowledge that he had to just sit there and listen and take on board what I had to say. And actually, that’s kind of where I suppose where this all came from. Because then with his kind of ethos, he knew what I was doing. And he kind of supported a lot of what I did, particularly in Norway, in Sweden, and there’s a guy, that guy that I actually won the prize with jointly, again, not well known here, but his name is [Eric Spencestud] [Jaz]Oh, I think I’ve seen him on Facebook, he posts some good ABB cases as well. Right? [Tif]You’re right, that’s right. But Eric is actually really sparkers prodigy. And if you want to use a better term, I mean, he’s basically the person that circuit gave all his material to and he stepped in when he was unwell. And he really sort of is trying to continue that message on. And quite oddly, the reason I met Eric was because by 2013, I was meant to be doing a lecture where it was just myself smirk on stage. And we had a little bit of slight crossover. So that was like, for me a dream come true. But then unfortunately, Abushi became ill. And that’s obviously you know, he was suffering a little bit, he became a lot at that point. And Eric stepped in, and I was like, the upsetting Who’s this Eric guy, type of thing. But actually, I met Rick and literally from that day onwards, we’ve sort of clicked as, you know, extremely good friends, who, you know, we messaged and speak to each other and I said that dentistry about life in general pretty much every day about you know, where dentistry is, go and both of us have obviously been kind of been deeply influenced by circus. So yeah, to summarize, to win that award is a big deal for us. Definitely. [Jaz]And honestly, I can’t think of anyone better so you’re a man who says I’m gonna make you blush a little bit you’re a man who really doesn’t need to any might mean most of my listeners a ton of my listeners are from the UK young dentist and they all know who already Okay, so for those who are living under a rock, Tif is, if you don’t mind Tif, I didn’t ask you for introduction. I’m gonna make one up for you. That’s right through the eyes. And for the voice of me of me and you are the king or the other good. Maybe the Guru is not right term because I feel that term is won’t do justice. I think you’re just an amazing person and your niche area of Ortho-Restorative and how you really pushed minimal invasive dentistry is fantastic. You’re one of the nicest most humble most giving clinicians you’ve always got time for everyone, young dentists, everyone, you’re a master educator. And I know that because I’m pretty sure you gave two day keynote lecture in Scandinavia recently, right? Or is it always in New Zealand? [Tif]No, it was actually both the two days were were Norway. And there was one whole data very large audience and then another hands on day and then New Zealand was actually the year before where again, it was a whole day. And then I did two days in Australia, but that you know what, these things they come around and you take the opportunity when you can, [Jaz]No but Tif to to be able to speak for two whole days as a keynote speaker. Firstly, you have to be really engaging, which you totally are in if you’ve never been to one of the Tif’s course. And speaking opportunities are jumped at it. Really, I mean, I saw you in Sydney, if you remember. [Tif]Yes, of course. [Jaz]Okay, so I was living in Singapore at the time, right? And we were going to come back to the UK. And I thought, Okay, let’s go Australia. So while we’re there in Australia, I just noticed the dates have to happen to coincide and I didn’t want to wait another six months or a year to come and see you speak because you know, it was about the it was the Ortho-Restorative, the Dahl, hence why you know, which we’re going that’s what we’re talking about today Dahl and you know, I’m so glad I went and I’ve learned so much. I’ve gone through lots of Dahl cases which you can definitely get into nitty gritty of today. But I just want to emphasize Tif, you’re a fantastic educator, because you’re not only to put on a two day program and to really engaging but to have enough content to fill around seven hours per day, 14 hours. That is spectacular. And we know on Facebook, you have so many amazing follow up cases year after year after year. And I love how you present it two years, five years, 10 years, you’re very honest of this one’s with polishing, this one’s without polishing. So I think that is amazing what I also love about your cases Tif and I’m sorry if I’m calling any other dentists out here Instagram dentists, whatever, but I just don’t like it when dentists take one type of photo with a ring flash and then their final photos all the bounces and stuff okay, I’m not about that. I’ve noticed even though you’ve got bloody 15 years plus follow up, your lighting is always consistent and you’re never trying to hide anything. And that really in today’s era deserves so much kudos. [Tif]I have to say that’s probably just come down to laziness and like kind of stuff I try. I did try it. But I just thought more or less the fact that I mean, eventually I think over time you start you do actually look at the images more Honestly, I think what it is, is that, you know, I did play around, if you look at some of my images are a little bit different. Because if I did go from ring flash to [twin] [Jaz]You might upgrade equipment, and I get that, but yeah, I know that you try and keep you’re not trying to like, you know, make one look not so nice. And the other one look, no, that’s exactly what my point. [Tif]You’re right. I do admire the guys that do that very well, because I mean, some of those pictures are beautiful. But to a certain degree, I think what I’m also trying to do is get people to focus on what you’re actually looking at not just to think, oh, what a beautiful picture. And actually, you know, I think what I’ve learned, and it comes back to what you said before that same people again, and again. It no one expects everything to look perfect, 5, 10, 15 years down the line. In fact, when it looks imperfect, you learn so much more from it, you see what I mean? Because it enables you to kind of get an expectation of how things are going to change. You know, this whole I think there’s you know, you could have a whole conversation on this whole before and after mentality is actually half the problem, what’s wrong with dentistry, but people are just focused on providing a service, here’s what you pay me, thank you, goodbye. And that’s the end of the relationship. That’s actually what I read. One of the things I learned it’s furka, it’s completely wrong. And that kind of method, that kind of attitude goes all the way through dentistry I find. It really is, it’s kind of it’s in there. I say, you know, it’s in specialism. And if you think about specialists, the way that they don’t just don’t ortho what generally other than perio, most specialists will do a very complex treatment, it’s done, goodbye. Okay. And that is not, I don’t think that’s the way the dentist should be. I think I’m not saying we don’t, you don’t have specialists. But I think that particularly nowadays, remote monitoring, all the things we can do, there should be so much more cross communication between people who are looking after a specialist created treatment or complex treatment, and the person actually carried it out. So I know slightly stray, the point being is that the photo, the reason for having long term photographs has really sort of made me understand that actually, that’s what dentistry should be about, it should be about a longer term relationship with the patient rather than this whole, you know, get 20% of the rich people through the door and sell them as much treatment that you can do. That’s just I did that for a while. And that is total, and I’ll be a bit rude total garbage. And it’s actually and I actually bought thing is borderline unethical, that whole kind of mentality of just no big ticket treatment, and then you just display basically just disregard the patient. I’m not saying that a lot of people do. But I do believe that in certain elements of dentistry, you know, work particularly smile driven dentistry, there is this kind of emphasis where you’re just always focusing on new patient, you know, it’s with a new patient. [Jaz]Yeah. There’s a whole massive market on Facebook all the time advertising, are you looking for new patients, 73 new patients in three days and all that sort of stuff [Tif]This is the thing I mean, I’m sure we’ll get into it. But I’ll tell you what, I actually don’t like to new patients. I don’t there’s reasons for it, I’m most of the work I do that you see, it’s all on patients, I’ve had a bit of a conversation going with for a few months, at least, or maybe a couple of years. But you know, that’s another reason why we’re talking about dahl. But it’s another reason why there’s so much dahl, because in reality, you will do far more dahl on patients that you know, and have had an ongoing conversation with compared to a patient you’ve never met before. Because dahl requires patients to kind of understand why you’re doing it, and what the benefits of it are. [Jaz]Absolutely And what I found is with all the Dahl cases, there’s only one Dahl case, which I saw present a treatment plan and she wanted to go ahead with it, I did it. But you’re right, most of the other Dahl cases I’ve done. In fact, all your Dahl cases has done, there’s been at least six months of communication. Now obviously, with my six months, it doesn’t compare to your years and years, we just thought the way it works out. And on that note, actually, I should really mention that, Tif, you’re one of the advocates of being in one place for a long time. And you already mentioned this, you know about long term follow ups and whatnot. And that’s really admirable. And I know one of the things I was asked you at the end is any tips for young dentists, I know that you always talk about this. And the value of being in one place for a long time is amazing in terms of how much you learn. But it’s actually having an interesting effect on me, Tif. Because every time I’ve been in a situation in my life since qualifying 2013, where I’ve had to leave a post because we’re moving Singapore or moving back. I’ve had your voice in my head, really be disappointed in me. You took the blame for this. So you’re having a great effect on it. You get you’re getting people associates, associates nowadays, you know, as a young associate, I can say it’s we’re moving around too much I think and I think what you teach to stay in one place to see a follow ups is just sensational. [Tif]Yeah, if you’ve got to come back from Singapore to the UK, that’s acceptable. I totally get that. You know, that’s fine. It’s a life decision. But I think that you’re right. There are a lot of people who I think they kind of make their move around from practice to practice in areas actually aren’t that far away from each other. And I’m totally, What are you doing that? You know, I met one associate, I want to chat young chap, he met me in a course and you know, after a lecture, he said I really enjoyed that and but you can see he was down I could see he was explaining he’s had nine jobs in nine years. You’ve never seen your work. You know you basically had nine years of not really learning a lot, because the reality is, you know, I’ve learned and I say sort of beginning my lectures, I’ve done a lot of courses over the years. And I’ve watched a lot of lectures. But I’ve learned more from seeing my own cases than any course I’ve ever attended. And that is so important. Because to be able to face your own work, even when it looks rubbish is an absolutely key part of being a dentist, you know, and actually, when I looked at work that I encouraged the patient to pay for, you know, and I said, you know, we’re going to do this, I’m going to do that. And I came back and I looked at it, and there was a leaking margin on our composite that I’d done four or five years ago, when I looked at it partly because the other thing, and it may get into it, but I always use intraoral cameras for every single checkup, okay, it’s quite a rare thing to do. I look at dentists having draw cameras, but they don’t use them every checkup. And I take a picture of every single tooth, and it takes me lithium. But what that does is it helps sometimes, both the patient and I look at something that I did three or four years ago, and if there’s a league, you know, I look at not happy with that, I’m going to redo it. And you know what, just doing that, if you’re not happy with something, and you redo it, and it might cost you like 250 pounds, whatever of your time, the fact that you’ve done that is better marketing than any 1000s of pounds, you can spend on Instagram, trying to get a load of people through the door, because what you’re actually telling that patient is your primary focus is their health, their care, not money, you see my point? [Jaz]100%. And it’s something that I learned from actually [Tom Seeley] also does this and some of these great dentists like yourself, and [Tom Seeley] that when I went to shadow [Tom Seeley] once, you know, he’d come across some fantastic 9 out of 10 anterior composite, and because it wasn’t 10 out of 10, he wouldn’t force the patient, we say look, I think I can do a little bit better. If you have the time for me, I love to make it better for you. And that is your right that is the ultimate way to and he’s not doing it because he wants to market himself to it as he just generally wants to do an amazing job, I take a leaf from that and what from you’re saying. So that’s a great tip to if you see work that is not to your true standard, and you want to really fulfill your objective of making something beautiful, long lasting, then just replace it and the patient will you know, tell 100 people [Tif]Exactly. And then you know what, then the patients like you, they become friendly with you. And you know, and then then when they send someone in to see you that new patients very different to a new patient that you pulled in off Instagram or wherever. And I’m not saying that Instagram patients are terrible, blah, blah, blah. But what I’m saying is, you know, in my career, you know, a long career, I’ve noticed that the patients who get referred are so I found them so much easier to treat, it so much that you’re not having to win them over than somebody who’s just coming in and who’s just kind of you know, you get those kind of patients who are sort of trying out lots of different dentists and looking for price and that sort of stuff. And I’m very careful with those people. I don’t start treating them very quickly. Sometimes that might that but when it’s somebody that I know, I’m not saying that drop my defenses, but I found that over time, those people because their family and friends, you know, they’ve already they already love you. You see what I mean? [Jaz]Yeah, they trust you. And also it’s the family of friends or people who you also enjoy treating and who you also trust. [Tif]Exactly. [Jaz]You also great. You already like this patient, the patient already likes you just from their prior relationship with the other patient. [Tif]Exactly. And I think you know, I think this is the thing, we’re having this conversation about this now, how often are we hearing this in the you know, when you go to a dentist? Yeah, all you hear. And I know with all due respect to them, because a lot of great guys out there who are great gurus are getting new patients. And I think that some of the guys are amazing. But I don’t hear enough people talking about this subject. And actually, I think the effect it has on younger dentists who are not established is to make them feel under pressure that they’ve got to sort of somehow market themselves as a brand to then have all these new patients coming in. And that’s just not true. What you need to do you get back to what you said we need to do is to stay in one place, build trust, be honest, talk to people, tell them what’s going on, you know, do things right, and then it would take two or three years, potentially, but you’ll start to see these people coming back who actually trust you. And that’s really how that’s how we should be. [Jaz]And it just highlights again. But again, being in one place for a long time it has that you have the ability to do that by building rapport. And one more thing I mentioned is Zak Kara’s episode thinking comprehensive. One thing that Zak said in that episode, which always resonated with me is he’ll never treat a patient who can’t have a laugh with. [Tif]Yeah, I think he’s totally right. And actually, you know, that kind of sort of goes back to what I said about not jumping in too quick in that what I tend to do is, I mean, if someone’s coming in for quite comprehensive treatment, the bottom line is they’re going to probably need hygiene, a couple little minor things done anyway, what we’ve always done in our practice, we know you’ve got hygienist, it’s a great thing to send someone to an hygienist, sometimes you just have to travel to hygienist and just say, How did you find the patient, you know, because you can learn a lot from that actually, better be careful what I say here, but, you know what I mean, but the bottom line is that, actually, people need to visit the practice a few times, so you can really kind of get your head around them. I sometimes send patients off to the associate, they’ll do a refilling or something, something I don’t really do those. And again, I just do some simple stuff. And then before you really get into the big treatment, just make sure that this patient’s kind of on board with the whole kind of concept of the way everything works. And let’s face it, it’s just pleasant, a pleasant person to deal with someone you’re gonna have a laugh with. Exactly. [Jaz]Perfect. So that’s been one of the best intros I’ve ever done. Thanks. So much. Obviously, there’s so many gems in there. No, no, but this is awesome, I’m probably going to break this up into two episodes. So it’s the first part communication gems and life coaching, if you’d like for dentist, which is that’s what it was, it was full of great information. And so now, what I’m probably gonna have to skip is, look, the audience I pretend to listen to this podcast is already quite learned. I don’t doubt for a second they don’t know the core principles of Dahl so if anyone doesn’t know the core principles of Dahl, you know, localized tooth wear, obviously, Tif I’m happy to touch on it. But I don’t want to delve too much on the history, the lateral carefusion, the mechanics of that. I want to do more people who are actually case assessing, getting their hands dirty doing it, follow up, splint therapy, that’s the stuff on I’m going to. So for those dentists who actually want to learn a bit more about Dahl, I’m going to put some resources, PDFs dental update that sort of stuff in the blog post itself. So you can download that. So you know, if you want some background reading if you can but I really want to have Tif here, I really want to get to the things that I know you discuss it on your course and your two-day course, but things that other you wouldn’t necessarily be reading from that love day or anything. They’re the real nuances. So if you don’t mind can I just shoot you some questions? [Tif]Yeah, absolutely. [Jaz]So you know, if you senses which is the, who is the ideal patient for the let’s say, let’s call it the composite Dahl technique, because one the question on it later on, it could probably lead up to it is would you ever do Dahl in porcelain? So you go straight to porcelain? And then you want them Dahl in. So start off maybe by just saying, Who is the ideal patient? What percentage is time are you doing in composite? And then would you ever do it in porcelain? [Tif]So basically, I’d say the ideal patient is someone you already sort of mentioned, we localize anterior tooth wera, it’s also a patient, you’ve sort of known and been following who you explained to them about their anterior tooth wear they’ve got a localized anterior teeth wear and I’ll emphasize I think it’s important to say, but there’s no significant posterior wear, that’s key, because the point the way I look at it, it’s not it. And we know this is not true in every case. But in many cases, wear often start and localize anterior patient with anterior guidance, and then posterior wear can potentially follow not always we know that, but it can follow. So what I’m usually doing is looking in everyday checkup on every one of my patients, I’m always looking at their anterior tooth wear, tooth surface loss and the anterior guidance. And if I feel that their anterior guidance is starting to reduce, they’re starting to get close, they’re getting posterior contacts, and they’re starting to obviously, if they’re starting to, you know, occlude on sort of dentin, then that’s the type of patient who would be great for Dahl. Dahl, in my opinion, is actually an early interceptive treatment. It’s an and you’re saying, would I put Dahl Or would I do Dahl in patient straight in porcelain? You know what I have in the past, but the way I would look view is, if you had to do in porcelain, it’s probably too late. It’s not right. But by that time, it’s probably too late. Because it’s quite rare that the front teeth are that badly destroyed, and there’s no effect on the back teeth, do you see what I mean? Now, quite frankly, I mean, Dahl, the limits of Dahl are and the studies say about five mil is what and by the time you’ve already got five millimeters of anterior tooth surface loss, the post, there are cases where you get a huge amount of alveolar compensation and you still [Jaz]So five mils anteriorly is basically how much you’re building up. So the posterior that’d be around about maybe, depending on the ratio, you know, 1.5:3, depending on what, it’s not always 3:1, obviously is a rough one. But would you say that’s how much it opening up at the back? [Tif]Yeah. I mean, if you really think of it equilibly and you think of the jaw, like a hinge, you know, obviously and actually even then, as you go closer further to the back, you’re a bit maybe an equal one and a half to two mil, and then each segment at the back has actually only got a mil or so to move. So it’s not like you’ve got two mil of actual movement of each segment. So it’s so actually you often find that he do move five mil at the front will create about two roughly at the back ish, it depends on the patient’s , or the other sort of stuff as well. But I mean, that’s kind of fine. But if it’s beyond five mil, you know, if they want beyond five mil and we’ve got then we’ve also got wear on the posterior teeth. That’s significant, then really that’s it that you’re getting to full mouth [territory] [Jaz]And that’s something I took away from your course, Tif. So if you’ve got a basically how to make it tangible, if you’ve got exposed dentin posteriorly and you’re just doing this beautiful dahl buildups anteriorly, giving them anterior guidance, but you still got exposed dentine posteriorly and those teeth probably will benefit from restoration, which is exactly my right and that’s your point. Actually, that patient is a full mouth rehab case rather than you know, Mr. boat for dahl technique. [Tif]Exactly. But the interesting thing is the technique that I use on the front teeth the way I build the teeth up, and I’ll use that same technique on a full mouth case, but the slight the way I do it, and the way I do it is I build a thought those the anterior is up again and there are soft temporize, the back teeth to stop those teeth from moving and then through the process. We then have these buildups on the anterior soft temporaries on the back teeth to stop the moving and then I effectively wait for the jaw to deprogram and I’ll go through my whole usual full mouth process from that point. So you can use the same bonding technique, but the key point, as you rightly said is if you’ve got wear on the back teeth, you don’t want those teeth to move. You need to hold those in them in position [Jaz]Because you want the space so you don’t have to hack them down anymore. And that’s exactly but then interesting point you raised there is when you don’t want the posteriors to sort of move in those cases where you’re doing more of a full mouth rehabilitation in those cases, I think is good because the whole principle of full mouth rehab is you want to establish the anterior guidance first. Anyway, you are doing that anyway by doing your doll you’re establishing anterior guidance and with the dahl i think is a great exercise for learning occlusion because you’re then adjusting. You’re using your articulating papers, you’re getting the you’re creating the correct smoothly anterior guidance is a great way to directly learn occlusion I suppose, the principles of anterior guidance because dahl, the basis of dahl is on that. Would you agree with that? [Tif]Absolutely. Right. And that’s the thing because you’re actually using on patients at an early stage who aren’t you know, these aren’t big TMD patients, these aren’t patient is smashed all that back teeth part. And this is kind of me, one of the questions that we were sort of thinking about here was, you know, why do people not appreciate it and one of the biggest problems is a lot I think a lot of people use dahl on the wrong patients when it’s too late. And dahl is really for patients that you’ve had a relationship with you they understand what’s going on, and to actually say to imagine to brand new patient who’s got a bit of wear on the lower anterior teeth, imagine trying to say to them, right, I need to build your anterior teeth out to improve your anterior guidance and disclude your posterior blah, blah, blah. Jaz’s Outro: So thanks so much for listening to part one. Stay tuned for part two, which be coming out soon. Have a little break for me for a while. I mean, isn’t Tif Qureshi is just a pleasure to listen to. He’s just full of so much knowledge and information. So thanks so much as always Tif. Look forward to part two. And once again, thank you so much for listening all the way to the end. And please, just like I said, last time, check out occlusion2020.com, which is the occlusion course by Dr. Michael milkers, which I’m proudly sponsoring. Tickets are flying for that which is so great to see. And like I said before, I’m determined to make this the best to date seminar program on anything let alone occlusion in Europe for 2020. So please come and join us for occlusion and lamb chops.

Not only did I finally get Michael Melkers to finally come on my Podcast….I also managed to get him over in November 2020 for his signature 2 day occlusion program! The event was rearranged from May 2020 to November 2020 due to Covid-19 – therefore new tickets will be added. Check out Occlusion2020.com for tickets. I present my first ever Video Podcast below – but as always, the audio version is available by direct download above, or from iTunes, Apple Podcasts, Google Podcasts, Spotify etc. Need to Read it? Check out the Full Episode Transcript below! This episode’s Protrusive Dental Pearl is shared by one of the talented Dental Technicians I use, Hit Parmar – how can we give our patients the experience of what a splint might feel like, as if to test tolerance and compliance? “How will I know I will not gag or be able to wear one in my sleep?” – a common and valid concern. Listen to the audio podcast to find out how you can manage this and test the waters! (within the first few minutes of the introduction to the episode) In this fun and informative episode, we discuss: – What is the point of using a Facebow and Articulator? (you may be surprised by his answer..!) – Are we really designing Occlusal schemes for optimum function (spoiler – we’re not!) – Why is our understanding of Occlusion…’sub-optimal’ once graduating? – Which is the best Occlusion camp? Dawson? Pankey? Kois? LVI? – Which is the ‘best splint’? – We discuss his upcoming 2-day Occlusion in Everyday Practice program in Heathrow 27th and 28th November 2020 Do join us in November for occlusion and lamb chops at Occlusion2020.com You will never find a better value Occlusion or even Michael Melkers course ever again! https://www.youtube.com/watch?v=UpQQg9daDak Click below for full episode transcript: Opening Snippet: Hello everyone, and welcome to Episode 15 of the Protrusive Dental podcast... Jaz’s Introduction: You can almost hear the excitement in my voice right now. I have none other than the Dr. Michael freaking Melkers on the podcast. And the reason I’m so excited is because as you know a lot of you know, I saw Dr. Michael Melkers in Stockholm last year in his two day course, absolutely just inspired me so much was a massive, massive part of my occlusal journey if you like. So I’m so excited to have him on the podcast. And for some of you who might have seen my Facebook exploded about a week ago. So for those of you who haven’t been my Facebook page is facebook.com/protrusive. And on there, you can check out the video version of this podcast. So you can see me and Michael, Michael Melkers were sort of, you know, our faces, interchanging and it’s the first ever video podcast I did. And it went well. Thankfully, a few little minor glitches, which I mentioned are sorted out in terms of streaming and stuff. But overall, if you prefer to watch rather listen, then you have the option for this podcast episode to sort of watch that. So yeah, that’s on the Protrusive Facebook page. And if you want to listen to it, that’s totally cool. That’s why I’m recording this. But you do get an added benefit of you know, I’m putting in the Protrusive Dental pearl for today and a few other extra bits. So let’s just dive right into that. My Protrusive Dental pearl for you today is related to occlusion and splints. And I learned this from Hit Parmar who is a dental technician at Fine Art dental studio, which is in Birmingham. And I met him at Kushal Gadhia, Rahul Shah and Victor Gehani sort of Ace course, that’s acecourse.uk.co I believe. We were discussing about splints and splints compliance, because we all know we all have those patients where the compliance with splinters is not so good. They feel it’s too bulky, not comfortable. And I had one sweet old lady asked me look Jaz, we’re recommending this, you know, 400, 500 pounds splint And what if I don’t get along with it? You know what, that’s completely reasonable. You know, you make a purchase, and you just don’t know whether it’ll be therapeutic for you, or it will feel comfortable. And if it’s not comfortable you’re not gonna wear it. So I completely understand the concern my patients have, but I’m sure you guys do as well. So how can we give our patients an experience of wearing a splint without actually you know, them forking out for the splint itself. And I’ve seen a device a couple of ways using notes, the blanks for like the FOS appliance and stuff like that. But anyway, the one that is more accessible to everyone in GDP land is the following, which is what Hit Palmer taught me, which is, you take a silicon impression, a putty silicon impression and you can use like a non-perforated tray for this. So if you’re trying to, let’s say simulate a Michigan splint, you take a full arch putty impression. And then you remove the putty index from the metal or plastic tray. And now you stick that putty back in. And you say “This is your splint, this is going to sort of recreate how bulky it might be.” And it’s important to actually get it looking similar. You can actually trim it and stuff to make it give the patient a splint experience. So I think that’s a really clever way to allow our patients to experience what a splint may feel like, which is really clever. So that’s my pearl for today. And hat tip to Hit Palmer for that one. And as you all know, I do like my splints, there was Episode 11 we’re talking about coloring them in with a sharpie marker to sort of see the parafunctional pattern and where that patients produce. So yeah, splints love them. Because splints can be protective appliance. And you know, you’ll listen in this podcast I think Michael Melkers and I’m not just saying this his three minute summary of splint. If you want to go straight to that you can go on my Facebook and I just soon as you cut that bit out, actually, that little summary of splints that he does on this podcast is such a bloody easy way to learn splints, it really simplifies things, which really are over complicated for no reason and you’ll see that. So before I dive right into the episode, I need to tell you about a visit that Dr. Michael Melkers is paying us in May 2020. And believe it or not, you know my podcast is you know, it’s been incredibly fun to do this and I’m privileged and honored to be the sponsor of occlusion 2020. So occlusion 2020 is going to be the occlusion event for Europe in 2020. And I want to make this I want to help make this literally the best most accessible occlusion sort of two day seminar program ever, literally. And I’m so excited. You can see from my social media, I’m pouring my heart and soul into this I really want people to to learn from Dr. Michael Melkers because he gave me so much in my practice, and it’s not just occlusion, he teaches his case planning, bigger cases, case acceptance and communication. So, occlusion 2020 Please save the date in your diary. It will be Friday, 29th of May and Saturday, the 30th of May, it will be in Sheraton Skyline Hotel in Heathrow. And please go to the website occlusion2020.com and check it out, you know, I don’t like to waste money and stuff like that. But really, it is important you hear this bit now, when I hope Dr. Michael Melkers doesn’t mind me saying this bit, but basically, I paid 1500 pounds for his two day course in Stockholm, okay, and because the motive of this course is to make it accessible to everyone of all stages. The price, especially if you before 2nd of January is 695 pounds for the entire two days. That’s not per day, that’s the entire two days. So you know, I’m hoping that way, it’s gonna be accessible to DF1. And all dentists who I appreciate how expensive courses can be. And especially if you look at the occlusion courses, you know, just do your research there. You know, 1000, 2000, 3000 I’ve done [ ? ] online program paid like 3000 US dollars for that. So this course is going to be amazing. I’m promoting it as occlusion and lamb chops, because obviously, it’s mother’s restaurant in the hotel. So please come and join us I’ll be there. I’ll be really trying our best to make it really engaging and fun event. And you’ll hear about it in this podcast episode because right at the end, we discussed the upcoming course. But he’ll take you on a journey from literally a single tooth from a dot to dots and lines to planning more complex rehabs, what to do in patients are in different classifications. Not everyone comes in and class one, obviously. And it is just going to be an amazing experience, which I really enjoyed in Stockholm last year. So please come along. Show you support occlusion2020.com buy before second of January, it’s 695. Thereafter, I’ll be honest with you guys, there is going to be a second sort of early bird promotion, but it will the price will go up that’s that’s a certain you know, it won’t go all the way up to the sort of 895 that you see on there. So please come along, and I’d love to have you there. So let’s dive right into the episode Main Interview: [Jaz]Mike, thank you so much for coming on the Protrusive Dental podcast, this is a really cool new thing that we’re trying, it was your idea. And I was like, This is amazing. Let’s give it a go. So for the first time, we are sort of recording together. So thank you so much for.. [Michael]I’m excited to be here. [Jaz]No thanks so much. And one thing that if my wife ever looks through my phone, and looks throughout our chats, and sees us talking about webcams and how excited I am, then I’m actually glad that it’s gonna be released, so she can see. She can see what was about so yeah, Mike, thank you so much. I knew about you because your presence on ripe is amazing. That’s how I think I learned about you. And then when I saw that you were doing a program in Stockholm, I jumped at the chance to, and that was such a key learning experience for me in my journey with occlusion with something I’m very passionate about. So I want to talk about Stockholm and I just want to help them my listeners to learn about a few key concepts about occlusion. So that’s what we’ll talk about. So Stockholm. Wow, two days intense of Stockholm with you. That was amazing. [Michael]That was a really, really good time. You know, Johan Hagman is always such a great host. And we had people from, I think eight or nine different countries. It wasn’t a program. It was a study club, it was a get together, it was a gathering of friends. And it was great to have you there as well. [Jaz]Thanks so much. And well, what I liked is that Pasquale was there as well. And Najiya was there and you presented the prize to her, which I thought was very nice touch. That was very, very sweet, actually. So that was Yeah, you’re right. It was it was more than just a program that was something special. So I just want to dive right in in terms of learning points. So one of the things that, you know, I came away with a better understanding of is face bows and articulators. That’s what you know, as a out of dental school, I really had very little idea. I mean, yes, we’ve got shown how to use one. But really to apply it, it didn’t make sense to me. So if I’m sure it’s a question you get asked all the time. So for our listeners, what’s the point of a face bow? And articulators really all that? Are they, when are they needed? When do you need to use this? [Michael]Well, it’s just a tool. It’s like anything else we use in dentistry? It’s like when do you need to use for Carver? When do you need to use a mirror? We can talk about all the specific applications, but anything in occlusion or anything in our dental instrumentarium is to help us accomplish a goal and it should be to help us achieve that goal more efficiently. So we want predictability and practicality out of any thing. So before I answer about face bows, I’ll tell you I use triple trays all the time and I know that shocks people, I teach occlusion all over the world. I’ve been editor of the equilibration society, but it’s not about being a better dentist by using a Face bow. A Face bow helps relate it with somewhat accuracy, the hinge axis to the maxillary cast. Why is that important? Because it can help us have relative accuracy for opening and closing motion on an articulator and relative accuracy for motion on an articulator. But whether we’re using an articulator or whether we’re using a triple tray, what we really want to balance is, how much time does it take to use the instrumentation that is the face bow, the articulator, the protrusive record, versus how much time does it take to just take a triple tray impression? But then you have to balance either of those with the adjustments that are needed in the mouth. Because if you’re just doing a single simple crown, and you take all the time to take a face bow, you take all the time to take upper and lower full impressions, and you take the time to take a protrusive record, is that really saving you anything? When you have a single crown, you have confirmative occlusion that matches the adjacent cusp slopes. So for me, both of them have a place in my practice. [Jaz]Absolutely. Very, there’ll be some listeners out there who don’t know what a triple tray is. Essentially, it’s you know, I use them as well. And it’s basically a three in one hence why it’s called triple tray, it will get the upper impression, the lower impression and the bite together. And a lot of dentists as you know, Mike and it’s great that you know, we’re talking about this, a lot of dentists are against triple trays because they think it’s like it’s so it deviates so far away from the traditional teachings of, you know, articulator face bow just like you were saying, and to be fair, I completely agree with you, I think, in a bit, you know, in a canine guided dentition, where there’s already so much disclusion, and they’re just conforming, and it’s just a single crown. I think, you know, that’s probably what laboratories are receiving the most of nowadays. [Michael]There is. In the United States, it’s above 95%. You know, it gets into like, religious cults thing about always use this or always use that. And when you’re saying always, you’re pretty much never right. It is what we need to get the job done. Let’s just stop why we need occlusion. We need occlusion, so we can walk into the operatory, with confidence that we’ll be able to do our job well. We need occlusion so that we can walk out of our operatory knowing what we did is going to last and then we did it efficiently. And the other thing that occlusion builds isn’t teeth, it builds your reputation. Because if you’re fumbling and stumbling around and things are taking a long time, and things are taking a lot adjustments, patients can lose their faith in you. Now, if those restorations that you made, regardless of what how you made them, or what materials, if they break, then patients can really lose their trust in you. And your reputation can be damaged. So when we, when I think about occlusion And now I’d like to jump into all the face bows and all the other discussions of articulators. Honestly, no one needs occlusion, we what occlusion offers is the component that fits in between all the other components, we have communication, what is the patient want? We have treatment planning, How can we get there? And occlusion is really what makes it fit. Because if you look at treatment planning 101 is how do you want something to look, how do you make it fit. Occlusion is what gets us there and helps things last, regardless of whether you use a triple tray, regardless of whether you use a face bow or an articulator, it’s all just about dots and lines. It’s all about distribution of load and reduction of forces and shear that help our restorations last longer. [Jaz]I definitely took that away from your program. And also you mentioned about communication with patients. And that was an element of surprise for when I came on your program to actually you covered so many gems about communication, which I took away with me. So when the patient says something like sensitivity, and then they’re very brief about it, I do your technique, I sit down and I say, tell me about sensitivity. Or tell me about this. And a few other gems that you gave away that day, just a few ways to make patients feel comfortable and to be a good listener and a good history taker was also really key. But the other thing that you talked about is why when we come out of dental school, why is it that occlusion is perhaps very poorly taught or our understanding of occlusion coming out of dental school is not as good as it could be? [Michael]Good question. And it’s a hard one to face. Because, you know, I lecture in schools I’ve taught in residency programs, and I’ve of course I’ve been a dental student. The reason that occlusion can be taught, occlusion is not appreciated in dental school education. And the reason is, is we’re missing one key element in our education and that’s failure. Is occlusion, as I said, is a solution to help us meet a goal. And that goal is longevity. And that goal is success, because we don’t want things to break. We start in school, and we start seeing patients maybe the end of second year, in some schools the end of third year. And all you have to really do is make it through one patient each half day for the next 18 months. And you will have restorative and geographic success, because you will be out of there and we won’t see our things failing. But when I was in dental school, and we had paper charts, I mean, some of these paper charts were this thick. And if you look back, and there was failure after failure after failure, and you know why these patients were in these schools and in these programs? So long is because what we were doing was not necessarily working as far as longevity. The only thing we remember from occlusion in dental school is probably like you said canine guidance. Why? Because it was the answer on an exam, canine guidance as far as us providing any restorative care in dental school. All it was was a tick mark and a checkmark on the criteria we needed to pass that restoration or pass that written exam. It didn’t really benefit us when we were in dental school, because we never saw the better of it. Because like I said, we never saw the failure. So the reason we can’t learn or rather appreciate occlusion in dental school, is because we don’t see things fail. When we get out of dental school. And we start getting into bigger cases or anterior cases. And we start getting into all porcelain restorations. That’s when we see things fail. And that’s when people are drawn to occlusion as a need, rather than a requirement that they had to take in school. [Jaz]And I remember I want the DVD when I was in Stockholm, because I got to write that. Yes, it was failure that because you asked that question, what’s the one thing we don’t, you know, experience? So that was awesome. So next thing I know, I’m sure you get this asked all the time. And something I get asked as well, because I’ve been to a few lectures on the different schools of thought they know I’m going here now is someone says to you, okay, I’m a recent graduate. Should I do Dawson? Should I do Pankey? Should I do Kois? Should I do Spear? Should I go neuromuscular LVI? What do I do, Mike, you know, so what would your answer be to a dentist who wants to sort of delve deeper into occlusion? And there’s a lot of the sort of pathways out there. And obviously, you’re very seasoned in a lot of these schools of thought as well. Do they really differ that much? Is one really better than the other? And what’s your recommendation? [Michael]To take my class, I’ll say, this may be your first occlusion lecture. This may be your next but just don’t let it be your last. I’ve studied with every single one of those programs that you’ve taught that you’re that you mentioned, and I learned something from all of them. I think if I could give a piece of advice is don’t religiously get pigeonholed into campy arguments between teaching institutes, because all of them have something strong to offer. And all of them have their weaknesses. I’ve been a visiting faculty at Spear Education with Frank, Dr. Frank Spear. I’m currently visiting faculty at Pankey. I’ve taught at Pac-live back in the day when I was in California, and I have and currently have my own occlusion education programs. That being said, I still go out to other teaching institutes, I still attend lectures by other people. I bring all that up to help avoid some occlusion wars, because you’ve seen that on any of the discussion threads, there will be people that are from polar opposite camps that can get along. And then there are people that are from two different teaching institutes that have incredible similarities in philosophy, but they battle like cats and dogs. And that’s the thing that’s probably the most unhealthy in our profession, it’s unprofessional, disagreement, and lack of respect for other people with opposing viewpoints. So if you ask me, and people ask me this all the time, which Institute should I start off with? I asked them what they’re looking for, because all of the institute’s are excellent, but they all have a slightly different approach. So it would depend on what that person asked me and where I would recommend that they go. [Jaz]Cool. Thanks so much. The other thing, which I always think about is something that you taught me, which is aesthetics, function, structural biology, okay? But you may raise a really good point that actually when were designing occlusions, who is something that I put my own thought into this as well, that when we look at natural dentition, we rarely see the perfect occlusion, ie the textbook type occlusion, right? And then when we’re designing, or rehabilitating these you know, worn and destroyed occlusions. And we’re rebuilding them and we rehabilitate them into this perfect textbook occlusion. And are we doing that? Because where we’re trying to restore that function? But no, you told me that actually, it’s aesthetics, parafunction, structure, biology. So for our listeners, can you just explain that theory? Because that was a real lightbulb moment for me. [Michael]Well, thank you. I’m glad that was helpful. And that’s the lesson I passed along. So aesthetics, function, structure, biology, was actually a breakthrough viewpoints that were shared with me by one of my good mentors, Dr. Frank Spear, is looking at that aesthetics, how do you want it to look? Function, how do you want to make it fit? Structure, what needs to support that? And biolog, what is any of the disease processes that we need to address? The way that I’ve done a little play on words or switch? What Frank or Dr. Spear has taught me is I say, that terrifies me because I don’t believe that teeth were much from chewing and I know other practitioners do and other lectures doing that’s fine. What I care about is longevity, that’s the same thing they care about. The ideology of break down for me, is structural. So when do things break down? When teeth come together, we can argue about whether they come together when people chew, or when they grind their teeth. Based on my experience of 25 years, and based on the research that I’ve done in grinding patterns, I think that parafunction is the highest threat that we really need to mitigate. Now I was laughing a little bit while you’re talking because you said two things you said perfect, an ideal and textbook. And the only thing about textbook is taking an exam and a like we laughed about it based on dead white guys in Scotland, because that’s where all the anatomical studies were done at the University of Edinburgh, through grave robbing, and some darker arts of obtaining bodies. But if you go with a cookie cutter approach, you’re only going to succeed when you’re making cookies. And that is everything that we’re taught about occlusion and occlusal design and parafunctional control is really based on a class one occlusion, canine rise transition a crossover. So what I like to share in my programs is well I’ll go over that, and I’ll go over the class one is I really want my participants and my attendees to understand the why. Because if you only know the how, when the “How does it come along and fit that cookie cutter?”, you’re screwed, excuse my language, but you are and we don’t need a cookie cutter we need a bakery. Because sometimes things come in and class 3 some things they’ll come in class three edge to edge or past edge to edge or they’ll come in class two div one where you can’t start or you will even struggle to achieve any kind of anterior guidance certainly on the Centrals and it may even take a while to get to the canines. So I think we need is a better understanding of how we can adjust and adapt regardless of the occlusal scheme. So for me an ideal occlusion if there is one would be one that can distribute forces as best as they can and reduce resistance as best as they can with the goal for both of those to be longevity in the restorations. [Jaz]Amazing and the take home point for me it was only designing the occlusion actually we’re not designing them to chew and function. We’re designing them to resist their parafunction. And that was just a beautiful, simple way to really change the way I thought about it. So that was great. One last thing to talk about before we talk about your upcoming program is can you hear these fireworks? [Michael]Late Diwali? [Jaz]Actually, it’s a birth it marks the sort of the birth of Guru Nanak Dev Ji, which was the first the founder of the Sikh religion. And I live in the equivalent of Little India. So that’s what that was. But anyway, so one thing I speak about before we talk about your upcoming program is splint therapy. My gosh, people are so confused about splints. It’s one of the most controversial topics it gets a lot of questions when anytime anyone posts on social media about splints, and there are Like all parts of dentistry in occlusion as well, there are very polarizing news. And we can go into the whole anterior midpoints stop appliances and those who are really against it and whatnot. But one thing I want to kind of just talk to you about is that or tell you is that your DAASA, so dual arch anterior midpoint stop appliance protocols that you showed, where it was amazing, and the way the cases that you showed and the application of confirming centric relation prior to rehabilitation, and he talked about the different indications, that was great. And I’ve been using that in a lot of my patients, and it’s been a real game changer for me. [Michael]Glad you’ve had success with that. [Jaz]I’m using that all the time in practice, you know, in the right indications, and we’re seeing great success with it. So can you tell us just you know, briefly to anyone who’s not familiar with these sort of appliances, is why you think they have a place in practice? Is that too broad? [Michael]No, but I would actually probably even want to make it broader is why would you use any appliance to begin with? And that’s where I always want to start, I always want to start with the why, we get into arguments, as you say, and we get into disagreements, because people have their what and their how, and they want everybody to do their same how, like you have to do my how, you have to use my how, my appliances, when my mind this, this this. But in some ways those discussions were missing the why. So why do we use orthotics? Why do we use occlusal splints? Why do we use bite guards and night guard whatever you want to call them. There are just a few very simple reasons why we use them. We use them to get people out of pain, we get used them to help protect things, and we use them to help figure things out. Palliative, protective diagnostic. So if someone is hurting, and they could be hurting in their teeth, they could be hurting their muscle or they can be hurting in their joint, they need a palliative splint. I don’t care what design it is. If someone is breaking their teeth or breaking their restorations, and they want to keep those restorations intact, then they need a protective split. Now if we need to figure something out, whether it’s in other camps that want to figure out chewing patterns, or my approach, if we want to figure out parafunctional patterns, or if it is important for a joint position, then it is a diagnostic approach. And you can use full arch appliances for all of those applications. And you can use anterior midpoint stops for all of those applications. It goes back to the exact same thing that we were talking about at the beginning of this chat is we have a lot of tools, but we have to have goals and then we have to balance efficiency with them. The reason that I personally like anterior midpoint stop appliances or as you you said the the Daasa splint that I shared with you the dual arch anterior scribe or stop appliance is that when we only hit plastic to plastic in the front, there are no teeth touching. So if you want to protect teeth, and you have no teeth touching, the teeth get protected. Now if we have pain or we have muscle pain, and we want to knock that muscle pain down, when we only hit at the midline, the temporalis and masseter are knocked down by 70% to 30% muscle activity, less muscle activity can mean less muscle pain. Now in the third occasion, if you’re looking to get the joint to seat and the joint is not seated, and you only have a mid point stop appliance then once those muscles are have their activity knocked down and there’s no plastic in the back and in the way for the condyle to seat and the condyle could seat. When I look at an anterior midpoint stop appliance or the Daasa appliance, I look at it as efficient. Now of course, after that everybody’s gonna scream anterior open bite, anterior open bite, Well, you know what, if you’re condyles seats, you’re gonna you have the potential to get an anterior open bite. So if you, we, our profession was using CR appliances all these years, where all the anterior open bites? So there are ways to prevent anterior open bites. If you want the condyle to seat and you have a severe wear case that can be a good thing. But say you just want to protect the teeth or say you just want to have palliative care of the muscles. There are adjunctive appliances that we can use to help maintain MID or maximum intercuspation position. And that appliances in the States at least is called an AM aligner and it doesn’t come from CR dentistry. It actually comes from sleep apnea, or sleep medicine. So in sleep medicine when we were repositioning are repositioning mandibles forward so we can keep an airway open so people don’t die. What we were able to figure out or what they were able to figure out is, before we started the anterior repositioning splint, what we did was we took a wafer bite in MIP. And then they wear their nighttime appliance, then when they take their nighttime appliance out, they put that wafer in, they could re learn, or they could maintain MIP, so that they didn’t develop posterior open bites. We can use that same approach to help avoid anterior open bites when we’re only doing a protective or palliative approach and don’t want any occlusal changes. I know, I just, I know, I just went on blathering for a few minutes, but you obviously hit on one of my passionate points. [Jaz]Mike, in the last three minutes, I don’t even know how long you spoke for you’ve literally done such a fantastic summary of splints. So that’s amazing. Thank you. And for anyone in the UK listening, I have found a supplier for AM aligners so we can discuss that and share that as well. So yes, I know that’s a very unique part of your program that I learned about these AM aligners and the DAASAs which have been a great staple appliance. So thank you so much for that. So I think that’s all we’ve got time for today. Otherwise, you could be speaking forever about this. [Michael]I have to tell you, Jaz. This has been a really, really lovely chat. I’ve had fun with just chatting with you, talking with you and discussing, bringing up thoughts but I love the format as well. [Jaz]Thanks so much. And obviously we want to talk about your upcoming event now. So occlusion in 2020, 29th and 30th of May. Okay, you’ll be coming to Heathrow, London to the Sheraton skyline hotel. What is your programme about? [Michael]Heathrow occlusion 2020, occlusion in everyday practice the 29th and 30th. What I’m going to do in what I’m going to aim to do is take the attendees on a journey from one tooth dentistry all the way up to full mouth rehabilitation. I want to bring blend theory and practicality. And if you’ve heard one consistent theme in our discussion, it’s understanding the why and not regurgitating the how or the what. I want people to understand not just how to do something, but why they’re doing it. Because when you understand the why you can flex from one tooth dentistry to two tooth dentistry, to arches to quadrants to full mouth. So if you’re practitioner that’s doing single dentistry and kind of nervous about jumping up to two tooth or three tooth, or quadrant dentistry, we’re gonna have something for you. If you’re already doing that quadrant dentistry and you aspire to do you know arch, even full mouth, we’re gonna have something for you too. And then based on my past experience of doing this program for a couple of decades, all over the world, having new practitioners and advanced practitioners and specialists, we’re gonna have something for you to take home as well, because it is a better dentist the day after this program in some way, shape, or form. I know we’re going to have a great time, we’re going to be going over lots of cases. The blend in the theory with reality and how it happens in everyday private practice. [Jaz]And there’s a restaurant at that hotel. It’s called Madhu’s. [Michael]Oh, this is the important part. [Jaz]I knew you’d like this. Okay, so it’s called Madhu’s and it has the best, most tender, most succulent lamb chops you’ve ever had. [Michael]Well, now, none there. I’m signing up. [Jaz]Great, Michael, thank you so much. And it’s really always a pleasure talking about occlusion with you. And we look forward to you in London in May 2020. [Michael]We’ll see you there. Thanks for inviting me. Jaz’s Outro: So there we have it. I mean, he’s Michael Melkers is so generous with his knowledge always. So I hope you like that. Hope you enjoyed it as much as I enjoyed the recording that episode. Come and join us at occlusion 2020 in May. If you want more information, it’s occlusion2020.com, you can join the Facebook event page as well, see who else is going. It’s been a great response so far. So thanks so much for those who have supported me. And so the next episode will be Tif Qureshi, all about Dahl. Oh my gosh, a great, great piece of knowledge that he shares with us and it’s going to be a two part episode because it was just so much good stuff that it’ll be sort of harsh to cram into all into one episode. So be a two part episode, we’ll talk about communication and to fair in that episode, I do go in a little bit sort of deep into the occlusion sort of stuff. So if you’re still like a newbie into that and you don’t understand about deprogramming and these types of splints that you would use for dahl or or even how the dahl printer works because we sort of dive right into the sort of the fleshy you know topics the nuances of dahl them. They’re very, very basic. So I do apologize is a little bit heavy, but it’s for the for the purists for the geeks out there to listen to, if you’re not familiar with any of that sort of deprograms themselves more reason to come on the course obviously, which it will be in May. But yeah, Tif Qureshi,next episode. I’ll see you there. Thanks so much, guys.

I am joined again by one of the most passionate people I know, Dhru Shah! He also helped me with Episode 3 – Transitioning to Private Dentistry which is one of the most listened to episodes on my podcast. What drives you? How you can be more engaged as a Dentist? What are your values and how it is relevant to your career? Where and how you can develop passion for Dentistry – the best thing is that it answers a burning question I get asked a lot – ‘Jaz you’ve done a lot of courses, which one should I do next?’ – Dhru talks about a system where you need your day list and a highlighter to figure that out yourself How can we get more Dentists in a state of Flow As promised in the podcast, do check out Scott Jeffrey’s Value Discovery System and be sure to get your family and staff involved! For the video teaser of the podcast: Click below for full episode transcript: Episode Teaser: If your mind has been conditioned by external sources where people have put fear, fear of litigation, the word GDC, all these things into your brain, that challenge, that anxiety becomes worse. [Jaz] What drives you? How can you be more engaged as a dentist? What are your values and how is it relevant to your career? As you know, by the theme of the things I’m saying, I am joined today by one of the most passionate people I know. He did episode three for me, which was transitioning to private dentistry. And it was a fantastic episode, very well received. Probably one of the most listened to episodes I have. And I think it’s such a great thing for young dentists to listen to. So, we had grew back. Now we’re talking about your values as a dentist and what motivates you and motivation in general. This isn’t just for those people in a dark place. In our profession, there’s so much negativity around us. For sure, these people will benefit. But if you’re already passionate, you just have those final missing pieces in the puzzle, then this, I hope, will solve that for you. Because one of the things that we discussed is the importance of your values and how you can go through a values discovery process. And I’ll share with you how me and Dhru, which we didn’t even know he did it that way. And I did it a certain way and it turns out we did it the same way. So independently, we use the same tool, if you like, which is part of my Protrusive Dental Pearl, which I’ll come on to in a moment. What me and Dhru cover here is how can you develop and sustain your passion for your profession, which is dentistry? And another great thing that came out of this recording with Dhru is that it answers a burning question that I get asked a lot. Which is, Jaz, you’ve been on a lot of courses, I’ve seen your photos, which course should I do next? And just using a highlighter and your day list, Dhru will discuss a system for you to use, so that you can answer that question in a bespoke way for you, in a customised way, so that it benefits you as a clinician, as a dentist, the most. One of the themes here is also, how can we get more dentists in a state of flow? And we discussed what that, what we mean by flow as well. I’d stick around until the end of the podcast because it sort of ends with my own values. I share with you my own values after going through the values discovery process, I’ll share with you. And then my wife actually calls me to tell me that our baby’s crying and I had to sort of attend to that. So we sort of ended this podcast abruptly in a way. I mean, we didn’t really come to a conclusion because of that reason. But to fast it’s, it’s actually good the way it worked out. Protrusive Dental Pearl Otherwise, we could have spoken for hours, and no one wants that. Okay, so the Protrusive Dental Pearl for today is to do a values discovery process. This is important not just for you as a dentist, as a professional. But this is important for your life. If you’re not in tune with your values, how do you know that you’re living your life to its best potential? How do you know that the decisions you make in life are congruent with your values? So, I learned that a while ago and I sort of went on a mission to really learn more about myself discovery. So I came across a chap called Scott Jeffries and I found his seven step method for values discovery. And I found out through a podcast that actually Dhru also spoke about Scott Jeffries. And I was like, oh my god. So we have that in common as well amongst all things. So I put a link on my website page, which is www.jaz.dental on this episode 14 sort of page, and you can download the PDF or Scott Jeffrey’s values discovery process. Do it. In fact, one thing I did as I did, I’ve done a few days at my clinics. I work out for team meetings and huddles. I’ve actually given it to all the staff. I’ve tried to persuade the staff to learn their own values. And it’s a great little exercise to do with your team, actually. So I would highly recommend that. Thanks again for joining me. Your previous episode, Transition to Private, which was the third episode in the podcast, was actually one of the most successful episodes we’ve had, so I’m really, really pleased to have you back on, on the podcast, so thanks so much for joining me again. [Dhru] Thank you very much, actually, for inviting me again. I think you’re, we were the third people to do it, but your podcast has really captured the minds and hearts of listeners. [Jaz] That’s partly down to you, Dhru, honestly, so your episode really helped to boost it because that was a very big topic and I still get people on Instagram messaging me and they came onto my page after listening to that, that episode with you because they were interested in career progression, if you like in dentistry. And so the reason why you’re here today though, is we want to speak about motivation. We want to speak about morale in dentistry. What else do you want to speak about in this episode? [Dhru] I think that’s a big key for me actually motivation and understanding is what I want to talk about because from that. Let’s look at this way that what we want to talk about is to answer the common questions people ask which is either through I’ve lost motivation in dentistry. What are the career can I choose? Or they’ll go to you, Jaz. What courses can I select? I don’t know what course to go on. I’m thinking of going on a year MSc program, which people have done. [Jaz] I literally had that, like, yesterday. A message from a young lady. And, yeah, I mean, I get that to a small scale. And I know for a fact that you get that to, in your team at Tubules, get that to a monumental scale. Because you don’t, I know for a fact that you get messages along that vein about what should I do for my next step? People are confused. In terms of career progression, but I know that you get quite, dare I say, dark messages, revealing a lot of, sort of [Dhru] I think we, people are very trusting, I guess. [Jaz] Yeah, people trust, and, absolutely. That you obviously create a very trusting persona as tubules. So people can trust you with sensitive information. So the sensitive information that you have and you kept and you keep secret continually is good, but a very special insight. [Dhru] Which is a very, I mean, that’s where I kind of put it too, because what happened is, I mean, the talk on failure and fear that I did last year got thousands, 10, 15, 000 views across the web. But more importantly, what that made me think. We’ll say there’s a certain cohort of people coming to Tubules, and some people, so one group of people used to say that, the 250 per year subscription fee is very low, Dhru, you should bump it up, 500, 700. And another group of people saying, why are you eight times more expensive? Now, that means they were probably valuing it at 30 or whatever it is. It’s the same product, it’s the same price, it’s the same website, it’s the same education community, it’s the same study clubs. But there were two groups of people. One group who were finding this extremely cheap and one group who were thinking it’s very expensive. Now, this really set me off on a different pathway to understand the entire behavioral aspects of people, understand neuroscience, understand the psychology of passion at work. All these things. Now I’ve been reading about this and that’s why I sort of told you, let’s do this podcast, as a podcast. [Jaz] I know, I know, and we all know as Tubules directors that you’ve been on a mission in the last, I’d say eight months, nine months? You’ve always on the mission since the last 10 years. In this specific bit about what we call engagement at work, because essentially that’s a big part of what we’re talking about. How many dentists or how many people are in generally are engaged in their workplace. I know from the Gallup polls and something that you’ve shared at the Congress as well is about 87 percent of people are not engaged at work. Am I right? [Dhru] Yeah. I’m not engaged or actively disengaged at work. They basically, they hate their work or they’re a bit worried about it. [Jaz] This applies to dentistry as well. Let’s assume because we don’t know the exact percentage of the study wasn’t carried out with dentists, but if you assume that- [Dhru] Informal surveys across three or four dental Facebook groups are informal with just, I’m passionate about work. I just do dentistry for a living. I’d quit today. And there was, so there were four tiers and the two bottom tiers, I would quit dentistry today, or I do dentistry just because I do it actually. At least in 50 percent of dentistry was in that category. [Jaz] That’s significant because if you take into consideration the Hawthorne effect, the fact that people can see who’s voted for what option, and we always default to make our social media profile to look more positive than, to portray a positive life, the fact that 50 percent still chose a negative option and they were very honest, that’s saying something. [Dhru] That says it completely. I mean, you’re right. They’re saying something and then you’d move to the, I mean, this sounds a bit down, but you move to the BDJ article where nearly 18 to 20 percent of dentists said mental health challenges. Now, ultimately, this is the challenge. Now, at the other end of the spectrum, there’s you and me, and I’m quite happy to say we’re recording this podcast on a Saturday night And then I think that’s a different passion. You passion is when you do things cause you’d love, love them and you deeply care about these things. And when you love something so much and you deeply care about it, you’re willing to put that time, energy, effort, whether it’s a Saturday night or a Sunday morning or whatever. And invariably that motivation is coming intrinsically, not extrinsically. There’s a difference. An extrinsic motivation is something like, I want a big house. I want a big car. Listen, those are good rewards. Those are very good rewards. I’m not going to deride them. But when you use those as your motivators. Rather than what’s inside you intrinsic, they don’t last for long. And you lose that jet fuel very quickly. And you don’t then stand up at 23, 45 or whatever time I see on my blog at night doing this. You don’t do things like I do where I used to sleep two or three hours a night. I say I used to, cause I’m now at four, but you don’t. [Jaz] Congratulations, Dhru. [Dhru] Thank you. And you’ve mentioned this before. You’ve told me this before where you say you’ve used the specific words. When I’m in the flow, I’m doing a filling, I’m doing something in dentistry. I’m in the flow. You’re in the zone. [Jaz] A hundred percent, Dhru. And this is what we need to talk about as well, that how can we get more dentists to feel like they’re in a state of flow and maybe the name of the person who initially came up with a theory of flow. I once knew it when I did my dental education PG cert. It was like a Mihail something. [Dhru] His name is Chitsin Mihai and he’s done two excellent books. One of them is called flow. The other one’s called creativity and it is an amazing psychology. Something’s a globally known name. And those are two books I read as well. And flow happens when your skill set and your knowledge are equivalent to the challenge you’re facing. So if you think about it, if the challenge you’re facing is extremely high and you don’t have the skill set or knowledge to get that challenge, what you get is frustrated or anxious. However, if your skills are higher than the challenge, so the challenge is easy, you get bored very quickly. [Jaz] So let’s make those examples tangible. So the first one was when the skill set is too difficult. So let’s say you are a dental student, you’re doing your first molar root canal. And you are frustrated as you’re doing it. It’s going to take you five visits, and it’s going to be a stressful event for you, and the time will not go fast. You’ll keep looking at the clock. Okay, the time maybe will go fast, but it’s basically, you’re not in flow. You’re constantly having to think. You’re constantly in a state of stress. Whereas the other one is, you’re always anxious. [Dhru] You’re always anxious. Yeah, anxious. [Jaz] And the other, other extreme is you’re an endodontic specialist and someone’s referred you the most routine, single rooted incisor, sort of a single canal, and maybe you’re sort of just too above this and it’s boring for you. Is that a good example? [Dhru] It can get boring. Absolutely right. And that’s what it is. And then both of those factors basically are where flow is locked. Now, why do I talk about flow? When your skill, let’s look at the first, when you’re faced with a challenge, when you feel your skills and knowledge, don’t face that challenge. You think this is too complex. This is when things set in of anxiety. Will I be able to achieve this? Will I not? And as soon as you start thinking on that. If your mind has been conditioned by external sources where people have put fear, fear of litigation, the word GDC, all these things into your brain, that challenge, that anxiety becomes worse, immediately becomes worse. Does that make sense? [Jaz] Absolutely. It just amplifies all the negative emotions. [Dhru] It’s not a challenge, there are two things to talk about here and John Demartini says it very well, it’s either you take it as a challenge on the way or a challenge in the way. Now, you want it to be a challenge on the way because you’re on the way to something and this challenge, you have to take it as something that will help you grow, okay, that will help you grow so that you eventually get in the flow. Now to be able to do that, to be able to get your skills and knowledge to that level, one, you have to be ready to face those challenges without fear. But as soon as, and the second thing here is your mindset has to change. If you keep listening to the fear stories of social media, if you keep listening to people saying, oh, dentistry has big mental health problems, et cetera, what we were talking about as we started this podcast, it’ll embed into your mind. Don’t focus on those pain points. Focus on the pleasure points. Listen to the people like we have a tubules where people say, I had a challenge, but I’m proud to be a tubules because now I can do this procedure and I can do it confidently because you had number one, you had mentors who could inspire you. Number two, you had people, high level lecturers or whatever you call it, who showed you what’s possible. So you’re now aiming for what’s possible without thinking of those fear factors. Number three, the third thing I say is your support network. The community you surround yourself with is hugely important. And I’ll bring in a factor here of neuroscience. It’s called neuroplasticity, right? And I’m not going to go into deep details about it. But as a very surface thing, your brain, structure, function, and chemicals completely change based on the people you hang around with. And the way your body’s neurons fire completely changes based on the people you hang around with. It’s almost electrical circuits within your body. Now, if you continually hang around those negative fear people what’s going to happen is you’ll keep firing those neurons, which say something goes wrong in a procedure, something becomes a challenge. The neurons you’ll start firing are the fear neurons, but the neurons you want to fire are the neurons that say, it’s okay, this is a phase in my growth, this is a learning cycle. And you have a community around you that not only inspires you, but supports you. Because your brain structure function, this is neurological scientific stuff that tells you, you will function positively. Does that make sense? So now you’re working on those principles, and you will then say, because you say, I can now take this challenge positively, you will now invest the time, the money, the resource. Everything needed to educate yourself. And suddenly I realized the people who consider 250 quid cheap at these people who are ready to invest because they realize they have that network around them and they have the knowledge and the skills at their fingertips. because they can get it through either online tribunals or study clubs or whatever. [Jaz] Absolutely, and the only thing, two things that I can add on to that is, one is something we touched on in the last episode we recorded was that you as a person or even as a dentist are an average of the five people you spend the most time with. I think we touched on that last time and I still very much believe that. And what is fear? I mean, your talk last year at the Congress about fear and failure was amazing, but fear, an interesting definition of fear. I once read about was fear is a gap in knowledge that you have that where you are and where you need to be. There’s a gap in knowledge. So how you can reduce fear is either gaining more knowledge, upskilling yourself, or doing, or being more prepared for that difficult situation. And one way of being more prepared is, asking your mentors. And that’s again, the support network. So everything goes around full circle. It’s not just one thing and it’s independently. Everything is connected in what you’re saying. [Dhru] Yes, absolutely. All this is connected. Now, we will go one step deeper with this. If I tell you, get the right network of people, invest in the right education, these are processes I’m telling you, okay? Processes to say, go and join this study club or go and join this person or talk to this person. That 5 percent of people that surround you and who you become, like I’ve now given you the neuroscience behind it. I’ve given you the brain changes, et cetera. But those are processes. Now, to engage in a process, you will either engage in that process because somebody else told you to. So I might tell you to engage in that process because it will make you a better dentist, or you will engage in that process because it internally comes from you, right? That’s important. Now, I engage in that process because it internally comes from me because I know my values. And this is the second part to do, value determination. Values are what people consider important. Values are things that people will do, not only in private, in public, but values are things people will do when nobody’s watching. So, if I tell you, you’re walking down the road and you see a 10 pound note on the floor. That’s just, I’m just giving an example. Yeah. You might say, actually, I’ve seen that 10 pound, it doesn’t belong to me and your value say, I’ll give it to charity or I’ll give it to the shop next door to tell them this has fallen down. Can you let them know you’re kind of more altruistic while somebody else might say, huh, finders keepers, right? Put the 10 pound value in the pot and put a 10 pound note in their pocket. So the value propositions of that same scenario for two different people are different. So when you go to dentistry, the first thing to find out is, what are your values? What do you stand for? My values are simple. I know them. I like to motivate people. I like to help them because I love seeing the best versions of people. So when I go into practice, I have to motivate my patients. That’s probably why I became a periodontist because it was hard to motivate. Someone needing Composite, but it’s lovely motivating people to look after their health. And it probably dawned on me in the last year after so many years, but what I mean is I now look forward as a clinical periodontist to going to work and thinking, who am I seeing today? Whose life I’m going to uplift? And that uplift is what I, so my value suddenly becomes intrinsic. And because of that intrinsic value, I can now go and drive things forward. My value in tubules is I want to put that passion into people. I want to motivate them. So that’s why I study and spend time learning neuroscience. Why else would I do it? [Jaz] Absolutely. [Dhru] What I’m trying to tell you is internal values make you understand your purpose. Your purpose makes you drive your passion. Once you’ve got that, you will invest the time, the energy to do what is needed. And to do what is needed are the processes we talked about, invest in education, the right community, all that sort of things. [Jaz] This is really deep, Dhru. This is really deep. [Dhru] It’s really deep. [Jaz] I know, this is so true. With values, I mean, what you’re saying is I believe what you’re saying is one of Stephen Covey’s seven habits of highly successful people as well. [Dhru] That is right. [Jaz] Value centered. And something I’m always actually explaining to my wife as well, actually, is that, some people, profession centered. That’s a great example you can use, is that some dentists, their identity, their everything, is that when you say hello to them, when a stranger says hello to them, they say, hi, my name is Jaz. I’m a dentist. And that is your profession centered. So if something was to happen in your profession was to be taken away, that would be the end of your universe. Okay. So, it’s actually far better. It’s far better to be value centered. So I’m totally in agreement with that. [Dhru] And as more importantly, your values will form your identity. And that’s something true when you talk about that, that’s a link there, because when you live with your values. You do, you engage in behaviors, you engage in doing things and hanging out the people with similar values and that becomes your identity. So when you say I’m a dentist, you’re actually reflecting your values that as a dentist, I like to care for people, I like to give people smiles, whatever it is. [Jaz] So how can the listeners go away? To actually discover their values. Now I’ve got one exercise that I’ve done before do like a values discovery exercise. Now, before I come onto that, was there anything you were going to suggest to how the listeners can explore their values? [Dhru] I think one of the best ways to explore your values, I’ve got a list somewhere from a guy called Scott Carson. There are 300 values on there. [Jaz] Is it Scott Jeffrey? [Dhru] Scott Jeffrey. Sorry. [Jaz] Amazing. So that’s exactly what I was going to mention. [Dhru] Yes. [Jaz] Perfect. So I’ll put a link on. So guys, I’ll put a link on Scott Jeffrey’s value discovery exercise is amazing. So I’ve done it’s like seven steps to it. Do it with your dental team. And basically you end up coming up with about five or six values that define you. And you sort of almost make like a mission statement about yourself. And I’ve done this. I’m happy to share my values. Everyone at the end today, maybe Drew, you can as well. I might help people that might give them some ideas on how to do it. [Dhru] My values are very clear and it’s on the, the interview I did, interview with the CEO, which was the opening day of the second congress. Now, more importantly, values also shouldn’t be just about yourself. Like I talked about the three circles that are your values, the values of a bigger system, which is your community, your profession, and then the global value. But moving on and not just Scott Jeffreys, but John Demartini also is a very good book called the Values Factor. But if somebody really wants to know something, here’s a theory because we’re going to go back and help dental listeners So I’m not going to go deep in values with everything, but here’s something to do. Everyone walks into dental practice every day and you see anything between 10 to 50 patients depending on the environment You are in. Each patient walks in has a certain procedure that needs doing. It could be an exam, it could be a composite, it could be perio, it could be root canal, whatever it is, right? And secondly, there’s a certain characteristic of that patient. I think this is what people should do. Each dentist should write, make a list of all the patients they see for a week. Highlight in green the patients they enjoyed seeing. Highlight all the procedures they enjoyed doing. Highlight in amber the procedures that were like blah. They were neither exciting or inspiring. Neither were they boring or demotivating. Highlight in red the procedures that they found were absolutely killing them because they hated them. Now when you get, just when you start then defining the procedures in green, you will see a theme arising from that. The theme arising will center around two things. The first thing will be all the things, procedures they enjoyed doing. They’ll be very similar. The second theme that rise is they will note that the patients who came in were all of a similar type. They could be similar type, meaning they’re very talkative patients. There could be a similar type in that these patients were very smiling. There could be a similar type in that these patients were all very nervous. Now, what you’re beginning to find is procedures and the type of patients you enjoy. Look at the reds. Those are things that are being challenging for you. They’ll be challenging for two reasons. Reason number one, because you absolutely hate them. Reason number two, what we talked about before, because your skills and knowledge haven’t reached that point. Does that make sense? [Jaz] Yeah. There’s a gap in the knowledge. [Dhru] Between that red and green, the things you enjoy are the courses you should build your strengths on. On the red part, forget the things you don’t enjoy, but the red bits where you think, actually I would enjoy this, but my skills and knowledge are short, are the other courses you look at. [Jaz] Do you mean Amber? You said red, but do you mean Amber, right? [Dhru] Red. Red, actually. The red ones are the ones you hated. You hated them because, either you hate them because you don’t like that procedure, or you actually enjoy that procedure, but they were challenging. You highlight them as red because they were challenging because you were, your skills were not up to that level. So you hated something because you didn’t achieve the optimal result you would have loved to achieve. Right. Does that make sense? [Jaz] So you’re suggesting for the green things to go on further courses to improve on your strengths and? For the red parts to go on courses to improve on the weakest element of your system [Dhru] Yeah. So the red part where you know, red parts are two types. The first one is you hate it and you say, forget it. The second one is actually enjoy this, but I just don’t know why I can’t get better. That means you now need skills and knowledge to improve this area. The embers are blah. The embers are basically neither going to demotivate or demotivate you. So I wouldn’t worry about the embers. Look at the two green and red. Look at the two extremes because you will strengthen your strengths with the green and with the red. Where you actually want to improve but have a gap, it’ll strengthen your weaknesses. [Jaz] I think that’s amazing and I think everyone who may be feeling as though they’re disengaged at work and you’re looking to find, to know which courses to do. This is a great way to, to look at your sort of your workflow and the kind of dentistry you’re doing and where you should be heading in the future. Do this exercise, get yourself some green, amber and red highlighters and do it to find out the answers. So that’s a really great way to do it through. [Dhru] Yeah, I think, and I’ve just actually, I’ve recently helped a few dentists go through this process. [Jaz] And how did they find it? [Dhru] It’s very interesting. Absolutely brilliant. I go through a lot of emails, we do a little bit of value determination, a little bit of what they enjoy, daily life, then we go to amber green in practice as well. We do a lot of exercises. One of the most interesting things that comes out of this is dentists who had orthodontic courses. Suddenly realized actually the best part of the dentistry, they love the special care dentistry and they’ve now enrolled in sedation courses because there’s a complete dichotomy there. And people, it goes back to what we said in the first podcast. There are two things you do in life. Only two things motivate you, running away from pain or moving towards pleasure. And a lot of people run away from pain. I hate dentistry. I’m scared. I want to quit. Yes, that’s fine. But elastic, you’ll bounce back. Go towards pleasure. What do you want to move towards? You’ll be more driven to go in that direction than because you know where you’re headed. And what the Red Ember Green System does, it helps you define that. What’s your end goal? And you will head in that direction. And that’s what we want. Now, if you look at passionate people, passionate people share very specific characteristics. Number one, they have goals and values. That’s what we help create. Number two, because they have their goals and values, they know where they’re going and they know their purpose. They will invest time in it for education and invest time in building the right network of people. That’s what we talked about. Now when you start building that, you’re actually motivated and you invest time in knowledge, in increasing your skills, meeting the right people. Suddenly you build an identity around that. That’s the third thing passionate people have. The fourth thing then they end up having is that flow, that emotion. Because they get into flow state, and because they’re doing all this, automatically these people find the right environment, i. e. the right practices. So, it’s a process that people follow too, and you don’t look for the right practice, the right practice will find you. [Jaz] Yeah, very much. [Dhru] And that is why you suddenly realize some of the dentists only end up in this process. And a perfect example for me coming to my head is Harmeet, Harmeet Kuruval, who now runs the tubules rubber dam courses. And I know I big him up fair, a lot of times, but Harmeet was treadmilling in an NHS practice and really frustrated. And he kind of went through this process and he met me and he looked at tubules and he found inspirational cases and he said I can achieve this and start building his goals and now he’s ended up in a practice and has a practicing life where he can achieve and do the best industry he can. Without any sort of barriers and fences around him. [Jaz] That’s amazing. And what a top guy and a great educator as well. So that’s a good success story like many others within a tubules has set up. And I know you’ve helped a lot of dentists in that similar vein. [Dhru] Yeah, but I think it’s using these systems because you do that, you become so motivated. And you drive yourself forward. In fact, this evening, we’ve had another discussion. Somebody was asking about CPD and what platform should I use? And I said, look, it depends what you want to get out of it. If you want compliance, tick box CPD, there’s a million things that can achieve that for you. What CPD should be is your continuing professional development? So you’re investing in your education to help yourself because the more you learn, the more you will learn. That’s the way I look at things. You there? [Jaz] Yeah. Yep. Yep. [Dhru] That’s a lot of food for thought. I can, I feel some neurons are firing in your brain at this point. So yeah, that’s what I think is important for people to identify their passion and then go on the right courses for that. And if they do that, I think they will suddenly find everything else starts falling into place. And stop listening to the negative voices. We know there are problems, but the more times you talk about the pink elephant, the more times you can construct that pink elephant in your brain. And that pink elephant then stays in your brain. Does that make sense? Don’t keep listening and talking about fear, litigation, etc. It’s there. It’s not going to go. Start thinking about the blue elephant, the good things in your brain, because your brain will see the good things and focus on the good things. [Jaz] So surround yourself with positivity around positive people in our profession with a positive ethos so that you can construct positive neuron signals to sort of have more better thoughts and pursue your passion. And you can do your, the exercise that you described to help find out what it is that you need to do next. And I once read that passion is the opposite of burnout. So, and then some people disagree with me when I say this and I respect that, but I feel as though. You’re way less likely to burn out and burn out something that we all should be aware about, but you’re way less likely to burn out, if you’re incredibly passionate about something. If you’re working like I used to be working in three different practices, I drive 50 miles to go to Oxford and 50 miles back and people tell me Jaz, you’re crazy. I mean, that’s a lot of commuting you’re doing. Yes. Fair enough. I cut down on practice. Now we had a baby and stuff like that. But at the time when I was doing all that, I didn’t feel burnt out because I feel as though pursuing my passion and I was very, I was in flow. Most days I go to work and then finish the day with a, whoa, where’d that day go today? It’s the procedures I enjoy doing with patients. I enjoy treating in an environment that was conducive to excellence. So that for me was perfect. So I did not feel the sort of the presence of burnout because I feel passion is an antidote for that. [Dhru] I think I’m going to put something small there. I mean, first of all, don’t tell those people about commute about me because I used to commute to Belfast and back fly there. But that beside the point, passion can go to burnout. If you become obsessed, Robert Valerand is the the psychologist who’s done a lot of work on this. There are two types of passion. There’s obsessive passion. There’s a harmonious passion. [Jaz] I don’t know anything about this. So yeah, go on. Tell me about these two types of passion. [Dhru] Obsessive passion and harmonious. And the best way to explain it is that harmonious passion are people who are passionate because intrinsically motivated, but they also know where to put the brakes on, and the obsessive passionate, which I was probably was for a big part of my last 10 years. You don’t know where to put the brakes on. You go, you just keep going intensely. You keep flowing. Now that happens because you’re kind of driven by different motivational factors and everything like that. So passion doesn’t lead to burnout when it’s good, harmonious passion. And that harmonious passion comes when it’s in harmony with your values, with your intrinsic drive, with what you enjoy, because then you’re in flow. And when you’re not doing it, you’re fine because your brain is saying, I’m not doing this simply because I’m taking a small break. It’s almost like the example is runners, right? You run a marathon and then you take a rest. You don’t keep running and running and running because those muscles will get destroyed. When you take a rest, those muscles are not just recovering, they’re rebuilding and those muscles are building stronger than they were before. And that is the harmonious passion route. So you go at an intense drive because you know you’re called, but in between there, you take these little breaks and self awareness and harmonious passion can only be achieved if it’s intrinsically driven from within you, which can only be done if you understand your values, the green stuff that you enjoy, and exactly what your focus is. And you will suddenly be so motivated. You will achieve working three days a week, I earn more money than I used to working six days a week because of this process. [Jaz] That’s so good. And I love that you gave me another dimension there in terms of the distinction. So I, I felt as though my statement was passion and burnout opposite is that I actually got that from a guy called Grant Cardone, who’s a business guy. And that’s right. He wrote a book about this, be obsessed or be average. But I like- [Dhru] Obsessed to be average. [Jaz] That’s it. Be a BOBA. Uncle grand, very American, but I like that. You’ve actually look further into science and come up with some more, dare I say, educational viewpoint. And so that’s a great thing to chase harmonious passion through it being intrinsic with your and coherent with your values. So that’s amazing to do Dhru. Thanks so much. Before we wrap this up, any other key points? I want to mention one thing about how young dentists and dentists in general view social media, but before I do that, is there anything else that you want to cover? [Dhru] I think we’ve gone deep into this realistically and a lot of people may find these very challenging thoughts or very complex thoughts. Actually, these are the things dentists need to learn because all we learn is dentistry. You can teach me very good composites. This is the kind of stuff we need to get our head around to get a successful work life balance and a brilliantly passionate career. [Jaz] So then the only thing I’m going to say then is, dentists, and particularly young dentists on social media, be it on Instagram or Facebook, be very careful not to compare yourself to the person on the other side who’s posting all these amazing cases. It’s so, so easy and I do it myself as well. And I start comparing myself to the work of others. And I think, oh my gosh, that’s such a beautiful rehab that’s happened. Or that’s such a beautiful level of composite. Why is this person so amazing, so good? Why am I so crap? Why is it that this person’s life seems so amazing and there’s so many issues with mine? So you have to, everyone, please remember not to compare yourself to others in life, in profession, or anything. Best measure there is, is to compare yourself to how you were two or three years ago. And look at how much you have developed professionally and personally in your relationships, in your career, in every sort of facet, but do not compare yourself to the people you see in social media.. Yes, you can use them to as inspiration to lift and you can, you can sort of analyze and figure out how they got there and use mentors to, it’s a great, it’s a beautiful thing when people can inspire you to do better work. But when you start looking at others, work on social media and start feeling crap about yourself, that is not a good place to be. Because when you, when I open up my Instagram nowadays. It’s a bit too dental. It’s like, oh my gosh, it’s like stunning work everywhere. But you have to realize that everyone usually puts up their best work and actually you don’t know the journey that each individual has taken to get where they are. And you really have to just focus on yourself and how far you’ve come. [Dhru] Yes, I think that’s important. And here it goes back to what we were saying, your green and red areas, because I sometimes see amazing full mouth rehab cases and I go, that’s brilliant. But actually, that’s not what I focus on. So if you know what your goals are, what your focus is and what exactly you want to achieve, then you’ll also filter out a lot of these cases out of your zone. [Jaz] Or rather you appreciate them for their beauty, but you won’t necessarily affect how you feel about yourself as a clinician and how it fits into your career. [Dhru] Correct. And I think most of us in all honesty are aiming to be good, competent dentists. Not all of us want to be that exceptional level where we can go on a big stage on a massive screen and put up amazing pictures of a single tooth with the best composite, with the best translucency, with the best lighting, etc. We want to be good, competent dentists who want to give our patients the kind of care they’re comfortable with, they can live a good life. And that’s the point. 95 percent of that, as Govinda Perth said, is achievable with the basics. 5 percent is that excellence we will always be chasing. Remember he said that in his lecture at the Tubules Congress. I think I take Govinda words very nicely that most of us want to be happy, competent dentists. So just focus on yourself and if you’re doing that, just continue to improve it. When you stop growing, you will get bored. So always find the next challenge on your way. But make sure that challenge is one step up from where you are, not 10 steps up. [Jaz] Because it’s important that it is one step away from where you are because growth only happens when you’re outside your comfort zone. [Dhru] Absolutely. And that’s where you need mentors to tell you what’s my next comfort zone. And that’s where you need your community to start shaping your brain in a different way. So your point about social media is pertinent, it’s important, and it’s really key. And again, another fact to add to that is don’t just end up on any Facebook group and any Instagram feed. Otherwise, you’ll get too much information. So social media select the right Facebook group or Instagram feed and people you follow. Select the people who are actually going to take you to the next step up. Otherwise, there is far too much information that will hit your brain and confuse the life out of your brain. You know the direction you want to go to. Just select the people to follow who will help you get to the next stage, the next pit stop to your destination. And when you reach that pit stop, then select the next people and the next people. This obviously means you’ll have to unfollow people. You may have to leave some groups. Don’t worry about that. You can join them in the future, but it means you’re always just striving to move to the next step. That’s another key to what you just said about social media. [Jaz] Ladies and gents, you have been tubalized. [Dhru] You have been tubalized. Well said. [Jaz] And it was full of a lot of gems in there. I like how everything turned full circle into the values. And I think that was the underpinning theme of this podcast was having your values. to set the right direction and the trajectory of your career. [Dhru] Yeah. I think people have forgotten that they look at other people and they follow their values, unfortunately, in dentistry. And I was actually very, very positively surprised you’ve done Scott Jeffries work because it’s really good. And if you enjoyed Scott Jeffries, you’re an audible, aren’t you? [Jaz] Oh I spend far too much money on Audible, even though I have this subscription. This is what I do in my 50 mile drive. You see, I’m always, it’s like driving university. [Dhru] I’m always learning and it’s brilliant. So John de Martini is the values factor. That’s the one to get values factor writing, that kind of, I think the first one or two chapters you’ll think, what the hell is he on about? He’s a little bit out there like secret, but he really, and then you read chapter four onwards and you think, bloody hell. This book’s blowing my mind. Then you’ll go back to chapter one, two, three, and say, I’ll need to listen to them again. [Jaz] I will totally check that out, but I’ve got my values written here on my phone. So I put the link everyone for Scott Jeffreys, the values discovery exercise. I think everyone should do it because I think it will really help you in your life, not just in your career, in your life to know what your values are. And sometimes it sounds stupid, I know, but who actually sits down to think about what their values are. No one does that. And it’s something that we should do. So here are my values. Number one, productivity to use my focus and determination to achieve fulfillment. Two, health, to live with strength and energy. Three, growth and mastery, to continuously upskill in the relentless pursuit of quality. Number four is sincerity, to always be kind, honest and act with integrity. And the last one is leadership, to inspire others and push boundaries. So you can use that seven step exercise to come up with your own set of values and then any time I’m ever in life come up at a Crossroads nowadays and I need to make a decision I literally just consult my values and I think about what my values are and I choose the option that will be most coherent my values. [Dhru] I think spot on absolutely spot on. Yeah, brilliant. Thank you so much, Jaz. [Jaz] Thank you Dhru. Cheers. Thank you. Well, I hope that passion was infectious for you. All those wondering about which course to do, you can now look at your intrinsic motivations and use a system to see what is it that will benefit you the most. So I hope you enjoy that. I’ve got some good episodes coming up. I’ve got some recording planned with Tiff Qureshi. So we’re talking about DAL technique. I’ve also got a great title with Kush Agadi. I don’t want to ruin the surprise for you restorative consultant. So I’ve got some great guests lined up as well as a few solo things coming up. So thanks so much for listening. As always, give me some feedback, leave me some reviews, share it with your friends if you enjoyed listening to this. If you think you know someone who maybe needs to find their passion, their values, and they really benefit from this episode, share it with them. Thanks so much and catch you soon.

In this mini episode (interference cast – see what I did there?), I discuss about key lessons in protocols and philosophies I have learned from 3 awesome Dentists: Prof Nicolas Martin, Dr Rajiv Ruwala and Dr Jerry Lim. Need to Read it? Check out the Full Episode Transcript below! https://youtu.be/_CEXnLyE_rw Full episode also transcribed and on Video to watch, including my IGTV. Take home points: Have protocols in place in Clinical Dentistry so that your workflow becomes predictable Train your staff well and make them familiar with your systems and protocols Have a Philosophy for Occlusion – does not matter if it is Spear, Dawson, Kois, Pankey, Neuromuscular or whatever! Have A philosophy Go all in – immerse yourself deep with knowledge, we owe it to our patients! Click below for full episode transcript:  Opening Snippet: Have a philosophy and it doesn't actually matter which philosophy you follow just HAVE a philosophy... Jaz’s Introduction: So welcome to interference cast. This is one of my top podcast episodes where I disrupt in the middle of the flow of having guests. And I just ramble on about important things, or things that I think are important anyway. And I hope you gain value from these. So this episode, or this interference cast is all about protocols and philosophies. Three really cool people I’ve learned from and they’ve all had the same message, the same key theme, and I want to share that with you guys. And that is from three different awesome clinicians who have helped me in my career. It’s all about having protocols and philosophies. So let’s dive in. Main Podcast: [Jaz] The first person was Professor Nicholas Martin from Sheffield, he was one of my restorative consultants, he was one of the academic leads at the university. And he’s the one who really planted the seed in my head. He basically taught me that with every procedure you do, you need to have a protocol. And that’s how you make procedures predictable. If you don’t have a protocol, then you do things based on your mood, or your nurse’s mood, and your results will be inconsistent. And you’ll never be able to pinpoint what goes well and what could be improved. Now, that doesn’t mean that you can’t change your protocols. And you can’t try different techniques. But it’s important to sort of make things consistent, so that you can pinpoint what is it in your practice that is being successful? And what is it that’s causing, let’s say, postoperative sensitivity, or pain, or any sort of restoration fractures or wherever it might be. So it’s like yourself auditing right? If you keep changing and chopping one day you etched for five seconds, the other day, for 45 seconds, it’s no consistency, you will never know what actually works. So it’s important to have protocols in place, and have them laminated somewhere, let your nurses know, so that they know exactly, you know, you know, sometimes when you’re etching, and then a nurse or leans over with the suction, it’s only been seven seconds. Whereas on a different day, the nurse will wait half an hour, 45 seconds until he or she leans over for the etch. And if you’re led by your nurse before your sort of wash, that’s not dentistry, you need to have a protocol in place, see to have a time is in place so that you and the nurse both know how long you’re etching for. That’s just an example. So that’s a first person who taught me about the importance of protocols. So fast forward some years later, when I’d qualified and dentinal tubules, website was in his early days, and it had a forum which was very active, it’s now evolved. And it’s way past that it’s way bigger and better than the forum. Tubules is just a movement experience itself. So a dentist, who I really look up to is Rajiv Ruwala. He was posting a fair bit on the forum, and he actually posts a lot on Facebook, he were mainly saying on the dental groups. And again, I always, you know, I look out for his post because, you know, I respect what he has to say, he always has good, valuable input. So in his posts on the Dentinal Tubules forums, I was sort of scrolling down. And a question that he had asked a few times is, what is your protocol? What’s your protocol for this? And I really liked the way he thought his thought process was, he sort of echoed what Professor Martin taught me as well at dental school. And really, you know, I when I left dental school, I thought, okay, no one really does that in the real world. No one uses rubber dam. No one does it the way that he you know, Prof. Martin explained it. But then I met Rajiv and I had the pleasure of shadowing him a few years later, visit his practice. And it was just very inspirational. I loved how he streamlined his protocols, and his nurses are really well trained. And I’ve since learned the importance of following checklists and the correct training of your team to maximize your results. So thank you, Rajiv, for echoing that. And so finally, the third time I received a really powerful message with protocols and philosophies was in Singapore. So as some of you may know, I spent a few years working in private practice in Singapore, which was just an amazing experience. If you wanna learn more about that. That’s Episode One of the Protrusive Dental podcast. I arranged a shadow probably the best known dentist in Singapore. That’s Dr. Jerry Lim. Check out some of his work on online just google Dr. Jerry Lim. He has such a beautiful practice very advanced all the toys you could wish for. I sat down with him to pick his brain, you know, I was almost starstruck because I’ve seen him lecture a few times in Singapore you know he’s very, very kind to allow me to go and shadow him and just wow, I mean, his clinic was just probably the most beautiful clinic I’ve been to. It’s like a tall building in Orchard Road, which is like the main like equivalent, let’s say, Oxford Street of Singapore. Beautiful establishment. So what he saw when I was picking his brain, I asked him, okay, you know, which ortho system should I use? And which occlusion philosophy Should I learn? And, you know, that sort of question when we Were Young dentists asking away, were still very much into occlusion then and even more so now. And what he told me was brilliant. He said, Jaz, listen, have a philosophy. And it doesn’t actually matter which philosophy you follow, just have a philosophy. It doesn’t matter if it’s Kois, Dawson, Pankey, god damn it, it doesn’t matter if his neuromuscular dare I said, he taught me to immerse yourself in a topic and don’t go half assed go all in. So he said, Jaz, it really doesn’t matter. But whatever you do go all in. And it doesn’t matter which philosophy you have, just have a philosophy. So that’s a really important lesson right there. It’s actually if you’re sort of picking and choosing different paths, different philosophies, that’s cool as well. That’s what I’ve done in the moment. But thing is, I’ve adapted that as my own occlusal philosophy. So if you ask me, What is your occlusal philosophy? I’ll come and we sit down with you and explain five minutes exactly what my occlusal philosophies are. So have a philosophy don’t just make things random, it’s always the same theme as having protocols, and being consistent and being predictable. So it just means that you have to, for example, let’s say you’re using a new resin cement. But actually, you have to read the instructions for use, I mean, how many of us are guilty of using products and we’ve never read the DFUs, or you just follow what the nurse tells you to do. That’s not how it should be, that’s dangerous. I certainly make it a habit to every time I encounter a new product or a trade show, it’s boring as hell but you actually gain the proper way to do things. And that’s very important in improving your predictability. So go all in with everything you do, including having philosophies on different subjects, philosophies on materials, and actually well informed by the DFU for example. So going all in also means that you don’t just settle for one opinion, or one weekend course, we owe it to our patients to have in depth knowledge and clinical confidence in what we’re doing. So thank you for listening to my interference cast. I hope you enjoyed that. Jaz Outro: Thank you to all those three dentists Prof Nicholas Martin, Rajiv Ruwala and Dr. Jerry Lim, for influence me in a really positive way, and for getting those points across to me, which I’m sharing with you all now. Join me for the next few episodes. Thank you for listening.

This episode is for all dental students, but particularly those in 4th and 5th year. I was joined by my friend Prateek Biyani who runs an awesome resource for students at Dental Notebook (check it out!) Need to Read it? Check out the Full Episode Transcript below! Protrusive Dental Pearl: If you’re a Dental student, I recommend attending the Dentinal Tubules Student Congress. It is jam packed with great speakers and really fits well with students. GREAT value and I wish we had something like this when I was a student! Our aim was to give away all our tips and advice that helped us during finals. We cover: MCQs App 9:06 Key books that helped us 8:30 Importance of study clubs 6:21 Great resources 7:46 SoundNote app 10:33 Integrating evidence base in to your answers 15:50 Top tips for OSCEs 17:14 How to do well in a Seen patient or Finals patient exam 24:01 If you found this useful, be sure to share it with your dental student colleagues. Good luck everyone! Click below for full episode transcript: Opening Snippet: You should in all honesty, you should be quite proud of what you're presenting. This is your best clinical work in dental school that you've been working on for however long... Jaz’s Introduction: This episode is dedicated students because I remember all too well. Being a student and how nervous, me and my flatmates were, we had this sick feeling to the core in our stomachs. So this one’s dedicated for you guys. So you can smash your dental exams. And I’ve got today with me, Prateek Biyani, who is a total whiz and like computers and stuff. Me and him made an app together called food for teeth once one time and he did really all the hard work towards it. He’s fantastic with computers and very intelligent guy. He’s very well exams and that’s why we thought we’d come together and share some of the tips. So this episode is jam packed with lots of different tips to help you you know from discussing example OSCE questions, how to set yourself up for a good OSCE tips for us to get through our finals, how I utilize technology, how Prateek utilize post it notes, so he was a very old school in some things and what to do when you don’t know the answer. And an the importance of not worrying about small details, as well as body language. So we can discuss all these sorts of things. So you can smash your dental exams. Some of this will be relevant to any upcoming DFT interview as well. But really, this episode is specifically focused towards exams. I actually recorded this episode months and months ago, but I want to release it, you know, when the academic term started or after December so now obviously we’re in October right now, so I hope you enjoy it there. The Protrusive Dental pearl is also therefore dedicated to students because I imagine none of my usual dentist listeners are listening to this episode just pretty much marketed, specifically for students. So dental students who haven’t listen to my podcast before welcome, it’s all about, it’s a lot to do with occlusion, but it’s a lot of general dental stuff to help people out and so I love doing. So this episode hopefully will help you in your journey. So the Protrusive Dental pearl for this episode once more is if you’re a dental student, okay, and you want to do well and you want to mix the right people I strongly recommend look into attending, the Dentinal Tubules student Congress, if you know someone a year above you who went last year, just ask them. It is jam packed with great speakers. And it’s really at the real pitch at the right level for students. And Dentinal Tubules has a great ethos, it’s usually held a week before the main Dentinal Tubules congress. I think in 2020, it will be around about end of September mid September 2020. So watch out for that one. I’ll post it on my Instagram and Facebook when the time is right. My Protrusive Dental pearl for today is to join and look out for the student Congress for Dentinal Tubules, you really set you apart and you will learn so much. So that’s my main pearl. So let’s dive right into the episode, me and Prateek. And I’ll join you for the outro. Hope you enjoy. Main Interview: [Jaz]Prateek, tell us about yourself. And I will then maybe say a few things as to why I invited you on the show tonight and why I think you’re a great person to speak about, you know, Exam Success. So Prateek, tell us about yourself. [Prateek]Yep. So I graduated in 2016. From the University of Sheffield, a couple of years junior to yourself. I then went and did my FD in Halifax for a year. And then since then I’ve been doing DCT jobs. So I did DCT one and maxfacts in Sheffield, and I’m currently in DCT two job and just feeling maxfacts again. [Jaz]Awesome. And tell us about your website. [Prateek]So yeah, in I think it was in third year of dental school, I started a website called dental notebook, mainly because I felt I was gathering quite a few revision notes as I was going through dental school, I thought it’d be useful to share these with other students. So I thought I’d create a central resource for students to access revision notes, or the little hints and tips for exams, scenarios, OSCE tips, things like that. And since then, it’s just grown. And I’ve had guest posts from yourself, from other guys around the country contributing to and just a database of knowledge, essentially, [Jaz]You know when something I do on a weekly basis. Now I type in IOTN on Google Images. And you know, your website comes off in number one, number one, right? But it was teeth geek that donated that about a website. Unknown Speaker [overlapping conversation] [Jaz]I mean, you have the similar background that we know we wanted to share information at the time of students. And it’s great that you’re keeping that up. So and that’s one of the reasons I’ve invited you on today because I think you’re a great person to speak about that. Also, you know, you’ve been quite modest, you haven’t really said the other things, but you’re a, you know, high achieving honors distinction as well? [Prateek]Not in the ultimate degree. But along the way. [Jaz]Along the way. You know, you get lots of distinctions and honors overall. And I remember you were always a high achiever at dental school, so guess I’ll have to mention it because there is some credibility as to why we’re doing this and I got 100% in the clinical examination in Sheffield, which I think was never been done before. Yeah, and got distinction clinical exams overall. And I like to think that my scores are quite good and but it’s important to mention that because you think these two random dentists is talking about exams. But you know, we do, me and you were very studious, I suppose. We like to really understand and grasp every element. And I think me and you can share some really good easy tips to help elevate people’s exam scores and get them their degree, but not only their degree, but get them retaining information better towards their exams and having good experience. [Prateek]I think that’s the more important thing because you’re not just passing exams, it’s your career, it’s what you’re doing. Long term. So you need to be happier. You understand everything, you grasp everything. [Jaz]Exactly. So let’s dive right in, Prateek. So a two things. Okay? There’s the academic part of every Dental Degree in the UK. That is, is it fair to say you can say right, first half is academic and second half is clinical, we can let you know first half the podcast, let’s talk about how we can get our listeners, this students to get top scores in their academic exams? And the second half, we can focus on clinical. SO academic, okay, shot, how can students emulate the type results that you know, the honors students get? [Prateek]I think one of the most important things is everyone’s very different in how they learn. And in first year, one of my biggest emphasis was on basically put on finding the best where to learn University information. Because through school, through college, whatever it may be, you learn very differently, the exams are very different. But what as soon as you come to university, the way you sit exams, I remember we had one mock in first year to give us a bit of an idea of what the exams would be like, you’re never quite sure how to go about preparing for them, how to go about revising. So that’s one of the really important things, early on identifying how you work and how best to return information. And some things that I’ve done myself. And I know that most of my colleagues have done, repetition, although it’s often frowned upon. And for me, that worked quite well. And it’s not failed me all these years. And even things like study groups. I remember, me and a few of my colleagues, we had weekly study group that we did near exam time. And that way you can feed off each other. And like I said, Everyone has a different way of learning. [Jaz]I found that incredibly useful. Group of us coming together, four or five, you don’t want anything too big. [Prateek]Exactly. [Jaz]Anything once a week in the library, we call it geek club. It was good. You know, it was even like when you come to, obviously final year, and you’ve got the DF one interview, so you know, you can use it for that element as well. So yeah, study groups and finding out how you learn. Yep, absolutely. [Prateek]And having plenty of resources. I mean, you’ve got your friends, you’ve got tutors, you have easy access to them, but also appropriate textbooks. I know, in first year, a lot of people see reading lists and like, I need this, I need that. But it’s picking out maybe asking a senior what is, what do, I actually do remember speaking to you about certain textbooks and things and you give me advice on what might be suitable for me to learn from. But I think the best books I bought through dental school are the MCQ and SCQ books. Because ultimately, that is what reinforced my revision and prepared me for exams. So it’s definitely something that I’d advise people to get, even if you just get one between your study group or whatever it may be. They’re very, very important and very, very useful. [Jaz]The one I recommend, I suppose, we’re jumping on that a bit, because it is clinical, but it’s got lots of academic references as well. Because you can always get short answer questions. Is it the clinical problem solving in dentistry? I believe it was Odell? [Prateek]Yeah, absolutely. One of the best books I’ve just been talking to some final years. And that is the first book I recommend to them. Even I have on my own, I will always, always recommend that because it is a fantastic book. I myself really, really struggled with [vibers?]. And they were really daunting. So when I struggled, that was the book that basically prepared me for it. And yeah, highly recommend it. [Jaz]Brilliant. And what technology? I mean, did you utilize technology when you were learning or revising for exams? Unknown SpeakerI did for some things. So there are because the issue with technology is it’s changing. So quickly, there were some apps that I used to use that no longer exist. There is one MCQ app that is very good, that does still exist. And it’s American one. It’s a dental boards mastery app that you can get. And that is essentially an MCQ bank questions. And you can go through it or record your performance on the kind of 10, 20 question exams, whatever you want to do. You can mark which questions you want to go back to, which topics you find difficult. So I found that quite useful. There were other MCQ apps at the time and if I say is continuously changing, the new ones come and then some will vanish. And then just websites I remember. There’s the for example, if you’re in first year tooth morphology is really difficult. There’s a Leeds University website that kind of has lots of pictures, you can look through aspects of morphology for teeth and kind of grasp a bit better. There are apps out there. It’s quite a niche area, though, I think, in terms of dentistry to find the right ones to help you. There are general things like, there, there are lots of flashcard apps that you can use. Some people like to use those for revision. So yeah, it’s finding again, what is best suited to your need. [Jaz]I think the reason why I got such high marks from about like, especially third year onwards, for me, it was down to one app. Okay? And it’s a general app. Okay. So it’s called, and there’s many like it. My one was called soundnote, and I still use this day. Okay? It basically the way it works is I’m there typing away notes, okay. And, as a lecturer speaking, I’m sort of almost typing what they’re saying, or my own version. Yeah. But at the same time, as me typing is recording the audio. Now, this is not revolutionary. But this is a way to work smart or revise smart, instead of sometimes having to go through the entire lecture, or people who record their lectures on dictaphones. And listening to the whole damn thing. You sometimes just want to know what the speaker said about one small that happened around the 32nd minute or something, you just you just don’t know that for you, you know, open up the lecture. So sometimes, you know, I brought in things like this bit is really important. Listen to this for exams. And I come back to it when I’m revising. I clicked on that edge and it revealed all the answers. So that’s a great way to revise smart, obviously, you have to check what your university rules and regulations are in terms of recording lectures and whatnot. So that’s, you know, something that needs to be checked upon. But for me, I think that’s been my biggest success story, only because it saved me hours when revising. And also, I found that the lecturers are the same people who end up marking you in those exams. And if you’re listening back to their voice, and the key important bits, and then you’re writing that, or you’re speaking that in your Viber, they’ll give you the mark [overlapping conversation]. So they know you pay attention. But you know, it’s like playing for their ego. You’re saying the phrases in the way that they said it And they’re like, yes, this guy, because everyone thinks they know what they have to say is the best. So that, for me is a massive tip in terms of an app. So the one I, it’s soundnote, and I’ll put the link at the bottom of this podcast. So that’s a good generic app as well, as well as obviously a flashcard methods are quite good what you said. [Prateek]I know. Another common one is Evernote. You can do audio, you can draw, you can type notes, whatever. And it’s available across all devices. So that I have used that in the past not so much recently. That is another good one. [Jaz]Seeing me as me and you have been qualified for a few years now. Maybe there’s some really awesome apps, and we just may well be. But hey, you know it’s something to get people started to utilize technology. Before I go on and give another tip in terms of academic What else have you got in terms of getting good results in the written exams? [Prateek]I think, kind of going on from what we’ve discussed when it was getting closer to exams. You mentioned a rather than spending ages trying to go through an entire lecture picking out the the most important bits are the bits that you’re forgetting, things that I found useful, are lots of post it notes. I know that whilst going around my flat, if there’s somewhere I’d go really often, I would have a post it note off something I couldn’t remember, sat there. And that would kind of hammer home the messages to me. And that was more relevant for theory compared to the practical things. Because that’s theory is where most of that knowledge is, you know, you’re having to remember those really awkward facts or that long list of bullet points or whatever it may be. So just helping with retention, that as well as lots of colors, kind of keep you interested on those, those drab long sheets of a4 if you have colors. And I know some people’s minds work that way, where they’ll remember what colors were where, or what pictures were where. And those I found really helpful in terms of remembering key facts. [Jaz]And I’ll tell you one way maybe see if you agree with me one way not to do it. And that was a lot of people in my year when it came to revising the finals, went all the way back to their first year note. Right? And they were reading like, through first year stuff, second year stuff, third year stuff. Now, fair enough, some exams, some dental schools may involve, you know, large chunks of it. But to be fair, reflecting back, finals was 80%, 90%, fourth and fifth year stuff. It’s not that you shouldn’t go through it. But you should really keep it short and sweet and simple for when you’re going to the earlier is [Prateek]Absolutely. The way I looked at is was that first and second of the information is the foundation for what you’re doing now. It’s really that stuff should be within you somewhere. And I remember going down and like going back to the notes and like you said basically cutting everything out and only picking the odd slide or the odd thing that i thought you know that’s going to be useful to take forward and remember Yeah, going back. I know Some of my colleagues as well went back and went through all the lectures and everything. And it’s time that you can use on something more productive. [Jaz]Exactly. And if you’re really stressed, and you feel as though you haven’t given enough time, and you’ve got a short deadline, then you know, be clever about it, just go through the 4th and 5th year stuff, but I don’t recommend doing it that way. But if you’re really strapped for time that I would, at least a point. [Prateek]Ultimately, like you say, 80 90% is that fourth and fifth year, and that should technically be enough to get you through the written exams anywhere. So yeah, if worst case scenario, that’s the focus. [Jaz]Anything else, Pratkeek? On the how much more you go for the academic? I’ve got another one more thing. [Prateek]That’s it for my OSCEs and stuff. [Jaz]Okay. Now, I don’t know what you did during your written exams, Prateek, but what I did actively, when I was answering questions in the written exams, I was referencing papers. Were you? [Prateek]Yeah, so in my, when it came to finals, I created a little document kind of list of all the evidence for everything that I could find, whilst I was revising. So I use that not only for written, but even when it came to my, for example, patient case presentations and things, I kind of tried putting that in there just for the extra marks that so and so said this about, you know, the evidence what I’m doing, because ultimately, again, we need to show evidence based practice. And so for the extra marks for those little bonus marks, if you can retain some evidence, I think that’s completely good way to go about it. [Jaz]So you know, I’d write, you know, Gibson, 2011, PTJ, or whatever for, for whatever, you know, so that was a good way to do it. Now, you don’t need to remember every single paper and whatnot, I think just the key ones, like major systematic reviews, you know, you don’t have to remember all these in-vitro studies, maybe just sometimes in the lecture slides, you’ll notice that they reference, you know, a paper, and you can, you know, each theme to remember one paper is more than enough, and it’s not mandatory at all, I know a lot of people got loads of good marks who didn’t reference any papers, but it sort of backs you up. And it’s, you know, it’s not wanting to lose any marks. I think it’s a good thing to have, obviously. [Prateek]Absolutely. Agree with that. [Jaz]Right. So clinicals. And the main two things talk about, I suppose, are OSCEs, and the Finals patient, right? Please tell me what tips and advice you have to get through the clinical exams. [Prateek]I mean, in terms of OSCEs, I remember, we had, again, a mock one in first year that I had never experienced OSCE in my life, I was terrified. But I took it back to the basics of any exam, be systematic, be logical, and try to keep a clear head in what you’re doing. You everything that comes up on an OSCE, you will have come across at some point, you will have studied it in some way. So it’s making sure that you just think through your question, you don’t look at a question and immediately panic, that, oh, I haven’t revised this, or I haven’t covered this in X number of months, or whatever it may be. So just make sure you keep a clear head between stations, if something’s gone wrong, you don’t take that forward to the next station, you try to forget about it. And new station is completely different. And one of the biggest things that I can’t emphasize enough is practicing. There are some people have the mindset that you can’t practice for an OSCE, that you can’t, you know, like a communication scenario, it just comes to you naturally. But practicing these things gets you very, very far. And it comes back to what we were saying about doing study clubs and things like that you can practice these things with your friends. And you often pick up on things that they do that you don’t necessarily do, and feed off again, off each other’s knowledge, how you approach stations, that can only better your performance in OSCE type situations. [Jaz]Like an actor station, for example. Easily in practice. [Prateek]Yeah. And a lot of people forget basic things like nonverbal communication. And I know that even is relevant in clinical non-actor related stations as well in how you’re communicating with your examiner. If it’s just you one on one with the examiner, how are you articulating yourself, how you explain? Are you explaining things clearly? You know, are you not very confident about what you’re saying? Or is there some confidence behind whatever you’re discussing clinically, because that, again, shows what you’re like as a clinician. So if you’ve practice things, if you’ve gone through things, you’re more likely to be confident you’re more right. [Jaz]And if you keep arming, you know, you, you lose that magic about you lose about you, and I think it reflects on your overall mark. I think I remember during OSCEs, there was an OSCE station where we had to just very simply explained to a patient that the patient had periodontal you know, chronic periodontal disease. And you know what the most obvious way that most students lost marks? Can you guess, you know, imagine you’re at the station, which is the way in which students can lose the marks ie which important piece of information did the students omit? [Prateek]Risk factors jargon? Are you using jargon or? [Jaz]Jargon for sure, that’s on every station you’ve got to avoid jargon, but the main ones actually forgetting To mention to the patient that actually you’re going to get some sensitivity afterwards. And you’re going to get something called recession when your gum lift. “Mrs. Jones, it’s better to have a long tooth than a tooth no longer. Youcan say that with a smile on your face. And yeah, you make it. Make your tutor laugh. You know, you say with confidence, and you know, you bring your personality into it. Yeah, it’s only gonna get you lots of marks. [Prateek]No, absolutely. And I think that a lot of that comes from the practicing bit of things, if you just go in there having, thinking that whatever you do on clinic is right? More often than not, as we’re probably all guilty often on clinic, we end up slipping here and there, we develop a way of explaining something that may not necessarily be exam correct. So that’s where the practicing bit and picking up on things that you may not necessarily, you shouldn’t necessarily be doing in an exam is kind of filtered out of you. [Jaz]And the other thing I had put OSCEs was for the clinical stations on or even like, pathology stations, for example, or any aspect of it. I think there’s only two sorts of things that will come up in OSCE. Either these things are common, or they’re important. For example, oral cancer always come up. Always. I can’t imagine a UK Dental Degree in fourth and fifth year where oral cancer will not be one of the 10 stations. [Prateek]It has to be in there. [Jaz]So whether it’s communication aspect of it, whether it’s the pathology, any aspect risk factors, you name it. So revise the important and the common ones. Now, I remember in my finals, the ortho peed station was a midline, supernumerary. And you get presented with this photograph of maybe like an eight year old and they’ve got one upper central incisor erupted, and the other one sort of not erupted. And then you saw look at a radiograph or, you know stuff there’s a supernumerary. All the thing is, as a student, you’re like, completely unsure of how to manage that. But they don’t need you to be an orthodontist or a specialist pediatric dentist to able to answer that, as long as as a GDP, you can recognize it. And you can say that this affects this percentage people when it’s not so common. And what would you do, I would refer to hospital for a joint ortho pediatric opinion. That’s all they’re asking of you. [Prateek]It’s all about safety, and being competent at the level you’re at. And I know, I’m in a similar situation to what you’re explaining where you might not know what to do. And I’ve been asked quite a few times when I’ve when I’ve asked a student, or what would you prescribe for something? And they’re like, Oh, I don’t, I don’t know. And I just as I say to them, like, if you don’t know, don’t lie in your exam, and just be honest, that you don’t know but see how you would kind of remedy that. So I would go and check the BNF to see what medication to prescribe in this situation. So at least it shows you’re being safe, you’re not guessing what to prescribe and you’re still managing the patient’s problems by going and finding a solution. So knowing everything isn’t end of the world, and they wouldn’t be surprised if you knew everything, it’s about being safe, being able to just go out as a beginner. Beginner, as they say, into practice and managing patient. [Jaz]Yep. And the very, very bottom, the very, very basic of all things that need to be uncompromisingly sufficient, is medical emergencies. So that’s the only real time I can remember anyone sort of failing really, or something really obvious, like, in a patient with very obvious dentures dermatitis, and you just don’t, you know, pick up despite being given hint, and you don’t pick up on it. So that, you know, unless they wouldn’t fail anyone in the clinical exams unless you A) make a medical emergencies related mistake that can endanger your patient or B) miss a very obvious, even like a common clinical condition that you know, every dentist like it’s like missing Gingivitis, a denture stomatitis, missing an ulcer, which is, you know, clearly and also, [Prateek]Again that just shows you’re in safe, doesn’t it? Like you’re not fit to? [Jaz]So it’s important, you know, instead of just revising pemphigus, pemphigoid the whole time, just look over the basic things and make sure you know, you can imagine yourself as a general practitioner in practice and seeing the most common pathologies. [Prateek]Common things are common, you know. [Jaz]Common things are common exactly. Anything else got for OSCEs, before we move on to finals? [Prateek]Nope, that’s everything. [Jaz]I’ve got finals patient in Sheffield. You know, we see this finals patient over how many over months or years for me, I saw one with for over two and a half years, I had some friends who saw their patients just four weeks. And complete the course treatment because you know, that was the only patient that they could sort of meet the criteria. And they did really well, as well. The way it works is you get five minutes to present, your patient whilst two examiner is looking in the mouth and looking through the notes. And to fair, they weren’t even listening. Do you remember that? They weren’t even focusing more on the patient and having a look at the treatment and the photographs, right? And then they take it aside and they sort of grill you for like five minutes or 5, 10 minutes on various aspects. And I imagine there’s a component like that in most dental schools. So What tips do you have for the students about this, you know, final patient or clinical type scenario? [Prateek]Yeah, I think to be honest, this this is relevant to any level dental students. The earlier you kind of identify these patients and start working them up as a potential finals patient, the better it is. So as soon as you see a patient, you think they’re going to need a range of treatment that they may be suitable for your final exam, it’s quite useful to start taking photographs and start studying models things like even if it’s in second and third year. But the way I saw this exam was, it was probably apart from a finals person, probably the exam where you have the most control as the student, you essentially dictated what the exam would be like, in the sense that this was your patient, your treatments, you knew that you should know the patient inside out, you know, that notes completely back to front. And so it was the exam where you could kind of direct the examiners, and you could prepare in all aspects possible. So the biggest things for this particular exam, in my opinion worth I said, knowing your patient inside out and what treatments you’ve done. If you’ve and to be honest, everyone will have made some mistakes, or will have looked back and forth. And maybe that treatment wasn’t the best. And if you identify things like that thinking of what could you have done better and reflecting on it? Because reflection is a lot of [Jaz]And there’s no such thing you can’t actually do anything wrong. You can’t do anything wrong, as long as you say, Oh, you know what, if I could go back in time, I wish I’d done the root planning, root service department first before I done that filling because now you can see so ugly recession, I wish I didn’t do it that way, you know, you’re not gonna fail at all. [Prateek]To be honest, I think the simpler cases that tick the boxes are the better cases, because you’ve got less to trip upon. I know, I’ve heard situations of where there’s been final patients with really complex dental treatment have had multiple crowns, fancy bridges, this, that and the other. But when it actually comes to answering questions about the clinical work that’s been done, students haven’t been able to explain what they’ve done and why they’ve done it. So having you know, a patient where I don’t know they’ve been anxious, they’ve been referred for some perio treatment, you’ve done some simple and maybe some complex cons or maybe an endo on them, or given them a denture that is a far simpler case to explain to show an improvement in their general oral health, which is the bottom line of this exam. Those are easier to discuss with the examiners. And as a student, when you’re going to be really anxious in this exam I think that will make your life so much easier, being able to have that confidence in what you’ve done. [Jaz]Absolutely. It’s a really good tip there. Pick something not too complicated. So the rule is, every patient every time take photographs, from second year, third year, there’s nothing to lose maybe a bit of time, but you probably will lost that anyway, you’re probably waiting for tutor. So you take photos, because I think one of the reasons why I did so well in my finals patient is I my photos are phenomenal. Not in terms of because I didn’t take them as a photographer that comes in Sheffield and picks them for you. It’s the before and after. Because before he literally didn’t know what a toothbrush looked like. Okay. And then just the oral hygiene improvement, I think just automatically was a pass. I think just by looking at that. So if you’ve got some profound difference in the before and afters, you know, so you know, I think if you see a patient really bad oral hygiene, that’s a goldmine, you know, get some photographs on that, work on oral hygiene and just do some basic perio, restoration, a crown. And literally, that’s all you need. [Prateek]Yeah. Absolutely agree with that. And like we’ve both said, identifying these people early on, the earlier the better, because the longer you have to, you know, figure out a good treatment plan for them, get things in order. Like you, my finals patient was someone I’d seen at the start of third year. And I think it was my first week of third year. So that had given me a good two and a half years worth of time to work on their oral health. And I think to be honest, that gave me more to talk about in my exam and to reflect on than someone who had got a patient four weeks before. So yeah, identifying them early is a big bonus, I think. [Jaz]Yeah. And if my flatmates are listening to this, then I’ll tell you something funny. I was so worried about something so stupid. It’s not funny. Basically, his pocket charting okay revealed that he had 30% of his pockets, right? That were four millimeters or more. So what classification of chronic periodontitis is he? [Prateek]Is it at the board? [Jaz]Is it localized or generalized? [overlapping conversation] pulling my hair out like oh my God, Is it localized? Is it generalized?? Guess what? No one cares. No one asked. I spent like a whole day worrying about this googling every single thing I could, asking five different perio tutors, and all their answers like doesn’t really matter as long as you manage it properly. [Prateek]It’s like when you start looking at your radiographs too long and you like, caries? [Jaz]Yeah, very much so. So don’t overcomplicate it, okay? They really don’t need you to have it too. That nth degree. So definitely, you know, keep it simple. And you’re, you know, some people obviously, some dental schools do case submissions on paper, that’s fine. Some dental schools do actual like, you know, viber type presentations. If you’re doing a viber type presentation, then you should be so well rehearsed in that, that it literally should be a slam dunk. Okay? You should, if you’re not good speaker, get out there. You know, there’s plenty of online video courses on how to speak complete, you know, Ted Talks, that sort of stuff, just become good speaker. And that will really elevate your the message that you’re trying to send your confidence that you use. And that’s a great tip to just polish up your presentation skills. [Prateek]Because again, that gives you one less thing to worry about in your exam. And it’ll make you more comfortable and more confident in what you’re saying. [Jaz]And smiling as well. You can walk into exams smile at the tutors like Good morning. For me, “It was good morning, Prof. Martin, Prof. Rod, how are you today?” They will, they looked at me though, they were taken aback that I’ve never seen such a smiley student on their exam day. And I think that really rubbed off. And they saw that, okay, this guy’s really confident. So, you know, it’s scary, was very scary. But I think it puts you in a good place in terms of mentally. [Prateek]I mean, I think you should, in all honesty, you should be quite proud of what you’re presenting, this is your best clinical work in dental school that you’ve been working on for however long. So I think there should be a degree of pride, you know, this is what this is a patient that I’m hoping to get me through and make me a dentist. So I think that in your mind, mentally, if that motivates you that should be something that you kind of look towards. [Jaz]And one last tip I have for the finals patient is when you’re giving the story or when you’re maybe right in the background, you have to, they really love it when you bring the social history into it. They were like, “Look, ideally, you know, we’d like to do it this way but we have to take it slow, these nervous patients we have to climate ties, we have to take into consideration that this patient travels from a long way. So that’s why we did longer treatments” and you know, whatever you can say, to show that you really listened to your patient. And you cater, you saw the treatment is very, very personalized or customized to that patient. They really, really respect and value that [Prateek]Yeah, I had a similar situation. My finals patient was quite an anxious lady. And she also smoked quite heavily. And at that time I showed the examiners a graphite drawn off of smoking levels and how they’d fluctuated and I basically said, Look, if you kept increasing this smoking levels, every time she was stressed in life, and then we brought it back down, then she gets stressed and go up. And they quite liked that I’d made that association with her life. And you know, it’s not just the teeth. I’m looking at her overall as a patient. [Jaz]Yeah, exactly. If you just say that, look, me and Mrs. Smith, you know, we’ve had a chap, but there’s a lot going on at home. And as well as you know, it’s important to give smoking cessation, we have to treat the patient as a whole and they love that sort of stuff. You know, when you say. [Prateek]Yeah, absolutely. [Jaz]Anything to wrap it up to find final tips for students sitting there finals or dental exams? [Prateek]Sounds stupid, but don’t get too stressed. In hindsight, I think we all get a bit stressed for finals, [Jaz]I was freaking out, man. [Prateek]It’s all that work you’ve done for so many years. But try to relax yourself as much as possible. Take time out for yourself away from revision. And if you work 20 well, not 24 hours, I hope not. But however many hours a day you will you’ll burn yourself into the ground quite early on. So it’s important. Yes, work hard. And take advantage of study groups work with colleagues, you know, help each other often becomes quite doggy dog. And finally, I found previously, but you help each other you all want each other to qualify. So yeah, just help each other, take it nice and easy. And use all the resources out there. There’s so many people out there willing to help. Some new resources available to get you through finals. So just take advantage of them. [Jaz]Yeah, I wish I didn’t really, it’s funny but I wish I didn’t work so hard to that final stretch of it. Because, you know, ended up being not as bad as I thought. And I think we’re you know, you can be your own harsh critic, especially after the exams and you know, I thought I’d failed some of those because you know, you’re being so harsh on yourself, but be kind to yourself, treat yourself. Take it easy, if you know I gave up gym for like three months, and I really liked to stay fit. So that wasn’t great. And it’s not great for your mental health either. So, but it’s difficult, you know, when you’re going through the exams, everything that you’ve done the last four, five years is building that moment. So the stress levels are just monumental. [Prateek]And I think a lot of that also comes from you hear what other people are doing, but you need to it’s a really silly phrase but you know, you do you, revise how you find best, you know, if you need to take half an hour to go to the gym. Do that just because someone else isn’t done. mean you shouldn’t? Because it’s ultimately, it’s your exam, it’s your degree and you need to get through it at the end. So stick to the ways that you know best stick to the way that I’ve got you through four years of dental school. And they weren’t say you’re wrong, [Jaz]It’s just another exam. It really is just another dental school exam. Stakes. the only thing is mental in a cycle, the stakes are a bit higher. Okay? And that’s why you work it up too much. But if you did well, in your third and fourth year, for example, then you know, you shouldn’t look at it any differently. And if you know, if you keep a cool mind about it and go with a level head, you’ll be absolutely fine. So good luck to any student who’s listening to this, I hope me and Prateek have helped you in any way at all to to get more marks and get through dental school successfully. Prateek, what was your website so they can check you out on there? [Prateek]dentalnotebook.com. Got lots of useful resources for finals. [Jaz]Brilliant. Now it’s a great website. And while I’m keeping out, man, thank you. Yeah, thanks so much, man. [Prateek]No problem. Happy to do it again. [Jaz]Let me know if you need anything in terms of, you know, advice about work or [Prateek]Yeah, once I start narrowing down a bit more, I think I will come pestering you. [Jaz]No, anytime, mate [Prateek]Alright. Cheers, man. [Jaz]Take care, bro. Jaz’s Outro: So that’s it. Thank you so much for sticking right to the end. I really appreciate it. If you like this podcast, please. You know, write me a review on wherever you listen to it on iTunes, Apple, Google, wherever you listen to it. Write me a review. Let me know what you thought. I’d like to read comments, obviously. And keep in touch. I’ve got some great episodes coming up. Mostly around the occlusion stuff that’s I’m really mad about but if any one has any recommendations. I’m doing one soon about “A question I get asked commonly by young dentists: Which course should I do?” So I’ve got somebody speaking about that as well. So I hope you enjoyed and thank you so much for listening all the way to the end. Have an awesome week.

Sorry about the delay fellow dental geeks – I have been enjoying fatherhood, revising and sitting my Ortho Diploma exams, and then was part of the epic experience that was Dentinal Tubules Congress 2019! Now I am ready to edit more episodes =) Need to Read it? Check out the Full Episode Transcript below! In Episode 12 I am joined by Ivan, aka The Implant Ninja! In this episode we discuss: Checking occlusion of your implants Implant protected occlusion Grey area of implant occlusion – at what point do you shift the load and share it with implants? Canines that are restored with implants – do we still aim for canine guidance? Do we need balanced occlusion in full arches? What do you tell your patients about implant longevity? Work/Life balance How to identify red flag patients (absolute GEM!) Having a system for your practice to produce content for social media As promised in the episode, the link for early, early bird registration for Tubules Congress 2020: https://www.dentinaltubules.com/congress-early-bird Implant Ninja’s Instagram to learn about his books and courses: Implant Ninja Click below for full episode transcript: Opening Snippet: All right, so there's two categories. There's red flags, and there's deal breakers. Red Flags means like, watch out. Deal breaker means I'm not going to treat you. Okay? So if there's two red flags, so this is just how I trained myself, if there's two red flags. We can't see them... Jaz’s Introduction: Hello fellow dental geeks and thank you so much for joining me for Episode 12 today. I am so sorry that I haven’t been posting so much at the moment. Basically, life got in the way. My wife had a baby. His name is Ishaan. I sort of referenced it in this episode. So this was recorded when Ishaan was two weeks, now he’s near a 10 weeks. So it’s taken two months for me to produce this episode. But going back on track now for lots more episodes coming up your way. I also had two other big events happen in my life. So one was my ortho exam. I’m doing a postgraduate diploma in orthodontics. And that’s now finished, please say a pass with distinction. So super happy about that. It was great to have been through the diploma but you know, when you’re like studying for an exam, it’s like finals. You like studying, studying, studying and then you just can’t wait for it to be over. So I’m glad it was over but honestly had a great time in Manchester with Mohammed Almuzian and the ACE group of orthodontics. So that was amazing, so good news to share with you in that aspect. And of course, if you’re on social media in dentistry, you would have heard about the Dentinal Tubules Congress 2019 it was a huge success. And I got to welcome to the stage Professor Marcus black because I was chairing the morning session on Friday, and also one of my heroes in occlusion. Dr. Michael Melkers. And he put on a great show. So the Congress was just phenomenal. So there is an early booking sort of system happening at the moment again, early bird discount for for the Congress2020, that’s a Dentinal Tubules Congress 2020 I don’t get paid to say this. I’m telling you because I want you to come I want to meet you there literally is the best dental conference/congress. I really is none of these things. It’s an experience. Along with his post I’ll post a link for you to become I think you can only book until the 17th or the 18th of October, so not long left for you to get your early bird discount to secure your place for next year. It’s held in Heythrop park in Oxford, which is a great place we sort of dominate the entire sort of resort if you like, and it is just phenomenal to come next year some amazing speakers like Mario Semenza, Didier Dietschi, Ed McLaren, Ian Dunn and Boota Ubhi, Tif Qureshi, James Baker, Andrew Chandrapal and Gurvinder Bhirth again. So do check that one out. So today’s episode is with implant Ninja, his name is Ivan, and it is full of gems, and it sort of went in a few directions that I wasn’t expecting to go for the better. And honestly, it’s phenomenal. So I’ll tell you how it’s broken down. I want you to think of this episode as it as though it’s broken into three parts. The first part we just discussed about implant and occlusion. So that’s the whole, you know, the crux of it, the clinical knowledge. And to people who are placing implants, it might be quite basic, hence why I titled it basic implant occlusion. But for those maybe dental students, DFs or those who just don’t deal with implants, so that there is some knowledge in there to be gained. And I also ask questions such as, when you’re replacing a canine, do you still want a, with an implant, do you still want to have canine guidance? And things like that, basically. So that’s the first aspect is the first part of it, we’ll be talking about implants occlusion. The second part of it, we’re talking about how Ivan, who’s a super busy guys, prosthodontist can achieve a good work life balance, and it’s very interesting, the way he’s designed his life, you might find that it’s very difficult to, for you to be able to recreate that. But actually, I think if you put your mind to it, you can set up a scenario where you’re working the right number of days for you. So you can have the right number of days focus on you know, the energy can go elsewhere in your life where you wanted to go. So we talk about how you choose work life balance that’s worth listening to. And at the end, we talk about how he screened his patients or rather how he has delegated now and trained his team to screen for patients who are red flag patients and what we call deal breakers, patients who he refuses to see. And this is so so amazing. This is knowledge and I want to apply it straight away. I’m going to train my staff up to to sort of watch out for these things when they’re dealing with phone calls or Facebook advertising stuff. Red Flag patients it’s really really great insight. So I hope you enjoy this episode as much as I enjoyed recording with Ivan, he’ to the top guy. And at the end, I can reference to his you know his online profile so you can learn more about what he has to offer. But before we dive into the episode I want to share with you today’s Protrusive Dental pearl, and this one is inspired by my good friend Zak, Zak Kara he told me to listen to James O’Brien’s podcast called full disclosure. So I checked it out. And I listened to the episode with one of my heroes, Malcolm Gladwell. And it was an interesting quote that Malcolm Gladwell said, it’s basically, there is something unattractive about someone who cannot change their mind. So there is something unattractive about someone who cannot change their mind. And I totally agree with this. And the context into which he was asked this was along the lines of what if you were proved wrong in one of your arguments, and one of your sort of theories. And what Malcolm Gladwell says, I really love is that you know what, I get happy in a way when someone proves me wrong, so I can improve myself. And I think as dentists, especially as reflective practitioners, we need to adopt this attitude. So if you are, if you know, hopefully not like this, but if you know, someone who is very, you know, “set in their ways”, and with new techniques, coming out better ways to do things, they are still, you know, keeping within that comfort zone and doing things the way they they’ve always done it just because of convenience, or economics or whatever. And they don’t like to be prove wrong, or they don’t change their philosophy or change their techniques or change their mind, then that is an unattractive feature about someone. So don’t be that guy, be someone who, you know, if someone came to me, and poo pooed, my work and said to me that you’re dealing with your case is all wrong, because of x y z, and that was credible, and there was evidence for it. And actually, I’d be like, you know what, thank you so much for showing me a better way. And I would like to think that I jumped ship completely overnight, and to do it, the, you know, the proven better way. So totally, it’s totally cool to change your mind, change your techniques, if it benefits your patients, if it benefits you as a dentist, so don’t be afraid to you know, just because you’re doing something a year ago to change your philosophy, don’t feel that people will look at you as Oh, you know, he used to it that way. And now he or she is doing a complete different way. What does that show about their beliefs or whatnot? Well, actually, you know, times are changing, techniques are developing you know, it’s a good thing to change your mind in dentistry and how, what kind of practitioner you are, change is good. So let’s dive right in with Ivan the implant ninja. Main Interview: [Jaz]Ivan, aka implant ninja. Thank you so much for joining me. You are from the States. Where about in states you speaking with me from? [Ivan]I am in Stockton, California. [Jaz]Oh, California, lovely place. And what’s the weather like today in California? [Ivan]Oh, it’s probably gonna be like 105 degrees. It’s, you know, we say California is not like, you know, it’s not like beachy, beautiful. I mean, it’s Central Valley. Lots of farms. Lots of problems. Like it’s not really like the nicest part of California. [Jaz]And did you grow up in California? [Ivan]Nope. So I was born in Lima, Peru, and I immigrated with my parents when I was two years old. We moved to Florida and then moved all around and ended up in Bay Area of California. [Jaz]Okay, and people from Peru, what’s the the national language approved? I’m sorry for my ignorance. [Ivan]It’s Spanish [Jaz]I thought so. So you are fluent in Spanish? Yeah? [Ivan]Yeah, I am. I mean, I speak like a gringo. But I still speak Spanish. [Jaz]Brilliant. And so tell the listeners out there a little bit about yourself about implant Ninja, and the type of practice that you have. [Ivan]Sure. So I’m a prosthodontist. I, you know, after my parents, I kind of like followed in their footsteps. They’re both dentists. And I decided that I kind of like their lifestyle. They, you know, growing up, they always went to my, you know, science camp, my field trips, and I wanted to do the same for my children. So, I decided I want to be a dentist and kind of have a flexible schedule. So I went to UOP dental school in San Francisco. Then I got married, I dragged my wife across the country went to University of Michigan, for prosthodontist. [Jaz]Is your wife, a dentist? [Ivan]No, she’s not. She is a hygienist. And so we actually graduated in the same ceremony. And she’s actually I met her in high school, because I would kind of a troublemaker in high school. And I ended up getting in fights and trying to like start a business in high school. So I ended up getting kicked out and I had to go to another city to go to high school. [Jaz]Wow, what a story. [Ivan]But it was great because I met her. And [Jaz]It’s destiny. [Ivan]Oh, yeah we’ve been together ever since. So yeah, I dragged her to Michigan. I think she was a little resentful at first about it, because it’s so you know, it’s so different from California. And I did my training there for three years. [Jaz]And she was also doing her hygiene school training there as well? [Ivan]So she so both of us finished our training. So I finished my dental training, she finished her hygiene training in California, and then we moved to Michigan, so I could do my prosthodontics. And just so she could, I guess just be with me. So she’s she got a license out there. I got a license out there. So we both work. We’re working at the same time. [Jaz]Okay. The reason I asked her about it, whether she’s dentist or hygienists is pretty much close enough really is because as dentist, we’re a very incestuous bunch. My wife’s a dentist, I know plenty of dentist married to other dentists. So even dental nurses or hygienists, or whatever, you know, so we do have a pretty closed loop. [Ivan]Yeah, it’s true. [Jaz]Fine. So tell us about implant ninja. That’s a really cool concept you’re going to have going there and tell us about how implant ninja came to be [Jaz]Sure. So I was in my prosthodontics residency, and I just started posting about my stuff I put start posting my cases, because one of the big pain points for me was when I was learning implant procedures in my dental school, there was not good resources. I remember I was doing a full arch case. And I was leaning on my instructor heavily for, you know, help with the case. And he told me to look it up on YouTube. So it was very, very, very hard for me to figure out what the heck I’m supposed to be doing with these cases, especially because like the senior dental students, they didn’t want to do these cases, because it didn’t fulfill their requirements. So they pass them off. And I was one of the people that was collecting as many implant cases as possible. So I decided that as I’m learning, I’m going to be posting things and bringing those in 2016 that I really started posting a lot and I found out that people really appreciate it a lot. So I decided to put it all together in a book. And it was a really, you know, really basic handbook. Nothing [Jaz]Is it the All-on-X? [Ivan]Yeah. The first edition of the All-on-X Handbook, and it got such It was like received so well, like a lot better than I thought it would be. And it was really actually I think, because it’s so unique. Most textbooks are so dry, and you know, you buy them to sit on the shelf, because you don’t want to read them. I don’t think anybody has time to read textbooks. So I wrote it in a way that’s like, you know, you’re having a beer with me. And I explained basically in plain English, what I’m doing. And so that was really popular. [Jaz]That’s really good. I really loved the title, you know, All-on-X. It’s just it was I really when I saw that on your website that’s cool. So I think that’s really cool. You had a lot of success with that. And then how that evolved into you’ve got lots of like a training series like videos now. [Ivan]Yeah. So I think that there were not too many dentists on social, on Instagram back then. And so I got, you know, I got a good size following. And I went to the DIA conference last year. And then I that’s when I realized that people were actually like, real people were actually listening. They came up to me, they said, hey, I’ve been following you for years. And I’m like, wow, that’s, not you know, I didn’t think anybody was listening. Right? I just and so since then I’ve gotten serious, you know, I try to really focus on the end user and the user experience and like what they would appreciate, so I think of them now. And so I kind of translated that into what I think is the best online dental implant course. Because like, I’ve seen implant courses, or I’ve seen sorry, online courses where you buy it, and it’s like a set of like, 10 videos or something. And I you know, that’s not that I think that’s given online courses a bad name. And so I’m very, very cognizant of that. [Jaz]How’s yours different? [Ivan]So mine, I really strive to do is make it interactive, and make it feel like I’m there. So the way I do that is by I have it in like quarter systems, you know, kind of like an academic school year. So we’ll start one shorter. And then there’s topics that are covered, and I’m available. And I’m doing like live demonstrations and things like that. So that’s kind of its way different. It’s pretty comprehensive in the set of like instructional videos, downloads, homework assignments, but on top of that, there’s a personal element to it. So like I actually mail you things, I actually like physically, feels like I’m physically there I think so that’s what I’m trying to do. [Jaz]That’s really amazing. I think something that I’ve set on time and time again and again on my podcast is standing on the shoulders of giants and you’ve had obviously mentors that you’ve followed, and you’re trying to package your contact to accelerate learning for others. And that’s what I think the new era of dentistry with all the different even on Facebook is certainly helpful forums, YouTube there’s lots of great stuff there that you can learn on and just messaging and study groups as well physical study groups, there’s always opportunities to learn and advance quicker there’s no point in reinventing the wheel. [Ivan]I think so but it’s I feel like it’s a little bit cluttered right now. That like for example, YouTube, you go to implant surgery YouTube, right? If you look up implant surgery, you’ll see like 100 different things, but you don’t know which one is you don’t know the context behind any of them. You’ll see implant going in, and then you don’t see like, okay, they didn’t tell me what they were doing. They just had some weird music in the background. Like I don’t know the follow up. I don’t know that. You don’t know anything. [Jaz]So you have to be careful, obviously, when you’re looking at content, when you’re trying to learn from that to actually, like I said, Have some context and some to actually make it educationally focused rather than someone just showing off their skills or showing off the hey, here’s a treatment. [Ivan]I think most people are just showing off their skills these days. And that’s why I feel really really confident that I’m going to be very successful because I’m very straight up like I’m not the best clinician, I feel like I do good work. I feel like I know these important things, you know, in and out, but, you know, I’m just like a regular dude that’s trying to share like what I’ve learned. [Jaz]Beautiful. So now that leads me very nicely on please share with me, Ivan. Okay, let’s discuss this as you know, my podcast school Protrusive Dental podcast, it’s got a bias towards occlusion, something I’m quite passionate about. I want to know from you about occlusion and implants. So let me tell you a little bit about my knowledge with implant and occclusion and basically with a single implant and and please tell me how you tackle it. With a single implant, let’s say replacing a molar and premolar, once you place your crown, after we know we’re doing a delayed approach, or whatever, it’s not getting too much into that, or maybe that’s part of it. So you can tell me, but basically, when everything gets together, the implant should not be holding shims. So shouldn’t obviously, are eight microns or 12 microns depending on which have you buy and it should be passing through. ie is the implant protected occlusion, So tell me, correct me, in terms of what I’ve said there in terms of a single implant and occlusion on that [Ivan]I think you’re spot on. And I think that if the patient has a full set of teeth, and they’re just replacing one tooth, it’s very simple, right? You just kind of leave that implant out not holding shim. And that’s pretty slam dunk case. The only other thing that I would add to that is that you would check the excursive movements. So you know how articulating paper has one blue side, one red side, usually I just put the blue side, have them bite down, tap, tap, tap into CEO. And then I would turn the articulated paper to the other side and have them do their excursive movements. And I make sure that my implant does not have any contact in excursions. [Jaz]Perfect, brilliant. So that’s the very simple case. Now, what about when you increase the number of implants? So this is, you know, we’re discussing before about the gray areas and you know, suddenly, well, what if you have like, three or four implants scattered? they’ve collected over time, and then you’ve also got natural teeth, which is maybe a scenario? I don’t know, is that a common scenario? Or not? Because it might not be common because either they need a, you know, full clearance and all on x? Or maybe they need they just have the one or two implants. But do you see that sort of a transition phase where there’s sort of strategic implants placed And there’s lots of teeth there as well? [Ivan]Yes. So I think the way to approach this question is, I think basing it off of a number of implants, is probably not the best approach. I think the best approach is seeing how stable is there occlusion otherwise, right? So if they have, I mean, if they have multiple areas of, I guess, multiple edentulous areas, and they are relying heavily on the new areas that you fill in, so if you have to restore occlusion to them, so they’re missing, I don’t know they’re missing two molars on one side, they’re missing three molars on another side, they’re missing canine or something. So if you’re reconstructing the occlusion into them, you have to depend on your implants to recreate those excursive movements and recreate some of the occlusal stops. So that’s like, that could be so many different scenarios. But you have to make that distinction, whether you’re recreate, you have to recreate the excursions and the occlusal stops, or if it’s already created, and you’re just filling in some voids. So, I mean, I would love to say like, Hey, if you’re doing more than three molars, you should recreate some of the working with some of the working movements, and some of the occlusal stops. But it’s real. It’d be hard for me to say that as generally [Jaz]It depends on so many factors. Yeah. And I completely respect that. And how about in situations whereby, you know, canine guidance is something that we use a lot for restorative convenience, the fact that it’s a good distance away from the temporomandibular joint. So the forces are less. What if you have a single implant replacing a canine and everything else in the tack? Now, in that situation I imagine that actually in that case, you don’t want canine guidance. Is it fair to then shift your guidance in that case to maybe group function and actually, to include or not to include the canine? Have you, I’m sure you must have encountered situations of replacing implants in canines. [Ivan]Yes, I think that is totally reasonable to do that. But so if they currently have canine guide, if they had canine guidance, and then you’re trying to shift them over to group function, sometimes it’s easy and sometimes it’s hard to some if it’s easy, if they are very close to being a group function, so if the rest of their teeth are just barely almost, you know, in contact with each other during the excursions, but sometimes that movement is a little bit further away. And so if that canine is gone, and if you can recreate the group function, I definitely would, but if you have to alter a lot to get there, then it’s a little bit difficult, you might have to do a little bit more work than you anticipated. To get that group function you might have to, you know, rebuild with some composite or rebuild with some crowns or combinations. [Jaz]Absolutely. So, let’s just now move on to full arch cases, something that you’re going to do quite a bit of so full arch dentistry. And when we look at complete dentures, so complete dentures with no implants supported the whole concept of the balanced occlusion or the lingualized occlusion so as the patient sort of excursus to the right, there’s still some contacts on a non working side to balance everything. How does it, is that have a role in implant full arch cases as well? [Ivan]I personally don’t think so. I, in my full arch cases, I restore them to a group function, it’s not going to be the same. It’s not the same proprioception it I mean, I guess what I’m trying to say is that with natural teeth, you want the heightened proprioception will help you to disclude your teeth and protect your teeth. But with full arches, I don’t have them rely on specific points about arch because what I think is most likely to happen is for that prosthetic material to fracture. And so I would rather put the patient in our group function, and no, I don’t have balancing contacts. I feel the balancing contacts, like in dentures is more useful for stabilizing the dentures. But these full arches don’t necessarily have to be stabilized. [Jaz]Absolutely. And one thing that I see a fair bit off is people coming in with, you know, a screw retained implant crown, let’s say, and they come in Oh, my implant crown is loose. And obviously, it just needs the screw tightening a little bit. Right? And I usually a quarter return. And that’s a very common, like in a mini emergency that you would see, is that right? [Ivan]Sure. Yeah. [Jaz]Do you think that you see that more in patients who parafunction as an observation that you made? Is that is that something that you buy into? Unknown SpeakerSo I’ll give you an example I, there was a patient that I placed in so, it was a scenario, where I go to other offices to work in their clinics, sometimes, and some clinics are faster paced than others. And I’m not proud to say this, but for one patient, I, you know, he had a treatment plan already, he had an implant already treatment plans for number 11. I looked at it, I was like, ‘Okay, great. Looks good. Let’s do it.’ So I did the implant. And then I went to restore him, you know, four months later. And then I was delivering the crown. And I kept checking the occlusion and the occlusion would never go away. So like, my blue dot never went away. Right? And I kind of took a step back, and I looked at the whole scenario. And it turns out that in his entire mouth, even though he had, you know, he had most of his teeth in his entire mouth. He was only occluding on the tooth that I was delivering. That was the only one. And so you know, he came back a couple times because the prosthetic crown kept fracturing. And he was a case parafunctioning on top of that. So I do see that my patients that have parafunctional habits tend to have more screw loosenings. Just kind of like, from my experience, but I don’t know if it’s, you know, directly related. [Jaz]We’ll never know in terms of that study probably is very, it would be very difficult to conduct but something I’ve noticed that patients come in and those with a bigger masseters and have other worn teeth. Those are the ones that come in, ‘Oh, my screws, again needs tightening.’ So that was just an observation I made. So Ivan can tell me any other principles or anything that you want listeners to gain in this sort of topic of occlusion with implant prostheses? [Ivan]I think it’s important to Yeah, I think there’s one takeaway from it, and you probably talked about it before, but to get shim stock. That’s like the easiest thing that anybody could do to improve their clinical practice, use shim stock, and the other conventional articulating paper. I guess, one good takeaway point would be drill home that no occlusion on cantilevers, right? So there’s no occlusion on cantilevers or full arches. And what I even do for several of my patients, and I tell them ahead of time that I will use a shortened dental arch concept. So I’m not going to be restoring for full arch, I’m not going to restore two pre molars and two molars, right? So I might shorten it by a molar, or if it’s a case where I cannot get enough posterior support with the implants I’ll even shorten it to one premolar and one molar. So you know, semi unconventional, but if the patient does not have a huge smile, and if they’re okay with that, then I think it works really nicely. To have a shorter arch and less stress on the implants, [Jaz]Less stress on the implants and less stress for you as clinician as well going forward? [Ivan]Yep, for sure. [Jaz]How often do you think implant crowns are, you know the longevity of them in terms of the fact that obviously they don’t have a periodontal ligament, so they take a lot more stress and strain within the prosthesis itself. And obviously, you get a very commonly crown chipping porcelain fracture, prosthesis fracture. When you consent your patients, obviously, you know, just tell us what is your, what do you tell patients? I’m your patient, I’m having a Upper premolar, or molar replace, what what kind of things Are you telling me in terms of what to expect from the longevity of both the fixture, the implant fixture and of the crown? Can you give us a flavor of that? [Ivan]Sure. I mean, it’s probably same thing that you tell your patients, I tell my patients, ‘Look, what is generally accepted for longevity, these things is 10 years, if you got it more than 10 years, you’re doing good. But a lot of that depends on, you know how often I see you, if you’re coming to all of your maintenance visits, if you’re getting your other teeth taken care of, then I feel like we can get you, get this to last for you a really, really long time.’ I’m not going to tell them, it’s going to last them 20 or 30 years, I’m not going to tell them it’s gonna last forever. I always under promise to all my patients, for sure. And then I try to over deliver to them. But yeah, I tell them that I wanted to get to 10 years and if we can get it longer, awesome. They got to come to the maintenance. [Jaz]Brilliant. And you tell them though, that ‘Oh, I’m expecting the implant to be maybe, you know, hopefully going strong. But sometimes the crown itself needs more regular replacing, or is that something that is not part of the process? I’m not sure you tell me [Ivan]Sure. Yeah, I’d say it’s a 35 year old patient, I will tell them that most likely to get this crown redone at some point. And I tell them that even though implants have a really high success rate, they also can have a higher complication rate in the long run. So this is not one and done. You’re not gonna, This is not the last you’ve seen of this implant, you’re going to have to do something to this in the future. Whether that is I don’t know, you’re gonna have to get it cleaned. But whether you’re gonna have to get some revision to it in the future is totally realistic. So I definitely warn them ahead of time because implants. I mean, our patients often think that implants are the solution, and it’s permanent, and they’re just not gonna have to deal with it anymore. And I just want to, I want to make sure to, to reset their expectations. [Jaz]But that’s really important. And I’ll tell you a story about a dentist in in England, in Sheffield, who I heard about, I don’t know who this dentist is, but you know, we all talk about this dentist who very famously, as part of this consent process for implant provision, he will bring the patients back for a separate appointment prior to implant placement. Okay. And he will give them a quiz, he will actually test them. Okay, you know, how long will your implant last? What type of complications can you have? So that should be like an examination, you know, like a school test, okay. And he also charges money to his patients for the privilege of doing this test. [Ivan]That’s amazing. [Jaz]So whoever you are, if you listen to this podcast, I love you. You’re doing great. That’s awesome. As consent to the max. Let’s leave that very fun discussion about occlusion implants. And let’s go to even more fun stuff. Ivan, can we talk about family and work life balance? [Ivan]Really, that’s like the most important topic for me personally, I think about on a daily basis. And yeah, there’s nothing more important than that. [Jaz]Amazing. And I talked to my listeners. Two weeks ago, my wife gave birth to a baby boy. So this is a huge part of my life. I’m may sound okay, or maybe I don’t I’m not sure, but I’m extremely sleep deprived at the moment. So it is. [Ivan]Is that your first? [Jaz]It’s our first Yeah, absolutely. How many children do you have? [Ivan]Congratulations. I just have one. I have one little girl. [Jaz]Brilliant. What’s her name? [Ivan]Her name is Olivia. And she’s two and a half. [Jaz]Amazing. So tell me how do you balance your wife, Olivia. And is it your practice? Do you own this practice? [Ivan]I own the practice. I don’t own the facility. [Jaz]Okay. So yes, you run your own practice, you run the practice or not? [Ivan]I do. [Jaz]You run the practice. You go to other clinics to place implants. You run a very successful implant training program, implant ninja. You’re very active on social media and I think you do a fantastic job of that. You have time to speak to me from the states to here for this podcast. How would you fit everything in and obviously some of you disclose now you’re very passionate about this. Please tell us, how can we run our lives better? [Ivan]Oh, gosh, I don’t know. [Jaz]Tell us about you. You do you. Tell us about how you make it work. What are your philosophies? How does it happen for you? [Ivan]Sure. Okay. So for me, family, above everything, for sure. But I’m the hardest worker that I know at least. So let’s see, I’ll just, I don’t know, like a formula, but I’ll just tell you what I do basically. So when I was going to, when my daughter was going to be born, she was born with a condition and it was uncertain whether to she’d be able to survive birth. And so my wife and I really focused a lot on finding the right experts to getting her, you know, safely delivered. And then her situation managed, because she was highly unstable for a while. And so I was unable to work, a conventional job. So I had to find the most, the highest paying job for the least number of days. And so I always, like looked at my time as, like, allocation of scarce resources. So anything that I’m doing my I have to allocate it for the biggest return. And so my daughter is doing fine now, by the same, I still got the same philosophy, I limited my practice to dental implants. And so what I did, even like three years prior to graduating, I made my website for my clinic. And so by the time I graduated, I was already getting phone calls to my cell phone for full arch cases. [Jaz]That is amazing. I mean, the level of dedication and enterprise that you showed there three years before, that’s great vision you have, [Ivan]Oh, thank you. Well, actually, sorry, it was two years before, because I knew that it takes a while to climb in the rankings in Google. And I really made my content very, very specific, so specific to the all on four. And I saw that most people just put marketing out there. But I actually made a handout. I made a PDF, like handout it was like 50 pages or something made it for free. For anybody that wants to learn, like on, a from a patient’s perspective, what Implant Dentures are all about. And all in four so that got me a lot of patients actually. And sorry, I tried to always keep cash flow as King. So I’m not gonna, I didn’t take out any loans for my practice, I just, you know, started seeing patients, I let the cash flow come in. And from the cash flow, I hired my staff, and kind of like, reiterated, and I got my practice going. And I kind of maintain that same philosophy. I don’t work five days a week, I only work two days a week with clinic. And I screen my patients very, very, very heavily. Anybody gives me a hard time. They’re out of here. Like, I feel like a jerk for doing that. I feel like like I’m a prima donna or something. But, honestly, like, I care about my managing my stress so much. Because life is just too short. [Jaz]This is amazing. This is just so good. This is. I’m loving this, as soon as you say that, you know, I’m sure anyone who’s listening to this or any dentist, listen to this right now. As soon as Ivan said, about this concept, you’ve automated had four or five names of different patients or patients that face come up. I know what I wish I screen them better. How do you screen them? Tell me your screening process? Is this within the two days of clinical that you have? Or is this a separate day or describe [Ivan]Within two days, it’s within two days, I have a list, I have what’s called a red flags list. And I train my staff to screen my patients for me. So my staff, my treatment plan coordinator will see the patient first. If there’s any red flags, they will, if they’re red flags so much that they’re you know that they’re nixed from the practice, they’re gonna dismiss the patient before the patient even sees me so they don’t waste my chair time. [Jaz]That is super connected. I’m sorry to chip in, but I really, really, really interested in this. So if it’s okay, when you can share what you mean by red flag. So what I interpret as a red flag, okay, is let’s see expectations that are not realistic, for example. So for example, someone says, I want implants, and I want them to last forever. And they’re adaman that’s the case. And that’s an obviously it can vary or any restoration anything. If they have expectations that’s a red flag for me. Is that the sort of thing you mean, Ivan? [Ivan]Yes, exactly. [Jaz]The red flags. Tell me what are these red flags? I’m really interested. Okay. [Ivan]I feel like I’m going to get some judgment on this because I’m so picky, but I’m going to share it with you anyway. [Jaz]Everyone, please don’t judge Ivan. I think what he’s onto is really good. And actually, you know, if it means that we have a more successful practice with less stress, less repeat dentistry, less failures, because if patients are red plans, you know, it’s typical that they have the most failures. So let’s listen to Ivan and don’t judge him. [Ivan]Alright, so there’s two categories, there’s red flags and those deal breakers. Red Flags means like, watch out. Deal breaker means I’m not going to treat you. Okay? So if there’s two red flags, so this is just how I train myself. There’s two red flags. We can’t see them. So these are the red flags. [Jaz]And so a two red flags are like a deal breaker. Yeah. Okay, this is like in GGG, do you like soccer? There’s two yellow cards and a red card. [Ivan]Make it a soccer analogy for my team to be more fun. You’re banned. Okay? So red flags. Now the first one is says the word perfect as in, I want my teeth to be perfect. Okay? Somebody says they want their teeth to be perfect, but they’re perfectly nice patient. Otherwise, if they’re like a really nice human being, and really compliant, that’s okay. I’m willing to work with them. Alright, next one is a smoker that just will not stop smoking. And, you know, going through like two packs a day or something. [Jaz]Alright, good. That’s very sensible. Good. [Ivan]Next one is a poor health. I know, it’s very general. But what I mean is like an uncontrolled medical situation that they’re not motivated to take care of on their own, if they’re not motivated or take care of themselves. [Jaz]Okay, so we’re talking like diabetes and just generally not look at themselves other conditions, [Ivan]Yes but not just diabetes, or diabetes, and they’re not. And they tell me straight up, like, I’m not working on improving, if they tell me that, you know, they’re just not going to help themselves. [Jaz]Or maybe they, you know, they have been prescribed, let’s say, a Cpap for obstructive sleep apnea, for example. And they just don’t care. They don’t want to wear it. And obviously that can have issues with you know, perhaps parafunctional, bruxism, that sort of stuff. Is that would that count this is obviously me going back full circle to occlusion again. [Ivan]No, exactly. It’s somebody who basically shows that they’re not compliant with other recommendations, others. Alright, the next one is they’re looking for the cheapest possible treatment. If somebody’s looking for the cheapest possible treatment, that means if something goes wrong, and you have to modify your treatment a little bit, that person is just going to lose it and or they won’t be able to afford the right treatment. You know, I tried to deliver really good treatment, but if somebody is trying to cut corners with everything, you really just can’t get a good outcome. [Jaz]Brilliant [Ivan]All right. The next one is depression. It’s really hard to work on somebody that has depression, especially if they’re relying on you to fix their problems to get you know, it’s too much pressure on you. Okay, yep. All right. Some another red flag is got a refund from a previous dentist for their work. [Jaz]Absolutely all they say that ‘Oh, yeah, I just sued my, obviously I sued my other dentist now I’m here to you that to go watch out on that one as well. [Ivan]Oh, sorry. So that so sued. So that’s actually my deal breakers category. Any lawsuit? They’re out of here. No second chances. I have two more red flags. Next one is that they talk so much that they interrupt you during your explanation. So somebody that always interrupts you. They basically take up double the chair time of anybody else. [Jaz]Yep. True. And if I came to your clinic, I would probably not be getting an implant. But this is something you have to deal on your podcasting. Sorry. [Ivan]Good. Alright. And the last one is just generally a bad vibe. So I trust my staff’s vibes, if they get a bad vibe from somebody, and they just can’t explain it. I just, I really listened to that. That counts as a red flag. [Jaz]Awesome. And honestly, I have no judgment. I have literally. I mean, I don’t know we’re talking about there was zero judgment that everything you said was completely reasonable, in my opinion. [Ivan]Okay, well, thank you that’s good to hear. I’m glad that we sympathize with each other because these are really important for me to keep my stress levels down and work family life. Because if you’re not managing your stress, it spills over to your family life. And what ends up happening is you think about it at night before you go to sleep, you know, you think about should I have done something different in that case? [Jaz]We’re all guilty of that. But yeah, deal breakers, go for it. [Ivan]So my deal breakers, I’m just gonna list them all in one sentence. So drug abuser, involved in a lawsuit, complained to the dental board, IV bisphosphonates and patient wants a bone in the mandible with radiation at above 55 Grays. So let’s say that’s not their, It’s not their fault, but it’s just I’m not going to place implants on. [Jaz]Yes, because it’s high risk treatment that you know, as part of a life decision that you’ve made to, to have less stress in your life that you’re following that and that’s completely cool, man. [Ivan]Thank you. So yeah, that’s how I filter my patients. So I filter it heavily. And I try, I’ve actually another thing that I’ve done for work life balance is raising my fees, got to raise your fees, too. So that way, I feel good about the treatment that I’m doing. I feel good about spending more time with my patients. And I guess just jumping over to social media really quick. It’s really hard to be active on social media as a clinician, you know, if you’re, first it’s hard to capture the media on your patients, you’re stopping mid procedure, you’re taking pictures, you’re taking video or something, you could potentially compromise your patient’s treatment. And then in between patients, you’re like posting and you got to write a, you know, a clever caption on your post. It’s really hard, and I feel like people can get burnt out on and I was showing burnt out on for sure. [Jaz]Okay, so how do you get out that, man? [Ivan]So it’s all about the system. So before I was manually doing, I was taking pictures, I was uploading no more. I can’t do that anymore. I am so busy that I have to have my team do it, but they have to follow my system. And so we developed the system for social media, where we have to surf on any given clinical day, I have implant surgery in the morning, we record that. And we have a system already, I have to do intro, I do voiceover and then I do an outro. They record that. And then, [Jaz]and this is like a Instagram story like that? [Ivan]Sure. But the thing is like, I don’t make it, before I used to make it so that I take that in to put on Instagram in an Instagram story. But I want to make sure that I get the highest return for my content, because content is the hardest thing to make, because it requires your time. So what I do is I make one long form piece of content. So one long piece of content about my day. So that’s going to be a clinical video, that’s going to be something that interesting that happened to me throughout the day, and some pictures of my cases. And then my staff will go ahead and process that into a video, they’ll clip that into stories, they’ll do it already for me. And they’ll pull relevant pictures that seem cool, or little clips of video that seemed cool. And then they will save that to automatically post using, you know, like, you know, one of those automated social media posting things. I use Hootsuite. And so that posts it automatically. And then they’ll determine what’s relevant for LinkedIn, what’s relevant for IG post, Facebook posts. So there’s a lot of different social media outlets. So I want to try to get the most bang for my buck, so to speak with my content, because that’s the hardest thing to make. So now that I have, [Jaz]I’ve been I mean, I’ve got a picture of all these, like 17 year old girls working in your clinic. Because that’s the only people who are so proficient with all this, like technology stuff I like, I feel as though if I was to implement this in where I like, people like what the hell is this? What is an Instagram? [Ivan]No, no, it’s actually totally the opposite. I actually have I mean, it’s actually just not 17 year old girls, I feel like, the thing is, if you had a 17 year old girl, you might not be able to stick to your regimen. So I’m very, very strict with my protocol, we follow the protocol, everybody’s on the same page, the content gets distributed, boom, it’s good. So it’s got to be very, very systematic. That’s the only way to do it [Jaz]And obviously you’ve allocated, protected time for your staff so that they can carry this, these duties out at, you know, to the best of their ability, and to be able to follow the system then also, at the same time is doing all processing, taking phone calls or booking patients and being a treatment coordinator. How would you allocate these roles? [Ivan]The stuff because in order to know what is interesting for social media, the person has to know what a dentist likes. So it’s actually my treatment plant coordinator. My treatment plan coordinator at the end of the day, he will look over all the videographers footage, so I actually have a videographer also, all he does is record and edit. About my treatment plan coordinator will review all of the content, see what’s interesting, put it you know, put it together chronologically, and then he will distribute everything. [Jaz]That is amazing. [Ivan]It saves me so much. [Jaz]I’m just just amazed. It’s so so good. So this is exactly wanted from you about work life balance. So we already talked about how you keep stress levels low by filtering out red flag patients. You’ve talked about how you’re maximizing your time in the clinic, with the way that everything’s arranged, with how the social media outlet is happening. Is there anything else that you want to talk about social media wise? [Ivan]Social media wise, I, before I had a system, I kind of like held back on content production because it all depended on me. But now that it’s systematized, I can make as much content as I want to because there’s a system and now I can go back and actually answer comments and DMs, it was really hard for me to keep up with DMs, because I get like, 100 a day. And then I don’t want to be a jerk, you know, and like not really answer real answers. And a lot of people ask me also, treatment planning questions in DM. So that’s something I still struggle with. But I am actually getting back to everybody now. I think that’s it for social media, man. Aside from that, just the my last thing is I have a dedicated space for work in my house. So it’s actually my garage. I have a huge wall of just whiteboards and that’s where I plan, I have my computer there that I do all of my other work on and I have a dedicated workbench where I can do my demonstrations and things of that sort. So I usually get up really early, always early six o’clock and knock out as much work as possible before 11 [Jaz]Amazing. So you’re obviously two days clinical, a lot of treatment happening those days. And then those other days you’re you know, you’re working on your sort of social media aspect, you’re recording footage. What else you’re doing and you know in the non clinical time. [Ivan]Sure. So for me, online education is the thing that’s like, if I could pick one thing, it’s just online education that I’m pushing that super hard, because I think that is the hugest opportunity that’s available to dentists right now or I guess healthcare and So I’m just pushing that I’m actually working on getting into VR. So I ordered a virtual reality headset tomorrow I have a full arch surgery and I’m going to I’m going to record it and I’m going to record it with a 360 camera and my macro camera so I’m going to record both. Aside [Jaz]That is amazing. Anyone who’s listening please check that out. That’s going to be especially if you’re obviously placing implants or you’re learning to place implants to have to see in the VR is a really cool. Do you know if anyone’s done that already? [Ivan]I have no idea but I if anybody’s done it, I don’t think I’ve done it well, because I’ve checked out some things I know I’m I really wanted to feel like you’re like literally in my office. So that’s the goal and I’m just having a lot of fun with it. Aside from that [Jaz]It sounds that and I can tell by the way you talk about it sounds like you’re having a lot of fun in your life and that’s exactly what it’s all about. Amazing and that’s a really nice story there. Brilliant. I think we’ve got loads of good content there for you know about work life balance and about occlusion. I really enjoyed that. Thanks so much, Ivan. Any anything else you wanted to put in the podcasts, anything wanted to ask you for the podcast or anything. [Ivan]And also, my daughter is having a series of surgeries in the next couple months. And so many of your listeners could put out some good vibes for us, we’re going to be relocating to Seattle to have her surgery done and we’re gonna have some dedicated time just to help my family get through this. We’re very positive about it, very optimistic, but you know, any prayers or you know, good vibes will be appreciated. [Jaz]That is very sweet. Well, you know, from the Gulati household, from my household we’ll be sending all the positive vibes and prayers and I hope everyone there’s a lot of power in collective prayer they say so all the best to Olivia for the surgery and All the best to you and your wife in terms of the stressful period be going through, but I hope everything goes well and please, you know, get in touch. Let me, let us know how it goes. [Ivan]Thanks so much, Jaz. Jaz’s Outro: So I hope you enjoyed that episode with Ivan. He shares lots of really lovely tips. You know, implant occlusion, work life balance. You know, our wishes daughter Olivia all the best and know at the time of this episode coming up, he’s probably in Seattle with his wife and Olivia undergoing her operations. So I hope everything goes really well for you, Ivan, when you’re listening to this. All the people listen to podcasts are with you and you know, our thoughts with your family. Thanks for sharing some amazing knowledge with us. Really appreciate all the stuff about red flags, and deal breakers which I think everyone will love. Thanks for listening. As always, everyone, thank you for all the kind words you’ve been sending to me over the last couple of months. We appreciate it. And once again, join the Facebook page Protrusive Dental podcast, I share a few in educational stuff on there. So please do like the page and share it. Next episode I’ve got a couple of recorded actually, I think next one will be Prateek Biyani for dental students, how to smash your dental exams. I’ve also got a few more which I’ll sort of lay out on my Facebook page. But thanks again for listening. I really appreciate it. Leave me a review on any sort of podcasting platform you’re listening on. Catch you on the next one.

Have you ever encountered the patient with all the signs of bruxism/parafunction, yet they deny this passionately? I see this daily. Patients are in denial that they parafunction – how can we communicate better with these patients? I am joined on this Protrusive Dental Podcast episode by Dr Barry Oulton to help us communicate better with bruxers! Need to Read it? Check out the Full Episode Transcript below! In this episode, which has a brilliant Protrusive Dental Pearl about ‘colouring in your dental splints’, we discuss: How to get patients to accept accountability of their parafunction and how it may attribute to restoration failure Are you looking for the signs of parafunction in your patients? Travell and Simon pain chart for referred pain</li> Muscle examination video (linked below) The role of your team in communicating Bruxism How to show patients their wear facets What if your patient declines a splint? (They are allowed to!) How to communicate with them the consequences Have you ever restored an incisal edge that keeps chipping? Use analogies and stories to communicate – here we share the Fence Post analogy Sci splints and B splints How to PROVE to your patients with a splint that they have actively been grinding on it! Dr Barry Oulton B.Ch.D DPDS MNLP, Owner, The Confident Dentist Academy Dr Barry Oulton owned Haslemere Dental Centre in Surrey for 20 years, turning it into an award-winning practice with a reputation for outstanding customer service before joining the Portman Dental Care Group in 2018.  In 2017, he founded The Confident Dentist Academy to help dental professionals learn effective communication skills and sell with integrity so they can have more impact and make a bigger difference, both professionally and personally. His 2 day course ‘Influencing Smiles’ course teaches Dentists and their teams how to communicate and sell  that translates into happy patients, a great working environment and, ultimately, sees profit increase.  He also offer in-house training programming and coaching for practices and dental companies and also online training products. He is on the editorial board for The Probe and lectures for companies such as Septodont, Cerezen, S4S, Practice Plan, Henry Schein and Wisdom Toothbrushes.  His website is – www.theconfidentdentist.com Take a look at his muscle exam video which is currently on www.theconfidentdentist.com/s4s which is very helpful demonstration of how to carry out a dentally relevant muscle examination. Social media sites – Twitter – @drbarryoulton  Facebook – The Confident Dentist  Instagram – drbarryoulton  Click below for full episode transcript: Opening Snippet: I don't believe that dentistry should be done in order to treat parafunction. I think it should be done once we've protected people from parafunction so that dentistry is a choice rather than a necessity... Jaz’s Introduction: Hello, everyone, and thank you for joining me today. I’m Jaz Gulanti. And this is the protrusive Dental podcast episode 11. I’m joined today by Barry Oulton really excited to have him on because he is someone who lectures all over the country about communicating with patients. And he also lectures about parafunction and parafunction control. So what I decided to do and the reason I approached him was to marry these two together about an episode about how to communicate with Bruxists. It’s a huge topic is something that’s probably born out of frustration, my earlier years when I used to speak to patients and the signs of parafunction are obvious to me at one stage they weren’t when I learned what I was looking for. And we’ll discuss that in this episode, it becomes obvious, you know, patients that exhibit signs of parafunction. When you speak to these patients, invariably, they actually deny the fact that their parafunction, I don’t know, I don’t grind my teeth. And there’s a there’s a way you can approach this so that they can actually take accountability for their parafunction, because ultimately, that has a huge bearing on the longevity, our restorations and their pain levels and whatnot. So I’ve got a great episode with Barry Oulton today, there is a Protrusive Dental pearl within the episode. So I hope you enjoy it. You can listen to it on Spotify, Apple podcast, Google podcasts, Stitcher, wherever you usually listen to it. So thanks so much for joining me. And I hope you enjoy Barry Oulton. Main Interview: [Jaz] Let’s just start Barry, thanks so much for joining me on the Protrusive Dental podcast. I was just having speaking to you earlier about how happy I am that I’ve got you to speak on this topic because I think you marry communication and topic of paraunction, occlusion, all that sort of stuff really well. So for those few people who probably don’t know who you are, can you please tell us a little bit about yourself? [Barry]Yes, sure. Firstly, Jaz, thanks for having me. I’m delighted to be chatting to you, and sharing some information with anybody that’s listening. So I am Barry Oulton I am a dentist, I owned my own practice in Hazlemere, for 20 years, private practice down in Surrey, I have recently sold it in to the Portland group. So I’ve become an associate, after 20 years of running my own practice, so that I can concentrate a lot more time on delivering my own training courses through the new company, the confident dentist Academy. So my background is qualified in Leeds ’93 did my VT, I then moved down south and I became a vt trainer. So I had five years of being VT trainer. Because I really enjoy teaching, sharing, training, coaching, things like that. [Jaz]Yep, that’s very evident from everything I’ve seen from you so far. You’re very generous with your knowledge. And that’s great that you’ve, you know, you’ve obviously had that theme for a long time as a, I didn’t know you’re a VT trainer as well. So [Barry]Yeah, I mean, I enjoy interacting with people. And as you know, this can be a bit of a lonely job kind it. So I’m bringing people on, I’ve, you know, so I’ve spent, I must have spent hundreds of thousands on my education over the last 20 years. And I believe that I could download what I’ve learned in 20 years, I could download that to somebody probably in the next three years. And if you can, I think if you can help somebody fast track and improve on what you’re doing, I think that’s something that we all ought to be doing. So I’m very happy to share. [Jaz]That’s perfect. And I think that ethos of that we now with the digital age and online presence and able to share so quickly, I feel that now for young dentists particular to be able to stand on the shoulders of giants is you know, so much more accessible now. And it’s great that we have mentors like yourself who are sharing, and just like you said, helping us to fast track and as you know, learning from the mistakes of others and an accelerating your progression is going to be so good. And something that I you know, I invest like you a lot in my education, I spent many thousands of pounds so far and I intend to continue to do so. And I’m hoping that I can learn faster than some of my like mentors like yourself, because I’ve got people like you who are sharing. [Barry]Yeah, I’m all for that. And why reinvent the wheel. So. And the other thing is, you know, when I’m sharing what I’ve learned, I always learn when I get the feedback, because just because I’ve honed some of the systems in my practice, you know, I’ve spent maybe 15 years honing some of the business systems and they work brilliantly. I also think that once I am sharing those I get feedback and I’m able to improve upon what I’ve already created. So I think it’s essential, you know, not just in our profession, but particularly in our profession, I think it’s essential that we’re sharing ideas because it makes everything better for everybody, including the end user, which is obviously the patient. [Jaz]Brilliant. So what are your interests? I know, obviously communication and helping dentists to communicate better with patients, but also, am I right in saying that parafunction is another one of your interests? [Barry]Parafunction is a huge interest of mine. And I’ve learned an awful lot over the last 12 years. And actually, so my training company is in sales and communication. And I was the first dentist in the UK to attend a sales training course. And it was 20 years ago. And then there were certain things that happened in my life that led me down the parafunctional route and the communication sales and NLP routes. And that was about 14 years ago, my wife had an affair, and pretty much the, for me for two years. I didn’t know. For me at the time, my kind of whole world, it felt like my whole world have fallen apart. And so I went and walked on hot coals with a guy called Tony Robbins [Jaz] Anthony Robbins. [Barry] Now I did his course three times. And there were certain things that I learned on that course that just utterly blew me away, in the way that human beings process information, and how we formulate our thoughts, our internal representations. And so, off the back of that I decided to go and learn all about NLP. At the same time, during the breakdown of the marriage and becoming a single father, I was breaking teeth. And a good friend of mine said to me [Jaz]Your own teeth or patient’s teeth? [Barry]Yeah, my own teeth. Fortunately, my dentistry didn’t suffer. So I broke a tooth. And a good friend of mine, a guy called Matt Everett said, “I think it might be grinding your teeth, you need a splint.” And I was like, “No, mate, honestly, I’ve been a dentist for 12, 13 years, I would know if I was grinding my teeth.” And so two months later, I broke another tooth. And yeah, again, Matt says, “Look, let me make you a splint.” And I was like, “Mate, there’s no way I’m grinding my teeth.” Another month later, and I fractured beyond repair my upper right five, which I had to have an implant placed. And I phoned up Matt Everett and said, “I think I owe you an apology. I think I might be grinding my teeth.” And he made me an anterior deprogramming splint. By the time they weren’t involved with NTI. And this was a kind of a revolution to me, because number one is obviously I stopped breaking my teeth. And number two, the discomfort in my head and neck that I was having, that I hadn’t really recognized, because it was just an incredibly stressful time. That massively reduced. And so I thought, Blimey, this, you know, there’s something in this. So that was the point that I went away and started to learn a lot more about parafunction. I spent a lot more time more with Matt Everett, and Neil. [Jaz] Great guys. [Barry] Fantastic guys. And they really helped me begin my journey. So I learned about parafunction, I did some training in the States. [Jaz]I just wanted to say I was smiling when you’re telling that story towards the end. Because, you know, essentially, the experience that you had, whereby you are in denial about your own parafunction is, you know, we, as dentists face this every single day, okay? And the main thing I want to pick your brains about today, what the main thing we’ll extract from you is, how can we communicate with these patients? So previously, two, three years ago, maybe even four years ago, I say to my patients, “Do you grind your teeth?” I used to ask them, “Do you grind your teeth?” And I realized some years later, that’s a ridiculous question. Because, you know, it’s like telling a diabetic person who doesn’t know they have diabetes. “Are you diabetic?” You know, [Barry]Yeah, you’re right. It’s exactly like that. [Jaz]That’s how I say it to my patient nowadays. And I instead, I think probably Pav taught me this was, you don’t you don’t ask them, ‘Do you grind your teeth?’ You say, “Are you aware that you grind your teeth?” But can you now just dive right in and tell me, How can we address this issue of the fact that the patient like you were in your own sort of journey, completely unaware, oblivious, and in denial, you know, you were telling Matt No, that can’t be the case until further damages have to happen. So how can we be more influential to our patients? Because we know we can see the signs of it, but the patients are completely unaware and there that creates an issue of trust, or mistrust. [Barry]Yeah, let me rewind a little bit because I think firstly, the majority of dentists are not aware that their patients are grinding and clenching to the significant amount that they are. [Jaz]Absolutely agreed. Yep. [Barry]And the reason for that is that even when I was a young graduate, we were really trained to be problem solvers. And therefore, we became focused on symptoms, not signs. And so if you look at the statistics and the studies, there’s a study done in 2001, UK, Germany, Italy, they had 13,000 patients. And they determined that they out of that cohort, 8.2% of them reported grinding during their sleep, and 6% had pain related to their grinding. Then there’s another study that puts it between 6 and 12%. And then a huge study in Sweden put it around about 6 to 12%. The thing is that these are patients that are actively complaining of the symptoms of parafunctional activity. When we look at patients on a daily basis, I without over exaggerating, I believe 95% of my patients show signs of parafunctional activity. [Jaz]Again, 100% agreed. And I feel as though is because over the last few years, like you, Barry, I’m really interested in this topic, I feel like it’s the key to success in our restorative cases. And we can help a lot of patients by diagnosing because I think once I learned to diagnose and actually my journey started when I was perhaps just after my VT, I was doing a part time job in a Saturday clinic. And I used to see patients who were treated by a Prosthodontist. And I’d read in his notes, when he’d seen his patients, he would notice all these wear facets. And in my head, I was thinking what wear facets, I don’t see any wear facets. And when your eyes open to this, that’s when you can start diagnosing and realizing actually, the problem is around about 95% where you can see the signs of it. [Barry]Yeah. And so I think there’s a lot, I think it’s the most misdiagnosed thing in dentistry today. I think that, you know, they did another study where they asked people do you grind your teeth? 22% of them said, “Oh, yes, I think I do.” 67% said, “No, there’s absolutely no way I grind my teeth” just like I did 12 years ago. And 11% when “I don’t really know,” then they examined them. And when they examined them, what they found is that 66% of them had moderate to severe occlusal wear. So that’s two thirds, moderate to severe, not even mild, right? And 50% of them had tongue scalloping. So that that’s nearly 100% of people have the signs of parafunctional activity, whereas only 22% had the symptoms. So when I’m lecturing, what I’m trying to do is encourage people to look at the signs because there’s so many things that we’re missing, that I believe are attributable to parafunctional activity. Such as you know, I get somebody in this is I’ve had gum disease, and I look and they’ve got wear facets from parafunction on the lower sixes. And their periodontal disease is only limited to the lower sixes. And what ultimately, I thought was actually that wasn’t a bacterial periodontal disease. That was a parafunctionally driven bone loss that ultimately led the periodontist to think that it was a bacterial disease. And so that’s why this patient presents with something that continued to get worse till we gave him a splint. And it’s now stabilized for the last five years. [Jaz]And I’ve got patients just like that. In fact, I’m treating a person with orthodontics at the moment who, his occlusion was such that he was only occluding on sevens and central incisors. So his sevens and central incisors only. And when he presented to me as part of my comprehensive assessment, his lower central refilled. And, and I also okay, and he had any trauma, you know, why would they root treat it? He has, “I have no idea. I just went to my dentist” having severe pain and he found his infection, no history of trauma, you know, to me, and you have to look at the signs and whatnot. It’s obvious he’s got these huge masseters, so sevens and centrals taking all the load, the central is going to lose. And that’s why they lost vitality. And the dentist never made that connection previously, from what I can gather from history. So we see, that’s the more extreme end of things, but we can see so much more along the way from these, from no sign to all these extreme sort of late presenters. So a lot of it is a tip of the iceberg. So that full circle, how can we become more influential to these patients because they need need our help to prevent them losing more teeth, having more muscular and joint rated pains? So where do we begin? How do we, how can we approach this conversation? I’m asking you, because I know you’re, you know, you’re probably thought more than anyone else about this because it marries communication and parafunction so well. [Barry]Yep. So the reason I went back and rewind a little to talk about signs and symptoms is that the first step for me is to ensure that it is part and parcel of every examination. So it’s part and parcel of your new patient and your existing patient examination protocol. Because when I’ve explained to my patients that I’m looking for it, that’s already sowing the seed that at some point, I’m going to discuss it with them, because I know and, you know, 95% of our patients are going to show signs of parafunctional activity. And so I want to begin that process of communicating with them right at the beginning with an upfront contract to the fact that I’m going to be looking at that. So I, my treatment coordinator explains that, ‘Amongst the examination, some of the things that Barry is going to be doing are..’ and she’ll explain what a BPA is, she will explain, you know, what I’m doing, when I’m looking at the teeth, and so on and so forth. She’ll also explain, he’s going to examine your muscles and feel your muscles of attention and tenderness. And then look at your teeth for any signs of grinding and clenching. Because what we know is that 95% of our patients grind and clench, and not many of them know it. And we give them some reasons of why we want to identify if they’re parafunctioning. Because, you know, we have lots of patients that have had root canal treatments, because their dentist was doing their absolute level best, chasing the pain, not realizing that the pain that the patient was having was referred pain from muscle problems, not from tooth problems. And so again, the first thing I show my patients is a trigger point shot by Travell and Simons Have you got that? [Jaz]No, I don’t. [Barry]Okay, so if you’re doing any parafunctional treatment for any patients, the first thing I would recommend you do is go to Amazon, I don’t know where else you can get this. But you go to Amazon and you look at Travell and Simons triggerpoint. They have developed a chart of trigger points for the whole body. But section two is the head and neck. And it indicates where the tension is built up from parafunctional activity. And in the muscle, you get a tender area, a trigger point, and then it shows you where the pain is referred to. And so as an undergraduate, I was taught that pain in teeth could be referred from top to bottom. And what I believe, that I discovered and became aware of 12 years ago, is that that’s incorrect. Over the last 12, 13 years, however long it’s been, whenever I’ve had somebody enter my studio now and say, Look, Barry, I’ve got to say but I don’t know whether it’s top or bottom. The overriding presenting pain has always been muscular. And so I palpate, the masseter, I find that trigger point, and it’s that that’s been causing that tooth ache. Now, I also recognized that there could be a problem with a tooth, maybe a pulpitis. And that has invariably caused them to parafunction more during the night. So that then they get the problem with the muscle because I got caught out about 10 years ago, I was really evangelical about this, a patient came in, you know, “I’ve got this pain, I don’t know which tooth it is.” And I was like,”Oh, I know what it is. It’ll be muscle.” And sure enough, they had trigger point problems. And I explained that what we need to do is give them a splint to you know, get the muscles relaxed. And that was sort the pain out. Two months later, they came in, they’d had no pain for two months. And then they came in with a blown up abscess on a tooth. And it made me realize that actually, they did have an underlying problem with their tooth. What that of course, was increased grinding and clenching, which they presented with muscular pain. But I had, at that point, I’d realized that what I hadn’t done is really look at the fact that there was an underlying tooth going on that was actually causing them to parafunctional even more. So now I haven’t made that mistake since. But 10 years ago, you know, getting into this in the early days, that was a mistake that I made. So in terms of communicating to patients, we start right at the beginning, we start in terms of our presentation of what we’re going to be doing in the examination. My examination protocol is very automated in terms of I operate a co pilot operation with my nurse so she will read out what she wants me to look at and I report on it. We develop that again about 15 years ago, because I was providing my examinations almost in silence, you know, looking at everything and then saying, you know, everything’s fine, which meant that my patients weren’t hearing everything that I was doing for them. And so we developed this co pilot system where my nurse says, soft tissues, and I’ll run through each soft tissue, she’ll say, saliva consistency and volume. So we have this whole thing that we run through. And the patient, first time we did it, a patient was like, ‘Wow, you’ve never done that before.’ And I went, ‘You know, I’m embarrassed to say, I’ve been doing that for you, every six months, for the last eight years, I just haven’t been telling you, I’ve been doing it.’ [Jaz]That’s amazing. It’s just building values. And it’s the same reason why I also do the same, Barry, as someone called Zak Kara, a friend of mine, taught me to be more proud of the way I examine and actually make it more vocal, I’m now checking for your muscles just like you do. When you’re in the video, I saw your muscle exam video, which I can direct people to that if that’s okay with you. Is to I also say, I’m now screening for mouth cancer, something that trying to think who taught me that a James taught me that to actually tell patients I’m now screening for mouth cancer. And they go away thing Oh, yeah, this dentist, he actually cares. He’s looking for mouth cancer, even though we all do it. Unless you mentioned that you don’t actually communicate that to the patient. So that’s a great point you’ve raised. [Barry]Yeah, I mean, it’s, it’s something that I think is essential. And if we can get all dentists during that, it means patients then value the professional because they understand that we’re not just you know, having a quick look flicking around, we are actually being very comprehensive in what we’re doing. We’re just at time, some of us are failing to highlight how comprehensive and how good we actually are. So it’s part of our exam protocol that starts the whole ball rolling in terms of communicating with patients about parafunction. And then there are patients that take time to appreciate that they’re parafunctioning and the ramifications of it, just like it took me time. And so I’m, I don’t jump up and down and start beating on the drum, I sow seeds, I talk to them, we take 23 photos anyway. So we’re able to demonstrate that, you know, you’ve got a fraction, you’ve got some gum recession, you’ve got some sensitivity, you’ve got some wear you’ve got some chipping, you’ve got this than the other, we also take a position because I call it dental gymnastics, you know what people do in bed at night with their mouths is phenomenal. And, you know, you can see there wear patterns, if they do parafunctional anteriorly, it fits like a glove, there’s multiple little jigsaw puzzles. So we get them, I get them to go into that position. Almost always the like, Oh, that’s really uncomfortable. I don’t do that. When we get them into that position, we take a photograph, so that we can demonstrate why their teeth have got little notches in or V shapes in the upper interiors, or whatever it is, we’re able to demonstrate. And, you know, some people take longer to appreciate that. And I’m in no rush. You know, I want my patients eventually come in saying, “Look, I think you might be right, I’d like to, you know, take your recommendation.” Many people just jump on board because we explained it so well. [Jaz]That’s another amazing tip I want to highlight. So this is out there to take photos of people in their sort of wear facet positions where the central notches and the where the lower incisors match up. Even on the canines, they can match up quite well sometimes. So take those photos and show your patients. And some patients, like you said might take more time to come around to it. And that’s completely okay. [Barry]Yes, it is. And the other thing that when we’re case presenting, if a patient, which is well within their right, declines to have an SCi, we will get them to sign a disclaimer. And the disclaimer, which is you know, not heavily worded, it’s a nice disclaimer just basically says I’ve been advised that I grind and clench. And therefore, my porcelain units or anything like that are not guaranteed. Because you know, very often you get people that have wear and tear on their teeth. And if they’re going to wear their teeth, they’re going to smash up the porcelain. So if they elect not to have a splint, then we get them to sign a disclaimer And that, again, adds quite a bit of weight to how important we as clinicians think it is that they as patients follow our advice and were in SCi to protect them from parafunctional at night. [Jaz]Absolutely, because a lot of these patients who come in needing rehabilitation of their anterior teeth is because of parafunction. And if we’re not, if we just restore them and leave them to it, they’re gonna break our restorations. So yeah, in my practice, absolutely. We do have Have guarantees for indirect work and direct work different years. But all of that is void and null if they don’t actually have an appliance or if they fail to maintain to wear an appliance. [Payman]Yeah, absolutely. I’m glad you and I are on this on the same page, really I am, just want to encourage anybody that’s listening to consider implementing that into their practice. Because if we don’t talk about that with patients, and something does break, invariably, it’s our fault, isn’t it? Patients don’t come back and say, “Oh, my new crown broke because I was grinding on it,” they come back and say, “Well, this was a faulty crown.” And actually, you know, it wasn’t, it’s just that may be [Jaz]And in a patient’s perspective. I mean, if it hadn’t been explained, or the dentist hasn’t looked for the signs of wear and parafunction, then and if they don’t know themselves, which in most cases they don’t, then it’s normal behavior for someone to say, “Hang on, this is broken, it shouldn’t have broken, it must have been something faulty with the product.” [Barry]Yep, exactly right. I mean, I had it, you know, 20 years ago, whereas I have VT. So 25 years ago, whenever it was, before I really knew what I know now, I had a patient who I thought had a chipped, upper right lateral. So I restored it with composite, that composite came off four times. And at the end of the day, the patient just thought that I was a crappy dentist. And I was disappointed, I thought I was a crappy dentist because this incisal edge composite kept coming off. Now, you know, I was wet behind the years, I’d only just come out of uni, I was in my vt, I didn’t realize that it wasn’t a chip, it was a wear pattern. And they were parafunctioning. And I was just repairing replacing the tooth that was missing, that they’d spent 10 years wearing away. And because I’d lengthened it, they were then taking 10 minutes to ping it off. And so it was you know, you don’t know what you don’t know. And so until you start to really know and understand that you’re looking for signs, not symptoms, you can’t misdiagnose things. And that’s I was guilty of that 20, 25 years ago, I less guilty of it now, obviously. Because fundamentally, I’m looking for this on absolutely every patient that walks through my door. [Jaz]Brilliant. And that’s so true. And I think we’ve all had that patient, I think every one of us can think immediately when you describe that scenario, and name of a patient popped into everyone’s head, and they sort of remember Oh, yeah, that was definitely the case on that patient. [Barry]Yeah, but it’s like the first time you prep a lower left seven, you got a nice millimeter clearance, and then you take the bite and think “Hang on a minute. It’s an occlusion again.” We’ve all been there as well. Right? When you realize that actually the there are certain things that you weren’t aware of in dentistry, or maybe you didn’t pick up at uni. So yeah, it’s a learning curve. It’s then the I think the idea is then to not make the same mistake twice. [Jaz]Absolutely. Last tooth in the art syndrome. And I think that could deserve its own episode in itself, basically, in terms of management and whatnot, but fine. What other tips can you share when communicating with our patients with parafunction or wear? Because one thing I found actually is that I’m sure I’m in fact, I’m definitely I’m positive that Barry, that when you are explaining to your patients about the signs that they exhibit of parafunction, and wear is that you’re probably the first person in majority of cases that discusses with them? [Barry]Yes, always. [Jaz]Yeah, exactly. And it’s always easier in the few times that I have been the second or third dentist. It’s just so much easier as [Barry]Well, it’s interesting, because I when I get patients that come in, and they’ve got a lot of wear, and I say, “Okay, so does anybody ever chatted to you about the grinding, clenching?” And they go, “Yes. Oh, my last dentist told me I grind my teeth.” And I said, “Okay, and what else?” “Well, that was it. They told me, they told me I grind my teeth” Full stop. No advice. No discussion about an appliance or anything like that. So it hasn’t always made it easier. They just are aware that they’ve grind their teeth. And so [Jaz]Yeah, of course. So the awareness aspect is what I meant, but whether they’re not, whether they have been explained that, you know, the rationale of how to take things forward, either in terms of protection or rehabilitation is obviously something that, you know, may or may not be discussed, but I find the awareness and the acceptability of the, you know, the trust, is there just a few notches higher when you’re the second or third person, but in the most cases or majority of cases, when you are the first person that people listen to for the first time. People are telling their patients actually, you know, did you know that you know, you actually do grind your teeth and here’s the evidence, and that’s always the trickiest bit and everyone will handle that differently. [Barry]Yeah, So in my communications training, one of the things when I learned so I master hypnotherapist as well. And one of the things we learn in hypnotherapy is the art of telling stories. people relate to stories and analogies. And so when I talk about parafunction to a patient, I don’t really talk about parafunction. I talk about garden fences. Do you want to hear my analogy? [Jaz]I love analogies and please, please shoot away. [Barry]Okay. So I was chatting my patient and say, “Look, do you have a garden?” And only once or somebody said, “No, I live in a flat.” And I’m like, “Oh, damn it. Do you know anybody that has a garden?” And the patient went, “Yeah, of course.” I was like, “Great. Do they have a fence?” And they go, “Yeah” “Okay, so let me explain grinding and clenching. In terms of your fence in your garden. It’s like me, creeping into your garden at night and rocking a fence post. Every night that you’re grinding and clenching, you’re rocking the fence posts, and they’re your teeth, and so I need you to picture me creeping into your garden bit weird, I know. But I want you to picture me creeping into your garden at night, and rocking a fence post. Now, if that fence post is made of concrete, and it’s set in the ground into concrete, then when I’m rocking that fence post, the energy that I’m using, is has to go somewhere, right? It was Einstein that said it or was it Newton, it was Newton. So that energy has to go somewhere. And basically, if it’s a concrete post in the concrete ground, it’s going to go into my muscles. And I’m going to have some muscle tension probably the following day. If that post is concrete, and it’s set in the soil, and every night I creep in and rock that fence post, over a period of time, whether it’s six months or a year, eventually what’s going to happen? It’ the soil is going to reduce around the base of the post. And that’s where we can get some bone loss and some gum recession. And that’s ultimately where teeth might be able to become loose from grinding, clenching. I said, Now, what I want you to picture is that fence post is made of wood. And the fence post is made of wood, and it’s set into concrete. And I come along and rock it and what happens is at the base of that post, it starts to splinter, you then come along with your garden strimmer. And you take away those splinters. And that’s where you get things called abfraction and I demonstrate are my teeth, I clicked them. Because I’ve got abfraction from parafunctioning years ago. And I said that’s where you get these abfraction and this bit of gum recession. The other thing that can happen to those posts is they can break. And I said and I’ve broken three of my posts, I lost two teeth, I had to have an implant, or you can chip and break the top of them. And so when I’m going to be looking at your teeth, what I’m going to be looking at is any of those signs, whether there’s some chipping at the base of your posts, whether there’s some groundwork that’s gone, I’m going to look at your muscles as well, because most patients have signs of all three of those aspects. And some patients have the signs and actually some patients have increased symptoms, where their muscles are sore and they present with headaches, neck ache, shoulder pain, migraines, all sorts of things. So I explained that as my opening gambit to a patient so that they can understand that there’s a variance in what can happen when you parafunctioning based on quality, a bone, you know, what the grinding on, what the teeth are, like, you know, all sorts of different things and they get it, it makes perfect sense to [Jaz]That’s a really lovely analogy. And obviously it sends home that message that sometimes it’s the muscles that take the hit, sometimes it’s just a teeth, it can be abfraction, obviously, sometimes it could be the TMJ as well. So that that’s a great way to explain to patients. In terms of now that we’ve talked a little bit about communicating with our patients and looking for the signs and whatnot. Can you briefly describe your splint protocols? Does everyone your patients always get an SCi? Or are there certain indications where you might prescribe a different type of appliance? [Barry]I would say that 99.9% of the time, my patients get an SCi Now, it might be a slightly different designed SCi, it could be an upper or lower. If they’ve got a deep bite, it’ll be a deep bite SCi where the discluded element begins within the palate, because I don’t want to open them up too much. But invariably, almost all my patients I provide with an SCi The rationale behind that is effectively it is as we know, an anterior deprogrammer. It’s separating the posterior teeth and providing disclusion during parafunctional activity. We know from the EMG test results that by wearing an SCi, it reduces the contraction of temporalis by upwards of 80 85% and masseter by 50%. And I believe that I mean, I haven’t done a full arch splint now for 15 years. I have done all of my Dawson Academy training. And so I am fully aware of providing the idealized occlusion if I was going to be reconstructing somebody’s full mouth, I want, you know, and dots in the back and lines in the front, I still give them an SCi. Because I believe that even with what some people would call a perfect occlusion, if you’re a clencher, the occlusion is virtually irrelevant, right? Because you’re still going to be firing off the muscles. And if you follow Robert Kern Steens belief with T scan, is that in order to minimize any damage and muscular problems, you need to have you, if you’re aiming for canine guidance, you need posterior disclusion in under 0.2 per second. Well, you know, I’ve got T scan and I’m not even going to measure that I can get posterior disclusion in 0.2 per second because I’m just going to protect my patient with an SCi. So, almost entirely, it’s an SCi. The things that might counter that is going to be periodontal involved anterior teeth, which, to be honest, I really don’t see and if they have periodontally, I’ve got some patients with periodontally involved lower anteriors. So I will make the SCi on the lower anteriors. If I have a concern about certain teeth, then I might make them a B splint. Now the B splints I will use which is basically a full arch splint with an anterior deprogrammer built into it. I will provide B splints for any orthodontic patients and any of my younger patients so kind of late teens, because I know from all of our research that there are no occlusal changes from wearing an SCi. But number one is if they’ve had orthodontics I want them to wear essix retainers anyway. So I will invariably make them a B splint, not an SCi. And then if I am concerned maybe that there’s still some growth or this potential of any occlusal changes through normal natural processes, I will then make them a B splint as well. [Jaz]Brilliant, and it’s great to discuss these protocols. And a lot of people listening might be at various stages of their journey in learning about these sorts of appliances. In the previous episode, or episode eight, I spoke to Dr. Barry Glassman, and we dispel some of the myths about anterior midpoint stop appliances. So if anyone wants to listen to that, please go ahead and you can listen more about you know whether in, whether they do or not cause a AOBs and that sort of beyond this podcast, more covering that one. [Barry]Yeah, can I just say if you haven’t listened to it, please go and listen to him. He is brilliant. [Jaz]It’s absolute sensational. He really changed the way I thought about a lot of the concepts and it’s essential listening, anyone can get to one of his courses or at least start off by listen to a podcast and go from there. But it’s interesting you mentioned about orthodontic retention. One of my favorite devices to prescribe for those who’ve had orthodontics is an SCi with essix retainers built into it. So [Barry]That’s a B split. [Jaz]Yeah, so I guess so the way that s4s sort of send it to me. Yeah, essentially that you know, there’s you know, B splint, E splint, U bank Splint, so many different names and whatnot. Essentially, the mechanics behind it is the same. And yeah, it’s the essix retainer built into it. So that can give you your orthodontic retention as well. And one thing that I found really helpful and again, this comes to the communication aspect back full circle is I don’t know if you do this, Barry, but I color my splints that I prescribed with a Sharpie pen black one, three coatings. And then when the patients come back for the review, is it I’ve never had a patient not grind in a wear pattern, it’s usually left to right sometimes anteroprotrusive and that then just really sends home the message that oh my god, I Yes, you’re right. I do grind my teeth. And I encourage my patients to email me and take photos daily of their sort of wear patterns being formed on their splint and I get loads of emails now saying, “oh, Jaz, you’re right. Here’s what I found and patients get involved in this journey. So is that something you’ve you ever do? [Barry]That is absolute stroke of genius and no I don’t and I will be starting tomorrow [Jaz]Amazing. Honestly, I think [Barry]It’s a great idea. [Jaz]A lot of things I say are not original, I learned that from Michael Melkers. But you know, this is great to do with patients. And you know, it underpins everything we discussed about in this episode so far about communicating to our patients. So sometimes we do have these patients who trust us enough to go ahead with a splint and still doubtful but when you color in I’ve never had a patient including myself when I gave myself a do large SCi with sliders and I have this from day one I had left to right wear I wish I knew I would do already and my canines I knew I was parafunctioning. But then you know, to wear it myself. And then when I woke up in the morning after one night of wear, and I saw that clean swipe left and right and everything else black, that’s like this is it, this is what’s good, my patients are going to see as well. And this is going to send such a powerful message. [Barry]I think that’s a brilliant I love that. And if you don’t mind going to nick it and I’m going to share it [Jaz]Oh, please do. Share it far and wide. And you know, this is what it’s all about in this podcast, to share little gems to help dentists and help patients because ultimately, the patients benefit, the dentist benefit. And it’s a great thing to do. [Barry]Yeah, that’s a really neat idea. I’ll be doing that. Three, three coats of Sharpie, right? [Jaz]That’s it three kinds of Sharpie. And yeah, it’s great definitely has to be Sharpie. I’ve used a different brand over, let’s call it a black permanent fat marker. And my patient came in. And she told me a week later that her lips went completely black. And I was so embarrassed and apologetic. And then I went to the shops, and I bought like a 12 pack of Sharpies. And I’ve always only ever use Sharpies, and then they work. I don’t use any other brands. [Barry]Other brands are available, but don’t use them. [Jaz]Absolutely. [Barry] Yeah, that’s really great. [Jaz] What I think we’ve got- Thank you very much. Any other last gems that you’d like to share? [Barry]Yes, okay. I would encourage everybody, when they’re communicating with patients, I would like you to learn how to build rapport. And, particularly if you’re dealing with a patient who is resistant to your recommendation or resistance as I was, their understanding that they’re parafunctioning, if you’re in rapport with your patient, you have a much better chance of your patient accepting your recommendations. So what we’re talking about parafunction and how we’re communicating. I think one of the biggest skills I ever learned in a, which improves my communication inside and outside of work was building rapport. So that’s something I would genuinely want people to work on and get better at, because it has a massive impact. [Jaz]The other thing, just couple of questions I want to ask, I asked a lot of guests this question is, did you know the difference between, a lot of people have different, parafunction and bruxism? Are they essentially same thing? Are there any nuances? Because dentists use these terms interchangeably. [Barry]To me, they are one and the same. Parafunction basically, by definition, is outside of normal function, isn’t it? Because it’s para-function. When I do my training courses for s4s, we do a full day, I asked the question, what is normal function? Because I show a picture of a mild wear? And I say, Is this normal? And everybody says yes. And I say Okay, so let’s think about this. What is normal function? Normal function in the masticatory system is eating, talking, swallowing, drinking. And so I throw out bags of Haribos. Other brands are available, by the way. So I started mixing Haribos and say, right, let’s do some normal functions together. get everybody to eat some sweets, while they’re eating. I say, right. This is normal function. How much are your teeth meeting? And unanimously, the answer is they’re not. And I said, that’s my point. During normal function, teeth don’t meet, there is a maybe a slight touch of teeth. When you swallow, teeth don’t meet [Jaz]A lots of near misses. That’s what Barry Glassman thought us, lots of near misses. And occasionally, they do touch in there, but nothing significant [Barry]Nothing significant. So then I share the photograph and say, Is this normal? And the answer is no. It’s not normal. It’s common. And it’s not through normal function. It’s outside of normal function. It’s therefore parafunction. So even though it’s mild wear and I said it’s also age dependent, because if that patient I’m showing them is 76, she might go, do you know what, that’s not too bad. But if that patient is 14 years old, I’m concerned where they’re going to be in 20 years time. So I’m keen that we are aware of what parafunction is. And basically, it’s anything outside of normal function. And it’s the same whether it’s, I don’t mind whether people classify as grinding, clenching, bruxism or whatever, it’s all the same, kind of outside of normal functional activity. [Jaz]Brilliant. And one thing I’m gonna ask you only because I, you know, you’ve got a lot of wealth of experience. And I’ve asked a lot of people who are like me, and you geeks of occlusion and wear and parafunction and stuff, and you get different answers. People who represent Dawson, people who represent Kois and Pankey, everyone’s got a different opinion about this. So let’s talk about a constricted envelope of function. Okay. So if anyone who’s listening out there is essentially people, for example, with a deep bite, and you see the lower incisors are really worn, and maybe the palatal of the upper is quite worn, and it’s basically as soon as they thrust their mandible forward, it’s all anteriorly guided, it’s a lot of forces anteriorly and when they’re chewing, the theory is that actually the lower teeth, and the upper front teeth are sort of in the way of their functions. Typically, do you think I’ve described that okay, as a constricted envelope of function? [Barry]Yeah, I think that’s a pretty good description of it. [Jaz]Fine. So some dentists believe, or some camps believe that actually, you can have a deep bite, or a constricted envelope of function, but really, in the absence of parafunction, that’s still not going to cause the wear, and whereas other camps are, quite strongly suggested with that actually, even if you have this constricted pattern of wear, you know, you’re all that’s the reason for the wear, rather than any parafunction, do you see what I mean? I mean, also, clinically, it doesn’t matter, because you have to treat that anyway, in one way or another. But did you see what I mean in terms of what the etiology of that wear is? A geeky question. I know. So do you have a philosophy opinion? Do you see what I mean? [Barry]I do see what you mean, it’s kind of chicken and egg, isn’t it? You know, I’m talking about what comes first, because you can see somebody that has a deep bite, with no wear. And clearly, there’s no parafunction, you can see somebody that has a deep bite with lots of wear. And you could diagnose the fact that there is a restricted envelope of function. But to be honest, if you release that envelope of function, if you were able to correct that, does that mean they’re not going to parafunction? And I would say, not necessarily. I’m a big proponent now of doing as little dentistry as possible. And so the first thing I do is to get any patient with any signs a parafunctional activity into an SCi, so that their dentistry is a choice rather than a necessity. Because if they aren’t struggling functionally, and it is para function, then the SI is going to solve it for them. And if not, it’s certainly going to protect them at night so that then we can have a discussion about whether we’re going to do dentistry further down the line. I don’t believe that dentistry should be done in order to treat parafunction. I think it should be done once we’ve protected people from parafunction. So that that dentistry is a choice rather than a necessity, if that makes sense. Do I make? Am I making that? [Jaz]No, no, that makes sense. Absolutely. [Barry]So I am not really often I don’t believe presented with restricted envelope of function issues that I then need to look at by doing any restorative work, because generally speaking, when I’ve used SCi for patients for nocturnal parafunction, their problems go away. And there are the odd cases where we will then sit and talk about doing some dentistry. But that’s not very often now, Jaz. Most mostly, I want my patients to be having the dentistry because they want it not because they need it. [Jaz]Brilliant, and we’ve talked a lot about the SCi appliance. So anyone out there who’d like to learn more about this s4s have some great courses along with yourself, Barry, can you just give them, people information about how they can come onto those? [Barry]Oh, yeah, absolutely. We run them. London and Birmingham, and we’ve done some in Sheffield. They are a day long. It gives you a lot of background about parafunction. You get a free Haribo. What can I say? We talk about, I talk about different splints. You know, there’s the odd occasion that I’ll use a different sort of splint if there’s some problems with the joints. But really, it’s focused on SCi, we show you how to manufacture a chair side SCi. We’ll give you a demo of doing that and just talk you through the whole protocol. And he had a huge discount actually on the chair side SCi so it’s well worth coming along for the day, you get the discount on the SCi as you go away, and you start making them. All of my staff, where Sci at night, and everybody benefits from it. So it’s a really good interactive fun day. And if you go to the s4s website, they’ll be able to list the dates as well. And I must highly recommend for a much more in depth training from a much more knowledgeable man than me is the other Barry. If you’ve not seen Barry Glassman lecture, he’s an absolute delight. And well worth seeing him as well. So please go to the s4s website and check out the courses that are available. [Jaz]Brilliant, I want to echo that as well. And I’m a big fan of using lots of different types of anterior midpoint stop appliances and there’s loads out there. There’s you know that the b splint, the eubank splint, the E splint, that I use something called the Flexi orthotic splits, there’s loads out there but I think in the UK s4s are certainly the the leaders in educating people about different types of splints and midpoint stop appliances. So as a starting point, I’d encourage anyone to learn the theory in the background from Barry Oulton and the s4s. And then from there, look into different other types of appliances. But if you’ve asked s4s, it’s been a great lab and I have no sponsorship from them or anything like that. But I just want credit where credits due, s4s is a great lab for any sort of, or appliance I prescribe. I use them exclusively for appliances, and they run great courses as well. So Barry, with that, thank you so much. We really appreciate you joining me today. Lots of great gems there. And I’ll put some links out there for the comfort dentist and s4s courses, anything else you’d like to share? And really great knowledge you gave me. You taught me about the, was it the pain map on Amazon? [Barry]Yeah, the trigger point by Trevell and Simons. [Jaz]I’m going to get that straight away because I think it’s so relevant because I’m looking for these signs and I never knew about these trigger points. So that’s my first purchase. Thank you [Barry]Alright, Jaz, thank you for having me. And I’m off to order a 12 pack of Sharpies. [Jaz]Lovely. Jaz’s Outro: Thank you very much for listening right to the end. That was Barry Oulton, thanks so much for coming on. I realized Barry is the first time actually spoke to them over voice if you like and I really liked him so I booked on to his course in December in London. So if you’re coming to the December course London please do say hello. As always if you’ve enjoyed the content, go on my Facebook page Protrusive Dental podcast Like it, share it. Subscribe on my website, jaz.dental for episode updates and blog posts and whatnot. And thanks again and the next episode is with the implant ninja. Someone called implant ninja find out who he is, what he’s about. He’s got great Instagram profile. And I was asking him about occlusion relevant to implants and also how to get a good work life balance. So it’s a really special episode actually. So I look forward to joining for Episode 12 out in a few weeks. Thanks so much. Bye!

Zak Kara is one of the best communicators I know. He is too humble to even entertain that statement, but it’s true! He shares with us real-world communication gems and they will blow your mind. In this episode we cover: How to communicate to our patients about longevity of dental work Importance of asking questions – ‘how long are you expecting this to last?’ What’s a linchpin and how we can ‘lead from the bottom’ Helping the team see the bigger picture – empower them – for example, how to handle the patient that walks in late? Why you should not care to treat everyone in your area What NOT to say to your patients Are you practicing proactive or reactive dentistry? Are we under-diagnosing? How to present a comprehensive plan Are you in the right practice? Design your work life The importance of ‘showing your working out’ in your clinical notes (you will love this one!) How Zak uses his iPad Pro to draw on his patient photos and explain – PDF Expert app Protrusive Dental Pearl Episode 10 – Use a UV torch to clearly see composite! Perfect for removing aligner attachments. UV torch for composite available on Amazon. I have tried this and it’s a game changer! Dr Zak Kara Whilst only a ten year career to date, Zak draws together a wealth of experience in dentistry from various parts of the world.From years spent developing his skills in practice on the East Coast of Australia, to relationship-focused independent private practices here on the South Coast, Zak has developed a reputation for providing a unique modern dental experience with old-fashioned rapport.Along the way, he has made valuable additions to the ‘patchwork quilt’ with a Postgraduate Diploma at the University of Bristol, further training at the world-renowned Pankey Institute in the USA, and Expert Witness Certification at Cardiff University.But on reflection, the most significant influences on his day-to-day approach come from humble beginnings. He grew up ‘behind the shop counter’ of his parents’ record shop learning to understand others and what makes people tick, and he annually leads dental teams in volunteering their skills with Bridge2Aid in rural East Africa.This unique personal journey informs his personable and unhurried style. Colleagues have described his approach as ‘contagious’ and ‘refreshing’.

Disclaimer: Opinions expressed within this interview are those of Aws Alani and do not necessarily represent the opinions or viewpoints of Kings College Hospital NHS Foundation Trust or Kings College London Need to Read it? Check out the Full Episode Transcript below! In this episode we discuss: Restorability is subjective – are there any objective criteria we can rely on? Implants vs teeth – implants are not a panacea. Implant systems go obsolete, teeth are timeless Importance of informing patients and managing expectations What to do in scenarios where one wall of a molar is completely missing – how would YOU restore it? A few case examples discussed Importance of the pulp for proprioception Importance of both the vertical and HORIZONTAL FERRULE How do you manage patients with asymptomatic cracked teeth? Influence of parafunction on predictability and restorability Partial exodontia technique Implants vs teeth – advantages of teeth over implants Protrusive Dental Pearl: Use an Iwanson gauge to measure crowns, burs, cusp thicknesses and anything else! You can buy one on the cheap from Amazon. Occlusion symposium September 7th: Register on Eventbrite Operative Dentistry Diploma-Applications open:https://www.kcl.ac.uk/study/postgraduate/taught-courses/operative-dentistry-pg-dip Aws Alani qualified in 2003 from King’s College London. He completed vocational training in Essex and held junior hospital positions at Guy’s Hospital and King’s College Hospital, before completing an MSc in Endodontics at the Eastman Dental Institute. He moved to Morriston Hospital in South Wales to work in the Maxillofacial Unit, initially as a Senior House Officer before becoming a Specialist Registrar. After three years in Wales he moved to Newcastle, where he completed his specialist training in Restorative Dentistry. During his training he completed relief work trips to Romania and Ghana with ‘Young Smiles for Romania’ and ‘Global Brigades’. In 2013 Aws became the International Team for Implantology Scholar in Toronto, Canada, working at the Hospital for Sick Children and Bloorview Kids Rehabilitation Hospital. He returned to London in 2014 to become a full time Consultant in Restorative Dentistry at King’s College Hospital. His main remit is the management of congenital and acquired defects within an MDT environment, working alongside Paediatric Dentistry and Orthodontics. He has published over 40 peer reviewed papers  and maintains an active interest in current clinical issues and research. He has won grants from the British Endodontic Society and the Royal College of Surgeons to examine novel tooth filling materials. He is a previous British Society of Restorative Dentistry and British Endodontic Society council member. He recently completed a Masters Degree in Medical Law; his dissertation was titled ‘Social Media and the Dental Patient: A medicolegal perspective’. He is the course director for the Diploma in Operative Dentistry at KCL which looks to upskill in a multifaceted manner through seminars, hands on simulated exercises and clinical treatment. More information on the course can be found here.  He has built 4 separate websites from scratch, his most recent platform (www.restorativedentistry.org) has over 100,000 reads and is subscribed to by dentists from all over the world. He administers 4 dental facebook groups, the largest of which has 28,000 members. BLOG www.restorativedentistry.org ​ Facebook Group Restorative Dentistry For All Facebook page Key Topics in Restorative Dentistry Insta restor6tive_dentistry Click below for full episode transcript: Opening Snippet: Now if you say to a patient that you are overloading the system and as a result of that overloading of the system something has to give in maybe your TMJ or it may be your tooth that also increases patient's perception of the issue IE it's not the ownership of the problem, isn't the dentist needs to put a crown on this tooth for me before it cracked. The ownership of the problem is now shared amongst yourself being yourself being the dentist the patient as well because they have to realize... Jaz’s Introduction: Hello everyone, long time no speak. There was no episode in July because I became a father. I am the father of a very beautiful, gorgeous, healthy baby boy. We haven’t named him yet. So that’s sort of the reason why I was a bit busy and occupied in the month of July and our guest today Aws Alani also recently became a father. So congratulations to him. We’ve got a jam packed episode today with Aws Alani. He’s a restorative specialist. And we’re discussing restore ability, right? Key topic, obviously, in our day to day practices, I sound very nasal, because at the time of recording, I was a bit poorly. So apologies for that. And there’s no outro today, but all the stuff that I that we discuss, any links that are promised, will be on my website, jaz.dental, or on my Facebook page Protrusive Dental podcast, please follow it for little gems and tips that you know from the podcasts and elsewhere I share on the page. So please like that. However, I will give you a Protrusive Dental pearl and the PDP for today is on the theme of restore ability is to use an A once in gauge. This is a good gauge that you know jewelers use. And obviously, we use dentist use to measure the thicknesses of things. These things could be cusps, as you’re looking for about three millimeters of cusp thickness. Or if it’s less than that, then you may consider to overlay that cusp for example, I use it quite a bit to measure the thickness of burs. And also for lab work that comes back, are my crowns thick enough in the occlusal aspect? Are my resin bonded bridges wings, are they thick enough quite commonly, labs to make them thin? Obviously, we know that they need to be at least 0.7 millimeters thick. So it’s good to measure that. It costs less than six pounds on Amazon, I’ll drop a link. So you know, it’s a easy thing to purchase. It’s something that every restorative dentist should have. So I won’t babble on anymore. Enjoy this episode, Aws the sort of things that we discussed on the description of this episode is quite a bit. It’s a very broad topic, restorability. So it sort of was it could have gone in any direction. And but I’m glad it went the way it did. It’s quite fundamental with a few sort of alternative therapies discussed as well. So I look forward to next. I’ve got great episodes lined up already pre recorded. So I’ll release them hopefully this month. Thank you very much. Enjoy. Main Interview: [Jaz] Okay, right. Aws, thanks so much for agreeing to come on to Protrusive Dental podcasts. Really good to have you. So can you please tell our listeners out there a little bit about yourself? [Aws]Yeah, so I’m currently a consultant restorative dentistry at King. And I’m basically full time. I qualified in 2003. From Kings as well [Jaz]People from kings, they tend to stay at Kings, don’t they? Stay within the M 25. [Aws]Not actually. But I left. Essentially I left London. I’m the London exile. I left London like eight years. I went to Wales for a while. And then I went up to Newcastle. And I came and I went to Canada for a bit and then I came back to London. [Jaz]Oh, that’s really cool. So were you practicing in Canada? [Aws]I was practicing. Yeah, I mean, it was it’s very interesting from a political aspect of dentistry because their system is much more generous, shall we say when it comes to dentistry. And it’s funded entirely differently. I so I work four days a week, largely managing patients through diagnostic clinics and patients that I see on MDT clinics as well. And I’m from Fridays, I teach on an operative diploma, course lead for an operative diploma, which is basically a combination of seminar based teaching workshops, Phantom head teaching and clinical teaching, chairside teaching in the second year. And that takes up a lot of my time as well, I suppose. And that’s essentially targeted for GDPs who are UK based and going through, you know, things like treatment planning, occlusal factors, you know, managing the endodontically treated tooth and all those sorts of things. So it’s been up and running now for two and a half years. And well, I’m hoping you’re going to be successful is one of those things that I’ve started I’d like to see blossom essentially [Jaz]Awesome. And so today we’re talking about restorability. Which is a huge topic, and It’s something that it’s subjective to a degree. [Aws]Very subjective. [Jaz]Yeah. Well, I’d like to learn is how you teach on deployment, how you also only thinks about restorability and which factors you take into consideration. [Aws]When I think subjectivity of, you know, restorability, the upward pressures on dentists now in the UK, from our patients, you know, patients now are less reluctant to lose teeth. However, they are. I think obviously, the downward pressure comes from things like litigation, the GDC, I think we’re becoming more and more squeezed and trying to push the boat out to try and essentially do some heroic dentistry to try and save them. [Jaz]The fee is in question. So when you’re in hospital, there’s no fees involved. And you just go by, okay, give me whatever you think is best. Do you think that could be a big factor? [Aws]For talking more generically, I mean, regardless of being hospital based, or otherwise, patients are more informed, because through Google and digital age, you know, when I was having a discussion with my DCT, recently, and we were talking about textbooks, and you know, a lot of learning now is accessed through Google. And if you imagine that you may Google something. And your patient has the same ability, the same accessibility that information as you do, because they can Google the same things that may be on the letter or phrases that you may say, during dent, more demanding as a result of that, why can’t you save it? Why can’t you? You know, do a call? Why can’t you all those sorts of aspects make things a bit more difficult, or not difficult, but at least it will affect our decision making, because we have to empower patients with an information and knowledge, you know, the amount of dentine remaining, for example. You know, the endodontic factors, the periodontal factors that may play a role in successfully restoring a tooth. I think for patients, they need to not grasp what they feel is right, they need to grasp what we feel is most beneficial to them, because every patient doesn’t want to lose a tooth. But on balance, we need to look at the restorability of a tooth fairly objectively, in that we have to balance these multiple factors, occlusal factors in providing something’s predictable to the patient, because anything can be restored. I mean, anything can be restored, [Jaz]But it doesn’t mean it should be. [Aws]Doesn’t mean, it should be and also the length of time that it’s going to be restored also, is something very important. Because patients want to know is this going to last me five years, I’m sure as you say, in private practice, patients would like to hang a number on the amount that they are investing in. And but you get those patients who, you know, again, talking about subjectivity, there are patients who may have had one bout of paradigm ethical periodontitis in their dental lifetimes. And they even though the tooth may be quite restorable, they’re keen on having just a tooth removed because of their experiences. That’s an eminently restorable tooth. You know, it’s got caris, it’s reached the pupl, but it’s eminent restorable. Whereas we have the other patients where you’ve had repeated restorations, you’ve had repeated post core restorations, and they just want to keep that tooth for as long as they can. [Jaz]So yeah, where you come from what you’ve experienced, obviously has a big bearing on the patient psyche in psychology and decision making. Yeah, one thing I want to ask based on what you just said, then implants obviously have grown massively over the last, you know, 30 years, let’s say, especially in the last 10, 15 years, but do you think, do you agree with me that perhaps in the last five years that when a debatable tooth comes up, instead of jumping straight to the implant, we’re going back a little bit back into heroic dentistry to try and get some more years out of the implant, out of the tooth, even? [Aws]Patients aware that implants aren’t the panacea, they are not the cure for every dental problem. You know, I remember maybe 20 years ago when implants first really became very popular. And the perception of it was that why would you throw the kitchen sink that tooth to try and save it when you can have it removed, maybe have an immediate implant and have it restored within three or four months, then the real you know, the test, the real test of any dental treatment is time and once you have, you know, teeth that develop peri-implantitis we’ve seen this last 20 years or so, the option of maybe replacing the implant or indeed managing the peri-implantitis is quite daunting renascence of more traditional conventional techniques to restore teeth with limited extra coronal tooth tissue such as the post core or such as maybe looking at root canal retreating a tooth and establishing, you know, a good coronal seal, I think to look at a tooth that may be unrestorable or at least questionable restorability and somebody who’s 20 or 25? If you were to engage in providing implant at that age, you know, it’s conceivable over the next, you know, it’s likely that generations are going to become Centurions and reach the age of 100, that implant will have problems over the course of time and indeed will become obsolete. Remember, is the implants, you know, we’ve seen things on social media we’ve got what implant is this and oh, that’s quite dated, I don’t recognize that. And the design looks quite funky from this 80s or 90s. But teeth don’t generally become obsolete, they’re very timeless, our teeth, you know, if you look at a situation where, if we’re looking at the let’s say differences between, you know, teeth, and implants, the key factor and I know we’ll probably get into this a bit more later on, is that teeth have periodontal ligament, they have this gel capsule, that can really do wonderful things in that it can manage occlusal loading, and essentially react to various different factors, whereas implants do not have that ability, they are very basic in that respect. Implants have become very popular, but, they only should be really provided in situations where we have, you know, good oral hygiene, and all of those other factors going for us, or at least we can modify those factors before we engage in that. But I mean, commonly, you know, if we have a patient, who is a young patient, who I feel may not be ready for an implant treatment, and has an apical lesion that I feel that the tooth has questionable restorability, then, you know, the explanation normally, the explanation or the discussion that we have with the patient is that, I mean, you have an apical lesion on this tooth, it’s got questionable restorability, we need to modify things to essentially make things more amenable to an implant in the future for you. And that may take the form of maybe a root canal treatment, and getting some apicall regression of that lesion before we even discuss that and also obviously buys us time. And it gives the patient a bit of a ,it gives you time to assess the patient’s perception of treatment. You know, patients that come in, commonly come in may say they feel implants are the perfect restoration, or, as I said earlier, the solution to all the problems, it’s not always really that way or it’s not always, it doesn’t always pan out like that, unfortunately, [Jaz]That’s a very regular conversation, I’m having with my patients when we’re deciding whether to save a tooth or not. And a lot of patients come in who may be external marketing that implants are just a replacement of teeth. Whereas, you know, as we know, implants are not a replacement for teeth. They’re a replacement for a gap. So it reminds me of when I was a fourth year dental student, I was sat with, do you know Raj Patel because Raj Patel is based in Sheffield, restorative consultant. [Aws]Oh, yes, yes, I know. [Jaz]Very charismatic, funny guy. I won’t say anything. Perhaps. If you’re a student, you know, you can be quite scary sometimes being on consult place with him. But you know, it was a great experience at the time. And I remember going around the circle with students, and we’re trying to sort of discuss what we know about implants. And I said, Why I feel now was the stupidest thing ever. And I said implants last forever. And Raj Patel, God bless. So he shot me down so hard, but I’ll never forget the beating that I had the verbal beating that I had from that day. And that was, you know, that was a perception or fourth year dental student that hang on don’t implants last forever. But that was a fourth year dental student and the public must definitely feel that [Aws]I think the implants are they are essentially a metal bolt, where you have a highly of compared to a highly evolved tooth dentine periodontal ligament, and essentially, you know, the romantic in us should, as dentists should be aiming to maintain teeth for as long as possible, not to the point of being ignorant about a tooth not being saveable because, you know, that would we be doing our patients disservice, but wait, you know, looking at an armamentarium, where we can keep teeth for as long as we can. I think, as I said, you know, things are gonna come around full circle, and patients are probably going to perceive that as well, you know, patients where teeth can be saved, we can upskill and gain extra skills in trying to push the boat out for teeth for as long as we can, whilst also informing our patients of those factors as well, which is, I think, is the key now, because, you know, if a patient is informed, if you spend, let’s just say, for example, you’ve got, you’re looking at, we’re looking at Lancome periapical and the distal margin is quite deep, and it’s close to out the alveolar [Jaz]Another common scenario that we see in practice, yep. [Aws]And you perceive that as a challenge, your time may be better served, as opposed to really sweating over a tooth and trying to get a good margin on the impression or an extra 10 minutes. It may be that you spend the extra 10 minutes explaining to the patient that unfortunately it can be very difficult to get the optimal margin here for these reasons, then the expectation is managed, you know, your outcome under promising and over delivering, there is a, that’s a great little anecdote, really for us in 2019 [Jaz]Absolutely and no more so than the challenging prognosis case. Absolutely. [Aws]So, I think, you know, changing our way in which we approach, you know, informing our patients and managing, you know, heavily broken down tooth, I think will evolve also, in that [Jaz]I find it very useful to, you know, draw the biting or draw the periapical that the patient can see, but actually draw it out and say this is the root, this is tooth, can you see that your hole is so close, and it just makes it and that scanned in as part of the note. So, you know, medical legally all very valid, and that’s, you know. So that’s a nice little communication thing that my patients find quite useful. And then they sort of remember that, you know, my tooth is knackered, and then it brings the expectations down. So if you just jump right in and say, where do we draw the line? Can you tell me where you draw the line? Now, for example, one thing I think about the first thing I think about when it comes to restorability, the word is almost synonymous with ferrule. So for me, the first thing I look at is has the tooth, for example, got a ferrule of at least 1.5-2 millimeters, basically, is that your starting point? Obviously, oral hygiene, perio factors, but can you comment on the structural integrity of teeth? [Aws]I mean, so there’s been a lot of work on this, as you can imagine. And, you know, we know that a two millimeter ferrule is required, and that we want to brace the tooth together. And essentially, the ferrule will not only allow give you an opportunity to, you know, bond tooth tissue circumferentially, but it also allows the tooth to be loaded, you know, the toth and the cool restoration, we did, you know, together as opposed to maybe wedging, or at least leverage against the tooth. So that the, you know, the ferrule is very important. There’s been work at the Eastman looking at various different factors associated restorability, there’s quite been, quite a few indices, [Jaz]Do you use them? Do you use these indices? I just want to know, in your practice? [Jaz]I don’t. No, I mean, again, I feel that because it’s so subjective. Because, yeah, I think a lot of these indices, unfortunately, they can’t really factor in patient expectation, but it also is very them to factor in the occlusal factors, for example, you can’t factor in the patient’s oral hygiene, you can’t factor in various different things. Essentially, we need to look at the tooth as a unit to just what tooth tissue is remaining above the gum, because again, volumetrically that can be quite difficult. So for example, you know, [ ] work at the Eastman, a subsequent to a number of really good MSCs Bobby ban lifted a really good MSc in 2000, looked at, you know, the amount of tooth tissue remaining and reconnecting to teeth that required his crown restoration. And the looked at splitting the tooth up into six sextant and measuring the amount of tooth tissue remaining. Volumetrically, if you’re just in and it’s common now, where we have one wall that is virtually intact, and the other wall be at the buccal or the palatal will be it appropriate up, you know, classic premolar buccally palatally, you have a massive amount of tissue on one side, not the other, you know that volume, ideally, would have been better serve, being distributed more evenly amongst the tooth. So it’s, you know, we don’t get those situations in some of those indices where you have a donor, a conventional, it’s quite predictable. The real point where we start to scratch our heads is when we’re missing so much on one side. And we are virtually intact on the other, be it buccal or palatal. [Jaz]Let’s make it tangible, let’s say a case I had actually about eight months ago and so.A lower right first molar it has about a half a millimeter of ferrule supragingival so there may be some subgingival tissue as well, buccally, so half a mil buccally about a millimeter mesial and distal, and then lingually we have the entire lingual wall intact, all other factors being favorable, what will be the restoration of choice, imagine let’s say we are going to restore this tooth because we in a certain way, another mouth who may choose not to and a different mountain that we may choose to get, you know, what would you suggest would be a suitable way to restore such tooth? Or do you think that it’s not even worth going there because the factors are so variable and I respect that if that’s the case. [Aws]Endodontically treated or not, Jaz? [Jaz]Not treated, not endodontic treated, [Aws]Not treated, so vital. And I mean, so what we’re looking at more often now actually is the enamel status of the tooth because you know, there’s quite a lot of conjecture about conventional preparations versus adhesive preparations. So you know, if you have, you know, a circumferential enamel ring that may bode well to providing a sort of adhesive restoration that may be quite neat in its design. In that sort of situation, you know, if you were to go, you know, conventional, that sort of situation and you’ve got lack of tissue, buccally, mesially distally, you know, if you prep that lingual wall, you’re not gonna have much left, as far as I know. So in that respect, you know, the onlay now has gone through, you know, an evolution as it were, because, you know, it hasn’t been the onlay on a molar tooth now really has made, there are numerous advantages of having an onlayover conventional restoration, you know, you can visualize the margin, you can, you know, you can control your moisture control, instead of going deep into a cervical region, you know, if the mark is supragingival your bonding and your cementation process is going to be a lot more predictable, they are a lot harder to prepare, than your conventional crown. Because you have to know two onlays of the same essentially, because it’s the margin of a non lay is very much dependent or indeed dictated by what the tooth is giving you to start with. Whereas if you were to, you know, if you were to go through Shillingburg and you were to look at that sort of preparation, every one of those essentially, if you’re doing your job and you were on the money, you every moment that you would prepare, it would look exactly like that book. Whereas, you know, the onlay preparation which conserves tooth tissue, you know, no two preparations are gonna be the same. And, you know, I think that sort of aspect when you, you know, you’ve described that sort of situation that lends itself to an onlay, I mean, I’m a huge fan of golden onlays, so you know, that can be my go to for certain situations, when it comes to teeth that are heavily broken down. [Jaz]So certainly, that’s what I one thing I consider, so onlay was definitely on the list. The other way that I asked one of our good colleagues, Mahul Patel, I sent him the WhatsApp photo at the time. And the other alternative we suggested, was a to elective RCT and do the split post technique, a cast, and then to restore it eventually. So that could have been, you know, another way a lot of work involved there. But definitely a very valid way to do it as well. The patient ended up choosing due to the fees, in other words she was having done is a massive composite, and then the day that breaks, he’s having the tooth out. [Aws]Again, I mean, if we go back to you know, electively root canal treating, I think what’s important is that we know what factors what advantages the pulp provides us with, you know, a vital pulp provides us with, you know, there is quite a lot of evidence, some of it is quite dated now, to show teeth with pulps are physiologically more able to manage loading, ie the pain threshold is such that there’s less likelihood for them to fracture than maybe a non vital tooth is because they may, you know, the proprioceptive nature of the tooth is able to manage, you know, sudden loading a lot more easier. I think, you know, obviously gaining what you gain by loss of vitality, that sort of situation is you can, you know, a call that you may feel is more predictable, you’re going to be gaining resistance, well not resistance and retention, but you’re gonna be gaining greater depth of contact of your restorations through the pulp chamber now, and you know, she went through the composite. And, you know, she’s probably been well informed by yourself as to what the practice is going to be. I think you know, for yourself, it’ll be interesting to see what happens with that tooth over time. And I’d like you to tell me what happens actually, because it sounds quite interesting to see how it pans out. [Jaz]So far, eight months, no issues, but I expect all just the lingual wall will break off eventually. And then she’s gonna have that tooth out. And that was very much I’ve walked through it and she wasn’t keen on spending best, is coming into implant territory. And we had that, you know, full on discussion with a drawing and everything. And that’s what she thought was best planned for her. I completely get that. And then we got to help our patients and be non judgmental. [Aws]I mean, you know, why does she have, why did the buccal wall fractured? That’s the other question we must ask ourselves because we can’t make the same mistake twice, if the buccal wall fractured as a result of occlusal factors. And, you know, we don’t look at cuspal coverage as as something that we require in these heavily broken down teeth and we’re making the same mistakes again. I think that’s also quite key is we don’t we tend to look at the tooth in isolation, whereas there aren’t going to be multiple factors that plays a part in why tooth has become unrestorable, or, you know, essentially making it more difficult for us to provide a restoration that’s very predictable. [Jaz]You were just talking about now is that all the endodontic studies about root filled molars like to break. I actually tell my patients not from molars that are root filled are extensive, for example, losing a marginal ridge obviously explained it in patient friendly terms, but I say it’s six times more likely to fracture. Now, I’m pretty sure correct me from this as from Ray and Probe 1995 study, but I like to give my patients sort of evidence based. So they know is six times they know you’re an individual, but according to studies, a molar as we know, with a loss of marginal ridge are six times more likely to fracture with a root canal. And that helps them to rationalize, you know, why exactly, we tell them to have something because once the root canal cause other thing is in my tooth fixed yet? [Aws]Yeah, I think for patients is, you know, putting, you know, putting value back into investing in a tooth, you know, a molar tooth, you know, well obturated, well restored tooth is very, extremely valuable to us as dentists and it’s communicating to them. So, you know, for our patients, it shouldn’t really be just a root canal treatment, you know, in the package should be restoration also. And you can argue that the quality of the coronal restoration is more important than the actual root canal treatment itself. Literature that’s intimated that the coronal restoration is the most important, one of the most important factors not only for the fact of keeping the bugs out of the root canal system, but essentially protecting what is now a weakened structure. [Jaz]With cuspal protection. Yeah. [Aws]Cuspal protection because essentially now, the more you know, as you, you know, we’re using loupes more often now. And we’re seeing things we’ve never seen before we looked down a pulp chamber, you know, where maybe 20 years ago, we may have not been using the most elaborate magnification techniques, we’re seeing cracks in teeth, that are inevitably going to affect our diagnosis, prognosis of teeth. You know, the other factor also is that when we’ve had those cases where we don’t know what’s wrong, you know, the root canal treatment has been optimal. And you take this cone beam CT, and you discover a fracture, you know, and that happened to my nurse recently, where she had root canal treatment done by some really expert endodontists. And, essentially, the outcome, and she had a CB CT taken. And I wrote this up as a sort of a, you know, editorial. And subsequently, we only actually found out what the problem was when the tooth was on the end of the forceps, unfortunately, and all the fracture all the way up the palatal roots, which wasn’t really seen on a CBCT. So, again, you know, we’re looking at ceiling but we’re also looking at protecting the reigning tooth tissue and, you know, inevitably, there is a finite amount of tooth tissue that we need to achieve both of those aims. [Jaz]I hate cracks, I think, oh, as restorative dentist and you know, GDPs and everyone in dentistry, endodontists you name it, cracks are have a huge bearing on restore ability, because the mere presence of a hairline crack just you know, turn through a restorability right upside down before because next question are asked us about cracks and how you manage them. But I just want to mention one more point about the ferrule which I think I probably learned about three four years ago. And I’d appreciate it I think it’d be good for listeners to hear it is when I look at a ferrule I don’t just look at the height of the wall by look at the ferrule horizontally as well. How much thickness so that sort of ferrule is important as well for bracing and giving strength for your future sort of restoration. If you’ve got something with that less of a horizontal ferrule, then there’s more flex in the dentine. Anything that you what you can add to that? [Aws]Yeah, so I mean, if we’re looking at some longitudinal work, so at the Eastman, their survival rate, or the median survival rate, I think it’s median maybe mean, I can’t remember off the top my head or post core restorations approximately 15 years that may have gone up over the years, that may have gone down, I don’t know, you know, because they don’t publish here. This is the last time that I know of, but their outcomes for new posts, ie replacement post is something like five years. And that may be due to you know, I would you could speculate that’s likely to be due to thinness of the denting wall subsequent to re preparation or indeed maybe root canal retreatment you know, we have this sort of movement now endodontic movement with regards to minimal access cavities or ninja access cavities, or, you know, it’s quite amazing to see, but one of the things that we may not appreciate just by being able to root canal treat an MB3 through you know, a pinhole is that you maintain as you said, you maintain that dentine thickness, and that builds resilience in the tooth and manage occlusal loading. And indeed, you know, it makes the tooth more able to manage or at least seal the tooth because your margin is going to be thicker ie you know, the distance that a bacteria or a bug needs to travel through that margin is going to be much longer to give them classes than when did the apex. So I think of the dentine is also very important as I said to you, there is an overt focus on the height of dentine with all the other factors such as the thickness as well. [Jaz]Cool, thanks so much. So cracked teeth, you have a lower seven in a patient with the worn dentition, generally intact dentition minimally restored, good oral hygiene. And you’ve been seeing this patient for a number of years, and you’re starting to notice that there’s this little crack on that seven is starting to get stained, the tooth is asymptomatic. These situations, I really don’t know how to advise our patients because I’ve seen a few over time, then they eventually develop symptoms, and others, you know, you can watch and nothing ever happened. So I never really know whether to recommend some sort of media gold, minimal prep cuspal coverage, like, you know, gold hat for these sevens. And something that I’m pretty sure you can say that there’s no right or wrong answer, it’s very difficult. But any anything that you’re any opinion, clinical opinion you’d like to give in these sort of scenarios? [Aws]So, I mean, obviously, it depends on the tooth and it depends on the situation. You know, there has been a lot of work on how to manage these sorts of situations, you know, one of my colleagues, Brian Miller, has looked at providing things that are composite onlay, so that, you know, up until that point, that crack has slowly it would have slowly started to propagate. You know, the tipping point will be when one of the cusps undermined so much so that you have a catastrophic failure and the tooth becomes unrestorable. Now, I have to explain that to a patient photography to grant you know, as you say, you’ve seen the patient over maybe three or four month period, if you took a photograph at times zero and then took another photograph, it’s three months or four months, the ability to convince a patient to go through that process of saying, actually, you know what, you have a crack here. And I’ve been watching it carefully for yourself. And it’s now starting to get stained, I feel that we need to manage this prevent this from propagating, you’re more likely to probably get acceptance of that, then if you would just say that, I’ve noticed this, I think we need to put an onlay on there. [Jaz]Absolutely. And this is something I’ve done very recently, actually, with a patient with an upper six actually that I noticed the crack and all my new patients will get a full series of photos at work. And I’m not sitting for you know, a couple of recalls or for recalls. Now two years, I saw him and then with his cracked teeth, I like to only for people with crack teeth, I like take subsequent. So follow up photos, because I’ve done no work on them, everything’s good, I wouldn’t take full occlusal series photos for everyone but famous, okay, got cracked, let’s just compare. And it’s so useful to have two years worth of before and after photos of just normal life and chewing without any denture involved, because you actually see a little bit more wear here and there. And you see the crack a little bit wider, perhaps a bit stained. And I think that can be a real good tool in general practice in any practice to sort of diagnose yourself and, and help in decision making. [Aws]I mean, I think when we’re looking at crack teeth, this is an our 21st century epidemic, I think, you know, it is something that we’re going to be managing more and more often. And, you know, those MOD amalgams that went in maybe 80s and 90s, during, you know, when, you know, desperately remunerated a lot better, those sorts of teeth will come back, and then they were present with issues. Again, you know, the common other common situation is when you have somebody with a MOD amalgam, and they want to replace for composite for whatever reason, and they come back with an issue after that, you know, pulpal sorts of issues, though, I think, for patients, again, if we’re thinking future thinking or future proofing, you have the constant factor that we can never really modify or really have any say in is whether or not maybe the patient will wear a stabilization splint or a soft bite guard at night to reduce the amount of non axial loading on teeth. Because that’s out of our control, you know, if they’re restless, they might probably less likely to make, to wear the Michigan splint that we might prescribe them. So if we have that constant parafunction, bruxism working on teeth that have cracks in them. And it is a constant and say, for example, that you spoke about, catastrophically fails, and that tooth is extracted. The remaining 27 teeth or 26 teeth, the amount of force applied to those remaining teeth actually be greater per percentage, because the amount of parafunction will remain fairly constant. But you have less teeth to take that load [Jaz]There’s a whole. Yeah, a pair of teeth that have now lost in that, you know, as a percentage quite big. Especially if it’s a seven or a six, if it’s a molar then that, I think greatly affects the equation, isn’t it? [Jaz]Well, I think that would be the real moment of realization for patients when that sort of explanation goes through and you say to actually, you know, you’ve lost amount of tooth, but you have another 26 teeth, bearing in mind that you have the wear facets on, you know, that I’m very generally positioned, you know, other teeth that are now going to be at greater risk and at that point, Discussing maybe onlay of a teach strategically to protect them, you know, teeth I mean six, sevens, for example, may not be out, you know, maybe come across as quite sensible at that stage. [Jaz]Absolutely. Treatment planning wise, I think that’s something a philosophy I follow that sometimes if you are having that sit and wait approach to the patient, but if something bad does happen, as long as the patient have been, you know, in it the whole time, then I’m a bit more aggressive in my recommendations, but I think that is what is actually best for the patient of their crack to emerge in molar than they are going to be cracks in other teeth to lesser degrees, perhaps to reach that failure point and is at that point is a good idea to then be more aggressive, I think. [Jaz]And I think, yeah, I think that realization is quite important patients that they need to manage or act upon the cracking, you know, I mean, I work in London, patients are generally quite stress. You know, it’s routine in my practice, that we go through, you know, a visual analog scale of stress for patients. And you know, when you ask the patient, are you stress and they say, yeah, I’m 9 or 10. And you want to translate that into what they present orally, you were looking for facets, looking for cracks in those sorts of situations. So I think, again, as I say, you know, we’re looking at restorability, but we’re also looking at what the forces on the teeth are going to be able to, [Jaz]I mean, the forces are so important, I mean, I’m a big fan of looking at. So one thing I do for all my patients, and you know, please tell me, what you think of this is, I feel that the masseters and temporalis muscles, and because that is a I think that’s really well correlated with the patients who have meatier, or more hypertrophic masseter muscles, and I grade them usually as mild, moderate, or severe. And it’s, it’s part of my custom screen, software vectors and the software we use for note taking, that every new patient will get their maseters and temporalis assessed, I’m looking for 10 minutes, but mostly I’m looking for the size of it. And already, for the patients who’ve got the biggest masseters, I’m already suspecting that there’s a parafunctional habit, and but I’d say about 95% of the time, I look in the mouth, and it’s exact sort of mirror of the size of masseters. So those with larger masters I am seeing wear into dentine, significant cracks. And I’m noticing that a lot more, sometimes based on the occlusion as well. For example, if they have got an AOB, and they’re mostly occluding posteriorly, with combined with the parafunction, then or it could be for example, their facial type, are they brachyfacial facial stuff like that deep bite, but that’s something I assess. And it’s supposed to be a sort of correlated to their bite force as well, which obviously reads into what you’ve been describing now in terms of their stress levels. And generally, the forces they’re playing, [Aws]I think, again, I mean, going back to restorability, you know, the, you know, the tooth that is heavily restored are indeed questionable restorability in a patient who is a parafunction patient, versus a patient who is not parafunction patient is quite essentially quite different. Also, you know, the fact that the role that occlusion plays, and maybe guidance as well, non working side interferences, all of those factors play a role. And, you know, just to say, in some of these indices, there’s quite a few of them now, I’m not buying in direction, every one in particular, the occlusal factors probably don’t care, very difficult to factor into that sort of situation. Now, for patients also, I mean, teeth evolved to meet or at least be in contact for 15 to 20 minutes a day during chewing cycles. Now, if you say to a patient, that you are overloading the system, and as a result of that overloading of the system, your Something has to give in maybe your TMJ, or it may be your tooth, that also increases patients perception of the issue, ie, it’s not the ownership of the problem, isn’t the dentist needs to put a crown on this tooth for me before it cracks. The ownership of the problem is now shared amongst yourself, being yourself being the dentist, the patient, as well, because they have to realize that, you know, we can’t help. That’s those sorts of huge amount of forces that are put on teeth that have minimal amount tooth tissue remaining. There we are. I mean, again, you know, we’ve come back to occlusion again, because it’s fairly important with restorability. I’m sorry, we’ve diverged. [Jaz]No, and this is important, because the crux of predictability is occlusion. I think that last minute of what you said, is going to be my main snippet, my intro snippet, my promotional snippet for this podcast, because I think that’s exactly why I say to my patients, you know, how many minutes a day in, you know, normally there should be together and I love given that information on patients because they really think Oh, I didn’t know that. And it has helped a lot of my patients over the years when they feed back to me that you know what Jaz, you told me that and I’ve been, and you’re right, I have been pressing my teeth in these scenarios and whatnot. And these are the patients so you have more cracks, you have more large restorations and you have more crowns, because their forces and what they’re doing with their teeth is just much more so I think what you said there was absolutely golden in terms of value that listeners will get from this. So I’m conscious of time. So I just want to ask you, I know there’s only so much we can cover, what are your main pearls that you think would benefit listeners and overall, you know, umbrella term of restorability, or it could be a certain aspect of restorability that you would like GDP is to be looking into more when making those decisions, is there anything in particular you want to mention out there? [Aws]So, I mean, again, I mean, it goes back to the amount of coronal tooth tissue remaining, but there’s dentine, or at least that amount of coronal dentin remaining, but also the adhesive status of the tooth. You know, it’s weird how, you know, because of the movement that we have in the UK with regards to management tooth surface loss, that we have this enamel ring around an upper anterior and we bond to it, where it has no resistance or retention form, we’re essentially relying on our adhesive component entirely. But as soon as we look at a molar, it doesn’t, we don’t seem to correlate that sort of same situation. I think, you know, what is important is that we have to max out on every stage and minimize, you know, any thing that may compromise each stage. So for example, if we were looking at, you know, our, for going to restore something adhesively, then, you know, we need to just look at maybe utilizing rubber dam, because if we get some contamination, and we’re doing an onlay that may be bonded on a Panavia or something such as Nexus, we don’t want to compromise that sort of situation. And we need to essentially, need to observe every stage and know and realize that we have to ensure, you know, the most optimal situation with these teeth that have what question restorability, you know, if we’ve got a coronal restoration, or if we’ve got, you know, an access cavity that is bounded by tissue, that’s not a situation that we will sweat over. It’s those, as we said earlier, we have tooth tissue or we have a deep margin distally. And, you know, we want to get a good margin as best as we can and the deepest portion, I think, the other factor is, is that if we get, if we nail that distal margin, and we get a good seating of our restoration on that distal margin, because it’s so deep, you know, you could you know, if we’re thinking devil’s advocate, we could say that that margin isn’t cleansable for the patient, and it’s likely to develop decay in the future. [Jaz]Then we go on to discuss the partial exodontia technique, which apparently was a technique founded by a chap called, Italian chap called Dr. Paolo Guazzini and probably bastardizing that word, but it’s a, it’s called a partial exodontia techniques, pretty cool. You sort of have an extrude tooth and you make a tooth that was otherwise borderline or unreasonable to restorable one, and that’s what we’re going to discuss now. [Aws]Now, I read something quite recently from I think it’s someone in Italy, where instead of maybe orthodontic extrusion, which may last quite a while, and may be quite difficult to achieve aesthetically, anyway, anteriorly, they were doing extractions of the root and then repositioning with a splint, you know, sort of like a trauma splint, but they were purposefully extracting a root. And, you know, creating an environment for the healing [Jaz]Partial extraction therapy, right? [Aws]Partial? No. So partial extraction therapy, correct me if I’m wrong is when you have the remaining root buccal to an implant. This is purposeful extrusion of the tooth through a forceps, and then creating a new amount of ferrulw extra coronally. [Jaz]Yeah, I think there might be a couple of lenses, or certainly I went to a lecture at the BARD, I think it was about just one and a half years ago, and a chap who had some sort of, he’s been taking 14 years where we had to show lots of great cases. So essentially, for those who are unfamiliar with this is you’re using forceps or like Seta, as he described, but you always have to warn the patient actually, if the bit on luxating breaks, and that’s game over. So just come in to the patient to come in with the mentality that this might not work. And you’re only doing patients who trust in the right sort of scenario premolar, for example, and yet, like you said, you just sort of luxating the tooth that are about to come out by a couple of millimeters. But you know, obviously, then you suture it, you know, in a tight way and you splint it, so that the alveolar bone will regenerate then about I think it was about two weeks later, he would root fill that tooth, and then you have instant ferrule basis, if that’s what you’re referring to, right? [Aws]Yes. So I mean, again, like I said, like we said earlier, I mean, we’re looking at innovative ways to keep teeth going. And you know, who would have I would have laughed if he ever told me 20 years ago that someone had, you know, suddenly someone has thought of purposeful extraction or luxation to gain ferrule and you know, it’s got traction, which it has, you know, people are talking about here was what people are doing routinely on I don’t know But the [Jaz]I don’t know anyone who in the UK is doing it routinely. And if you are, if you listen to this reach out, let us know, share your cases would be good to learn for everyone. But certainly I know Yeah, it was Italian man that actually presented at BARD I do forget his name. But yeah, I think in Europe it might be more popular. [Jaz]So then our discussion turned back to implant. Back there again back full circle with implants and their issues, you know, implant that was placed 20, 30 years ago, just with growth and aging, another BARD lecture i’d went to, and again, I forget, I don’t know his name, I’ll probably reference it later. But he said, all these follow up cases of implants, where the screw threads, so the implant threads were exposed, not because of poor technique of placement, these were placed by top dogs in implantology at the time, but actually growth and the forward and downward growth of certain types of long face females or whatever, and how they grow and how they end up their implants end up looking quite ugly over time. And that’s a huge ticking time bomb as well. I think for the future. [Aws]I think, you know, time is the test, really for any restoration. And I think, you know, implants a place quite early as well in patients, maxillary growth in adult males continues until the late 20s. So, as I say you there are cases that have come back where you know, teeth may have been extracted, and the patient may have been referred in and the situation is such that the implant is an ankylosed unit, and it has not migrated with the other teeth either side. And it is essentially, you know, the incisal edges is quite far cervically when compared to the adjacent teeth. With regards to the situation with exposed threads, and all that sort of all that other aspect of things, I think, you know, the change in implantology is realizing that once you’ve removed the root, that you lose the bundle bone, and you’re a great, you’re obviously a greater risk of bone resorption. And the buccal, [Jaz]Especially for anterior teeth, which got a very paper thin bone. [Aws]Yeah, paper thin bone or even, you know, if you’ve got somebody who has, you know, a very thin bio type, you know, in those sorts of situations, you may think twice about extracting a tooth, and providing an implant, when maybe, if we think also more globally, I mean, post core restorations or, you know, innovative ways in restoring teeth. You know, we’ve been doing, that is part of dentistry, that’s been done in dentistry for hundreds of years, or at least 100 years anyway, if we compare that to, you know, the genesis of implantology, which really has really, really taken traction over the last 25 years or so, when you compare that difference in experience, knowledge and research, you know, teeth, again, are superior in that respect, because there’s been more done on teeth has been more research on teeth in those sorts of situations, you know, a compromise tooth to a compromised implant in someone you know, in a loved one’s mouth, what one would you choose to have to treat for them? I would take a compromise, you would take compromised tooth. So again, that sort of paradigm, you know, that sort of not paradigm, but the association between teeth and implants, again, I think it’s swung back towards the teeth, even if it’s, you know, heavily restored, even if it’s looking tooth tissue I think that’s the way things will go. [Jaz]Really well. I’m mindful of the time. It is a topic that you can literally talk about for hours on end because I’m just like reading through the list you know, you said implant restorability interface, perio factors, endo structural, occlusal, aesthetic, patient litigation, and obviously a future development. So literally this episode could have gone in any direction. I’m glad it went the direction that it didn’t because we talked a little bit about occlusion, innovative methods. So it’s good to bring that all in together and talk about ferruel so thank you so much for that. I want to know a bit more about I think you’re doing an occlusion symposium in September? I’ll put the link out for everyone, can just please tell us about that. [Aws]Yeah, so you know, I we decided to do the symposium i think you know, lecture days are quite common a long time ago and lots of hands on courses have become you know, the norm now. But you know, this is a traditional lecture day with I would like to thank some for very good, high quality speakers. We’ve got Tif Qureshi. Talking about GDP, orthodontics and things like Dahl. We’ve got Sandra Brandari coming down from Manchester talking about cracked teeth and managing that endo restorative interface and occlusion and how to manage teeth and how occlusal load you want to endodontically treated teeth or indeed vital teeth effects things. I’m talking about occlusion past, present and future. And we’ve got Mahul, Mahul Patel who’s also going to be talking about controlling occlusion, you know, those certain aspects of maybe the crown provision process, where you know, you may look at a tooth after you know, you may have tried to restore it tooth the crown and those little things aspect of lack of control of the occlusion can result in, you know, maybe, you know, the crown not fitting appropriately or indeed the occlusion is not being as ideal as it can be. So, you know, it’s at the BDA, it’s 150 pounds and it takes about six hours of CPD. [Jaz]That’s firstly that’s a bargain. Secondly, I really like those people that have gone on board, Tif Qureshi, you know, he taught me Dahl technique. I actually went to listen to Tif Qureshi in Sydney, because I’m such a geek that when I was in Sydney at the time, [Aws]I mean, it’s a long way because he lives in South London. But anyway, [Jaz]I know right? I was on a different course, I was on my jollies. And I was there and I was, Oh my god Tif is coming and then my wife very kindly let me go. Because I thought okay, I might not get time to see him in London, because just the way life is. And I seen him in Sydney and his fantastic ortho-restorative course over two days talking about dahl and I was much more confident, you know, using dahl technique after that. So that is great. That is good talking about that. Mahul’s lecture sounds really clinically applicable. So as yours sounds like a very good day to take, a lot of nuggets. So I’ll be sure to if it’s okay with you put the link at the end of the podcast so people can look into that bargain of the day. So brilliant. Any last words anything you’d like to say? [Aws]I’m looking forward to subscribing and listen to future podcasts in the future. [Jaz]Thank you so much, Aws. I really appreciate that.